Retire on Your Schedule, Not Your Aching Back’s

Retirement is like heaven: you want to get there, but not too soon. Yet every year the careers of many still vital, engaged Michigan dentists are ended prematurely by work-related musculoskeletal injuries and the aching backs, necks, shoulders and wrists they cause. Happily, there are things you can do to avoid this fate.

In a 2015 ADA survey, two-thirds of responding dentists reported low back pain and neck pain.¹ A 2018 literature review found musculoskeletal diseases and pain to be “a significant health burden for dental professionals.”² And among five health problems cited as early career enders for dentists in a 2014 study in the International Journal of Clinical Pediatric Dentistry (IJCPD), musculoskeletal disorders topped the list at 29.5 percent.³

Of course, all adults face an increased risk of musculoskeletal pain as they age. But dentists lead this parade. (See “Treating Dental Patients Can Be a Pain in the Neck,” below.) According to the IJCPD study report: “A dentist can spend up to 60,000 hours in a lifetime working in tense and distorted positions, with consequent musculoskeletal problems. Dentistry does not lend itself to good posture; however, it is possible with instruction and practice to correct harmful postural habits that may be the cause of such stress and pain.”

For a rundown of such instruction, we turned to physical therapist Chris Nawrocki, MSPT, OCS, CEO of the Grand Rapids-based Center for Physical Rehabilitation. He helps dentists take care of themselves so that they can retire when they’re ready, not just when they hurt too much to go on.

Awkward positions. “The most common problem we see in dentistry is what we call postural syndrome,” says Nawrocki. “It comes from the repetitive stress of being in a head-forward, rounded-shoulder posture over and over again for sustained periods.” Minimize this stress if you can, even if it means re-equipping your office with new exam chairs, stools and side tables that reflect the principles of ergonomics—the science of adapting work tools and processes to the worker’s natural positions and movements.

The Center for Oral Surgery and Dental Implants recently purchased new ergonomic patient chairs made in Germany by Brumaba. They’re more expensive than normal oral surgery chairs, says the practice’s Emily Van Heukelom, DDS, but they’re worth it. “The contour of the shoulder support is tapered so that the surgeon can move in closer and needn’t reach as far—and thus doesn’t have to maintain an awkward position,” she explains. “And the chairs can tilt from side to side like a banking airplane, so that the surgeon can keep his or her neck and torso upright for less cumulative strain.”

Keep upright as much as you can, work as close to your body as you can, and limit sustained, extended stretching of arms, shoulders or wrists. Such stretching, says Nawrocki, “can create an imbalance in your musculoskeletal system that causes pain—the body’s way of telling you you’re imposing a pattern on it that it doesn’t like.”

What to do during the work day.  You can’t focus all day on your spine, shoulders, neck and wrists. But you can form good habits that become second nature. The interval is up to you—hourly on the hour, say, or before seeing each patient. But when that moment arrives, it’s your cue to take a break and do three quick exercises:

• The cervical retraction. In this maneuver, which Nawrocki alternately calls the chin tuck or the “reverse funky chicken,” you stand erect, eyes facing forward, and pull back your head and neck as far as you can about ten times in quick succession. This helps realign the facet joints, which connect the bones of the spine. (You can Google this exercise to find illustrative videos.)
• The shoulder-blade pinch. To open up your pectoral muscles, pull your shoulders back as if trying to make them meet.
• The hand clasp with deep breathing. Clasp your hands together behind your back, lift them upward and take ten deep breaths, counting them one by one.

In addition, if you can take a lunchtime break for a brief walk outdoors in nature and fresh air, so much the better.

What to do when you’re off duty. Buy a long foam roller, and when you’re home and ready to chill, lie back on that foam roller—head even, knees bent. Breathe deeply for 30 to 60 seconds, and then rotate your head from side to side. “That stretches the whole spine out,” says Nawrocki. Or, try extending your arms outward. (Search “foam roller opening” and “foam-roll pec stretch” on YouTube.) Nawrocki says clients tell him: “I come home at night and lie on that for one minute after work and my day resets. I release all the stress and tension.”

Of course, proper nutrition is also part of taking care of yourself, as is regular hydration throughout the day—and sufficient good-quality sleep.

No magic can keep the years from taking their toll, and the occasional musculoskeletal problem does demand not just better posture and targeted exercise, but treatment by a medical specialist. Still, these healthy habits can better your chances of avoiding a musculoskeletal injury that ends your career prematurely.

Advises Dr. Van Heukelom: “Ergonomics should be built into your everyday practice from the beginning because once you start to experience the symptoms of repetitive-stress injuries, it’s really hard to get your body to heal and to make enough changes fast enough.”

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¹ OSHA Review, “ADA Survey: Ergonomic Risks in Dentistry,” https://oshareview.com/2018/01/ada-survey-ergonomic-risks-in-dentistry/, accessed 16 December 2021.

² AAOMS Today, May–June 2021 (19:3), pp. 8–17, American Association of Oral and Maxillofacial Surgeons.

³ International Journal of Clinical Pediatric Dentistry, “Ergonomics in Dentistry,” Jan.–Apr. 2014, pp. 30–34, accessed online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4144062/, 16 December 2021.