Khalil Hussein explores the different solutions that work, and some that don’t, to help resolve back pain in dentistry.
Let me start this article by hitting you with some facts around pain and injury in dentistry.
- Pain and musculoskeletal injury are the number one cause of early retirement in dentistry. Followed by mental health issues
- Those working in dentistry experience a very high prevalence of pain and musculoskeletal injuries (Longridge, Panju and Fox, 2020)
- High levels of stress are prevalent in dentistry.
It is for these many reasons that I’ve made a handy list of what you can do (and what is a waste of time) to help yourself.
Effective back pain results
It doesn’t take much to get confused about what to do when you have back pain.
A quick Google search yields 4,480,000,000 results! There are even more when you search for what works for back pain. You’re also bombarded with adverts for all sorts of products that claim to help.
I’m here today to dispel the myths about what does and doesn’t work for back pain. Then you can make a better decision about your health and wellness.
Let me start by saying that by and large the most effective things for back pain in general are the following:
- Exercise and movement
- Strength training
- Stress management
- Quality sleep and hydration.
However, there are some products out there that are of use. Especially being a dentist and working in a high stress environment.
Things that don’t work
Now these are readily available on Amazon and they all have thousands of reviews. However, I am here to pour water on the fire.
When it comes to posture and pain, the evidence is clear that there is no direct link to ‘bad posture’ and pain.
Pain is a multifactorial issue. Posture is a dynamic issue. There is no gold standard of posture out there (if you’d like to learn more, I wrote another article about perfect posture).
Wearing a posture brace will do very little other than have a placebo effect. The evidence regarding their use is very low quality (Palsson et al, 2019) and most studies only show a change in general posture (to be expected from a posture brace) and have very limited changes when it comes to pain and disability levels.
So I would save my money on this one.
These are all the rage on social media and the internet. They were priced extremely high, but are now readily available for a much cheaper price point.
Massage guns work by providing rapid vibration and massage to muscles. They claim to do many things such as break down scar tissue, release adhesions and stop pain and injuries.
I’m here to tell you that most of these are not true. The only thing these guns may help with is temporary relief from muscle pain by desensitisation of the area. However, if it is a recurring issue, it will more than likely that your pain levels will return within a period of time.
If you have an injury these guns will not magically heal the area and fix your pain.
Scar and muscle tissue is extremely strong. It requires a substantial amount of force to deform it. So something that barely applies any force is unlikely to cause any breakdown of tissue.
If you get tight muscles after a workout or after a long day, it may help by decreasing the sensation. But then again, doing some movement/stretching or even just hopping on a bike to increase blood flow will do the exact same thing without the cost.
So I would give it a skip (unless you’re too lazy to do any movement that is!).
Very similar to posture braces, however back braces are often designed to limit movement of the lower back and provide support.
The evidence is undecided on their use. Some show a positive effect and some show no effect at all.
In certain cases such as patients with progressing scoliosis the evidence is a little bit better.
However from a clinical point of view, I find that these braces are only ever useful when the pain is acute to try and calm the area down. After this, they are not something I would recommend for most people. It gives the person a belief that their spine is fragile and needs support constantly.
As we know, pain is heavily influenced by fear and our perceptions about ourselves. So the crutch that holds us up can also be the thing that prolongs the pain.
Often it is better to slowly get back into normal movement and activity without the use of braces.
What does work?
One of the benefits of owning a good quality pair of loupes is that it allows you to sit at a more comfortable distance from the patient. It reduces the need to contort yourself into awkward positions to get a better view of what you are doing.
Now, I know many of you must think: ‘But wait, didn’t he just say that bad posture doesn’t cause pain?’
There is a difference between posture and ergonomics. Ergonomics is about making your job easier and more comfortable. Whereas posture is an arbitrarily defined set of numbers that relate to your spinal curves.
You might have slightly rounded shoulders. We would define this as having bad posture. But this might be your body’s most natural relaxed position. Therefore this is not a bad thing.
What is bad is putting your body into positions that you have very low tolerance for. For example having to work hard to get your job done!
Posture is a dynamic thing and it changes based on what you’re doing.
Different body positions are only bad if you are unable to tolerate them. Some positions are tolerable for a small period of time, whilst others are tolerable for longer periods of time.
This is where loupes come in. They allow you to sit in a more comfortable position without the need to hunch over peering into the patient’s mouth.
For 99% of people this position is much more comfortable and tolerable. That means you are less likely to have an injury or develop pain as a result.
I must place a caveat here. Remaining static in a comfortable position for many hours on end is not great for you. So I would still recommend you get into the habit of moving your joints and spine regularly to help them stay healthy (you can check out Dentistry Gym for good ways to do this!).
However, by and large, owning a pair of loupes is tremendously beneficial for you. Especially as your job requires you to stay static for long periods of time!
Another huge benefit of loupes is that you naturally see better as a dentist.
Better visualisation leads to higher quality work. This in turn leads to higher patient and overall job satisfaction.
Failed dental work and unfulfilling jobs are stressful. As I’ve explained in my other articles on pain, stress is a big trigger for pain.
Choosing a loupes provider is a minefield. So it is best to go with long standing reputable providers who have a special interest in magnification and ergonomics. It is also important to get custom fit for a pair.
Ergonomic seats come in all shapes and sizes. Some will suit you whilst others won’t.
Some people will find saddle seats are much more comfortable. Whilst others will find that these chairs hurt their hips. Some will find chairs with back support are more comfortable as they allow you to rest your back against them between patients.
The most important thing when it comes to seating is comfort. As I mentioned above, being comfortable and relaxed is very important when it comes to preserving your body.
Dentistry is highly stressful on the body as well as the mind. So we cannot overlook these factors and, as discussed, it’s not so important as to what position you’re in but more so how you tolerate it.
Higher levels of comfort mean a higher level of tolerance.
Saddle seats will benefit those who find being more upright is comfortable. And for those who like to move a bit more freely.
Backrest seats will benefit those who have very tight hips and find that they cause hip discomfort.
Interesting studies out there show that chairs that recline to 135 degrees show the least amount of stress on the spinal discs.
So to sum up, loupes and comfy chairs are great for preserving your body and helping to avoid pain. Whereas with everything else you should probably just save your money.
For more check out the Dentistry Gym for free exercises classes designed for dentists. Alternatively contact me for a free consultation for a more custom plan.
Longridge NN, Panju R and Fox K (2020) Work-related musculoskeletal disorders in dental students: a cross-sectional, Pilot Study from a UK University Teaching Hospital. J Musculoskelet Disord Treat 6: 79
Palsson TS, Travers MJ, Rafn T, Ingemann-Molden S, Caneiro JP and Christensen SW (2019) The use of posture-correcting shirts for managing musculoskeletal pain is not supported by current evidence – a scoping review of the literature. Scand J Pain 19(4): 659-70
This class is designed for viewers to carry it out with minimal equipment at home. We don’t use weights so these exercises are quite safe for most people.
However, before conducting any exercises please consult your GP or allied health therapist for guidance and advice about your own circumstances and whether these exercises are the right thing for you.
Always seek medical advice before starting any exercise program.