Dental Ergonomic Newsletter #12

Recent research shows that these 'stabilizing' muscles are intricately hard-wired to your sympathetic nervous system, so they respond strongly to mental stress or anticipated stressful activities. When the 'fight or flight' signal is received, they contract in anticipation of the fight that (hopefully) never happens. The muscles are left in a contracted state and easily develop painful trigger points. This reaction is not due to dysfunctional muscles, but is a normal, physiologic response to stress whenever the muscle contraction is sustained beyond its usefulness to a point of pain.

Add to this scenario the physical stressors on these muscles from the ongoing ergonomic challenges in the dental operatory, and we have a viscious pain cycle: physical & mental strain from job--muscles tense--trigger points develop--pain--mental stress in response to the pain!!

The medical approach to this syndrome is often medicines (NSAIDS, anti-depressants, muscle relaxants) and rest. This can be a 'bandaid' approach, since the underlying and exacerbating factors are not addressed.

ERGONOMIC INTERVENTIONS

Close Proximity. A common cause of lower trapezius trigger points is when the operator or assistant cannot get their knees under the patient chair and ends up leaning or bending forward over the length of their upper leg. If your knees cannot be positioned under the patient chair, consider straddling, using the runner up position or use a saddle stool to gain close proximity to the patient, and preserve your best operating posture. It is imperative to learn how to position patients properly to maintain an upright posture. Watch videos for the dentist & hygienist from the DVD, "Positioning for Success in Dentistry".

Neutral Shoulder Posture. Avoid rounded shoulders or holding the shoulders in a raised position. Loupes with a properly measured (long enough) working distance will prevent drifting forward into slouched posture and will also allow you to position the patient low enough to avoid elevating your shoulders while working. Additionally, armrests can be very helpful in minimizing muscle strain while reaching in front of you to work. Read article, "Backrests, Armrests or No Rests".

SELF-THERAPIES

Manage the stress response. Purely physical treatment often provides only temporary relief, since the emotional or stress component must be modified. Since these muscles are hot-wired to the sympathetic nervous system, identifying and reducing work-related stressors, as well as those at home can do wonders for long-term management. Progressive relaxation and abdominal breathing exercises also are excellent therapies.

Manage your trigger points. Backnobber

Self-treatment: Put 1-2 tennis balls in a tube sock, tie the end and place in the freezer. On the floor, lie on one cold tennis ball (between scapula and spine) or two balls (one on either side of the spine) & hold 30-60 seconds. You may also self-treat your trigger points using a Backnobber tool (right), which will treat many areas that cannot be treated with tennis balls. Specific directions for treating all the major trigger points can be found in the Trigger Point Workbook.

Professional treatment: Physical therapist, doctor or certified neuromuscular therapist can perform Spray & Stretch technique, followed by moist heat or ultrasound. The focus should be on the release of tight fibers, which are usually weak muscles. Release of the lower trapezius and pectoralis trigger points are often the key to release upper trapezius and rhomboid trigger points.

Stretch the problem muscles. Perform gentle stretches to the

painful muscles up to 3X daily. It is most effective to follow the Backnobber trigger point treatment (above) immediately with a stretch

to the same muscle. Tight chest muscles can perpetuate the problem, so pectoralis stretches are also important.

Middle/lower Trapezius Stretch

Rhomboid Stretch

Remember, do not embark on a strengthening program until the trigger points are released. Heavy resistance training on muscles with trigger points can actually worsen pain.