Scrap ergonomics – this month, Khalil Hussein discusses what will really help you live a pain-free dental career.
Ergonomics is not the marvel superhero that we have all been led to believe will save us.
It’s not going to come swooping in to save you from pain and injury wielding its magic hammer of 90 degree elbows and refractive loupes.
In this article I will put forth what it is that will really help you live a long healthy pain-free dental career.
The beginnings of ergonomics
But first let’s start by returning to the beginning of how ergonomics came to be.
The term ergonomics comes from the Greek words ergon(work) and nomos (natural laws). As early as ancient Egypt and Rome, an association between labour and health was noted.
Lung disorders and injuries were commonly associated with how and where people worked.
Ergonomics was then coined by a Polish author in 1858. It really took hold when research discovered different ways to make workers more productive and efficient.
As time went on, ergonomics turned towards modern day life where we are less involved in manual labour as we are stuck in prolonged postures for long periods of time.
It only takes a brief look into ergonomics research to find that avoiding certain postures is one of the key metrics that is of importance.
The problem with ergonomics
Now, I am all for making things easier and more efficient. Things such as four handed dentistry and keeping the patient close to you make sense. These things are designed to make your job easier.
Where I have an issue, however, is the extensive focus on maintaining certain standards of posture.
What we know from research is that there is no one correct posture for everyone because there is a significant lack of evidence about which one is the best.
All our perceptions around the best posture have very little, if any, evidence behind them. As well as this, we know from research that posture has a poor correlation with pain.
But this is still not my main issue with the message that ergonomics will save you from misery in your dental career. This is because there is one factor that is not accounted for in much of the education given surrounding the topic.
That factor is time.
Time or, for lack of a better word, ageing, is something that affects all living things. Ageing is what will happen to us regardless of whether or we want it to or not.
However, one of the key pieces of evidence we see recurring is that, with consistent use and training, a lot of the age related changes to joints and muscle can be avoided.
Working against time is important
Let me propose a dental example to you to highlight why working against time is important. Much like joints, muscles and ligaments, teeth are something most of you are familiar with (well, I would assume so, since this is a dental website).
If I were to present to you in clinic one day and tell you that for the next 20 years I was going to live on an island with no access to a dentist, what would I need to do to avoid losing my teeth or having any problems?
I’m sure you’d likely list the following things to me.
- Brush my teeth twice a day with a fluoride toothpaste, preferably with an electric toothbrush (solar powered of course if I’m on an island)
- Avoid sugary and acidic foods and drink
- Floss daily
- Have a healthy varied diet and make sure I don’t get things like diabetes or heart problems
- Avoid snacking too often and keep hydration levels up
- Manage my stress and avoid direct trauma to my teeth.
Doing these things will ensure that my teeth last for a very long time and do not deteriorate.
You need stimulation
Just like teeth, your joints and muscles will deteriorate. And what makes matters worse for dentists is that, for your whole career, you have been told to maintain one single posture for eight hours a day whilst treating patients.
Watch my video on how joint health is like tooth health.
Without stimulation and use, muscles and joints will deteriorate much faster. Doing so is like never brushing your teeth.
In addition, without stimulation and training, your body will slowly begin to replace strong muscle tissue and ligaments with less energy sucking tissue as you age.
It’s the same reason 15-year-olds don’t need knee replacements and why most people only start to experience back pain after the age of 30 years (see figure 1 for a better idea).
Their joints and muscles are unable to withstand the stress they place them under due in part to age related changes in muscle and joint health.
With ageing comes a host of physiological changes that occur in muscle and joint tissue. All cause mortality increases as do several other pathologies including decreased immune system functioning (figure 2).
As we age, our bodies try to preserve energy at all costs and so keeping muscle and joint tissue is of less importance because it requires so much energy to maintain.
Prior to adult life, our bodies maximise growth to get us to a healthy reproductive age so we can pass on our genetics to the next generation.
The body regulates muscle and joint health by signalling. If we use these tissues in a good way (without over stressing them beyond their recovery capacity) then the body believes that it needs these things to survive.
Pain and injury
In addition, muscle and joint health (flexibility, strength and control etc) are inextricably linked to pain and injury occurrence.
Whilst pain is a complex phenomenon that isn’t always linked purely to physical issues, there is a significant part that physical health plays in it nonetheless.
This is because a lot of pain occurs from lack of capacity to withstand certain stressors be they physical, emotion or chemical.
Injury risk increases exponentially when strength and flexibility loss occur, much like the incidence of broken teeth increases as teeth become frailer and weaker (figure 3).
If a tooth is weak and it is asked to chew on something a bit harder than normal, breakages can occur.
I hope that you are beginning to understand a bit more about why sitting in one position all day long is detrimental to your body and will increase your risk of developing pain and injuries.
So, what can you do about it?
Well, here’s the good news. Unlike teeth, your muscles, joints, ligaments, and bones all adapt and can regrow (to an extent).
So, with the right stimulation, you will be able to maintain healthy muscles and joints over a lifetime of dentistry (and even improve on them).
Mechanical loading is a very potent stimulus for your body. Not only does it provide nutrition for your muscles and joints, it also sends signals telling your body to keep the flexibility/strength you have.
Mechanical loading is also a very potent way to increase your flexibility, strength, and control beyond where it currently is.
So where should you start?
Taking on anything new is a daunting challenge for most people. So I would always go for the lowest hanging fruit.
Consistency combined with the right intensity will get you much further than just purely intensity.
You don’t need to start with the gym five times a week. Doing so would put you at risk of injury due to your decreased capacity, as shown in figure 3).
Instead start with just increasing the amount you walk every day. Start by moving your joints between patients. Start by incorporating some gentle body weight exercises at home for 10 minutes per day.
Once you have built up your strength doing this, move on to harder things.
The body needs a good reason to maintain strength and muscle mass as you get older, so it’s important that you do push yourself hard occasionally.
Keep it up
Working up to your maximum strength on several different exercises at the gym will help you maintain and even improve upon your levels of strength.
Learning to push yourself to muscle failure every so often is important, as it is a potent stimulus to the body (not too often though).
Changing your mindset around your body and thinking of it like you would teeth will help you maintain the motivation to look after your body throughout your dental career.
If you’re struggling for ideas, then you can always check out the Dentistry Gym and my free Youtube videos online to help with improving on your strength and flexibility.
Having good ergonomics is great, but just remember that time comes for each and everyone of us.
Without doing anything you will slowly lose what you have. Doing so puts yourself at risk of unnecessary suffering.
Remember to always take things slow as pushing too hard for extended periods of time will also lead to increased risk of injury.
If you are struggling with pain or are unsure about what to do, please find a professional to help you.
Just like you would encourage your patients to visit a dentist for advice, seeking the help of others can be immensely positive for your life.
Follow Khalil Hussein on his Instagram: @khalilchiro, or via his website: www.khalilhussein.net.
Contact [email protected] for references.
Catch previous Dentistry Gym videos:
- Pain isn’t what you think it is
- Acute lower back pain? Try this out
- Do this for your sore neck
- Things that work for back and things that don’t
- Easy neck strengthening for dentists.
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