Massage & Bodywork

March/April 2012

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technique BoDYREADInG THE MERIDIAnS | @WORK | ESSEnTIAL SkILLS | MYofASCIAL TECHnIqUES Brushing Up on Dental Worker Care By Whitney Lowe When most of us think about the dentist, we generally think about our own woes, not the chronic pain experienced by most dental workers. But, long hours spent in static positions bending over patients is a major complaint for dentists, dental hygienists, orthodontists, and those who work in other clinical environments, such as oral surgeons. The key to understanding musculoskeletal disorders among dental workers lies in looking at the postures they assume when working. Dental workers (except for oral surgeons) spend most of their time in a seated position bending over their patients doing examination and treatment work in a small, confined work spaceā€”the patient's mouth. 1 Dental workers often experience chronic pain from spending hours bent over their patients. OCCUPATIONAL STRESSES Image 1 shows the common posture for dental workers, where they are seated with their heads bent over the patient and manipulating instruments in the patient's mouth. The primary areas where musculoskeletal stress and injury are experienced include the low back, upper back and neck, shoulders, and distal upper extremities. This article explores musculoskeletal disorders in these areas and offers common treatment strategies helpful for addressing them. Low Back Biomechanical Challenge. Historically, dental work was performed with the patient in a special examination chair and the dentist or hygienist bent over the patient from a standing position. Exceptionally high tensile force loads are placed on the muscles and fascia of the lumbar region when a person is bent over from a standing position (Image 2). The muscles that control the spine are located adjacent to the spine, making it challenging for them to produce the strong forces required to hold the torso upright. More recently, ergonomic improvements have led to changes in this traditional posture. With dental workers now in a seated position and the examination chair much lower to the ground, significant stresses from standing all day in a bent-over position have been reduced. However, there is still an extraordinarily high rate of musculoskeletal injury reported in the dental professions due to the long periods that dental workers must be bent over their patients, holding their arms and hands out in front of themselves while engaging in very precise hand and arm movements. Long periods in a seated position with the lumbar spine partially flexed significantly increase compressive loads on the intervertebral discs, which can lead to disc pathology and possible nerve impingement. The seated position did not remove the need for 106 massage & bodywork march/april 2012

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