A young lady in her 30s comes through the door. She’s a new patient. She’s active and hard-working and usually fun-loving, but she can’t get pain out of her head. Literally. And it’s really starting to drag down her quality of life.
She’s been suffering with chronic neck pain for six months now. She’s had headaches for as long as she can remember and she’s used to working through these. But now they’re constant and more severe.
Yoga has always been her go-to. She feels pretty good right after class, but the pain is still getting gradually worse. Her neck even aches to do simple chores now, like washing the dishes and vacuuming.
There is one more factor that she has in common with many of the women I have seen with neck pain: she’s a dental worker. In her case, an assistant to an oral surgeon. She spends her days craning her head into awkward positions for long periods of time.
Sound anything like you? Well, let’s get to work getting you out of pain.
Stretching: The #1 no-no
Easy one out of the way first.
We’ve written plenty about triggers before in our past articles. One of the worst triggers for you dental workers with neck pain is often self-inflicted. Stretching.
Almost every dental worker I have seen with neck pain is plenty flexible throughout their whole body, and that includes their neck. You might feel stiff. You might truly have less neck motion due to your current pain. But all that doesn’t mean you aren’t still plenty flexible.
Lack of stability is usually the main problem that leads to your development of neck pain. High flexibility means it’s harder to stabilize your neck. Add in holding your head and neck in awkward positions for long periods of time, and your flexible neck is strained to its absolute limit.
So stretching is not what you need. Your muscles are plenty flexible. Their biggest problem is holding your 10 lbs head up all day!
“But stretching feels good” you may say. That’s what we call a stretch reflex. Stretching sends a neurological reflex to the brain that offers temporary pain relief, but it just kicks the pain down the road to come back later.
It’s like eating that large bowl of ice cream topped with crumbled oreo bits and teddy bear grahams, drenched in caramel and chocolate syrup, and drizzled with warm melted Trader Joe’s cookie butter.
It takes the stress of the day away for a moment as your taste buds ooh and ahh in their sugar bath. But your worries come roaring back later. Along with a tummy sickness equal to that of a third grader’s on Halloween night.
Pain reducing principles during procedures
Little ergonomic changes can reap wonderful rewards. The changes you need to make will obviously depend on what you find yourself doing during the day, and the equipment you have access to.
Let’s review a few position principles you can apply to all situations as best as possible. Then we’ll scan through some specific examples in the next section.
- You want to keep your head and upper back as close to neutral as possible. In your case, the danger is that your head and upper back are constantly in too much flexion as you bend over your patients or keyboards. Your chin will also want to jut forward away from your throat. No bueno.
- Keep your shoulders relaxed. When you are focused on something in front of you, like a patient’s mouth, and you’re working with your hands, your shoulders like to gravitate up toward your ears and in toward your chest. Don’t let those shoulders shrug and collapse forward!
- As much as possible, you want to keep one or both arms supported when you’re working. So if you’re with a patient, or molding a crown, or typing, you want to keep one or both arms supported. This makes it easier for your neck muscles and traps to stay relaxed, relieving stress off of your spine. Just make sure the support isn’t so high that it hikes up your shoulders to your ears again.
- Take position breaks as much as possible. Changing your position regularly, or just taking quick breaks from a position you’re holding, provides needed stress breaks for the tissues working hard to hold you up.
Pain reducing examples to use during procedures
- If you’re the one doing the procedures, you’ll want to invest in the right pair of loupes. These should have a steep declinication angle so that you barely have to flex your head forward in order to see straight down into the patient’s mouth. You don’t want your head to flex more than 20 degrees forward. Beyond that and your neck starts taking on too much stress fighting against gravity.
- In standing, you’ll want to adjust the height of the surface you’re working on to around elbow height. If the working surface can’t change height, then you have to. Use a step stool if you need to be higher. If you need to get lower, then spread your stance out into a sumo stance to lower yourself down. Added bonus to the sumo stance is the hip mobility and leg workout you’ll get.
- This is easy if you’re sitting. You can again adjust the working surface to about elbow height, or adjust your stool if it can adjust. If your stool doesn’t rise up and down…buy a new one. Or you can always use stadium cushions or books or other objects to raise you up in the seat. It may look a little funny, but it’s easier to laugh at yourself sitting on books then it is to laugh at your own neck pain.
- Obviously, you want to keep your head as neutral as possible, so you want to avoid cocking your head to one side and holding it like that. Major stress on the cervical spine there. Adjusting your position relative to the patient’s head and adjusting the patient’s head is vitally important to helping you retain a neutral posture. This is something I know you are already very familiar with in the dentistry world. So this just comes down to doing it and your team encouraging each other to stay accountable to good positioning.
- Make sure your operation chair has one or two armrests that you can use. Again, these should be at around elbow height so that when your arm sits on the rest your shoulders stay low and relaxed.
- Once you get going on a procedure, you usually just want to put your head down (but not literally, right?) and crank out the work. But taking quick little breaks can relieve a lot of stress on the tissues putting in the most work to hold your head up. This means stopping every 2–3 minutes for about 5 seconds to look up, gently move your head around in a small range of motion, then get back to work.
- You should warm up before the procedure. That’s right. Get into your warm up jump suit, crank the pump up music, and do some pulling exercises. Bring some resistance bands to work and do some rows or face pulls or lat pull downs before game time. This will get your posterior, posture-maintaining upper back and neck muscles firing and prepared to take on more of the load of holding your posture. Now rip off that warm up suit and get to work!
The low hanging nectarines: cervical hygiene
As we’ve just discussed, there are good strategies you can use to reduce cervical stress during procedures. But we also want to take advantage of easy opportunities outside of procedure time.
You are obviously familiar with teaching your patients about dental hygiene, so think of these daily routine changes as good cervical spine hygiene. These are the low-hanging fruit, nectarines being a most delicious variety, of cervical stressors we can easily change for the better.
- Whenever you’re sitting, especially if at work, place a pillow or folded up hoodie or anything behind your head. If your chair isn’t tall enough, then place the object as high up your back as you can. This is great for head support to relax the stress on the neck, but it also forces you to remain in a good posture. If you start to slip forward into poor posture, the object will fall and you will pop right back up to the better posture. You can even do this when sitting at home on the couch or wherever you find yourself.
- Speaking of sitting posture, especially if you have a head rest, you’ll want to recline your seat a bit rather than trying to sit straight up. Who on earth can hold that kind of board rail straight posture for more than 30 seconds? Especially when you’re focused on other things. Leaning back into a slight recline with head supported is the best for your neck and posture. This includes while you drive…within the limits of safety of course.
- Whenever you are leaning forward, like pulling clothes out of the washer or brushing your teeth or picking something up off the ground, place one hand down onto the stable surface below. That stable surface might just be your own knee sometimes. This gives your neck a little help so that the spine and muscles aren’t doing all the work to try and keep your head from falling forward.
- Be aware of phone head! Everyone looks DOWN at their phone, distracted by the screen of wonder while their neck strains to hold up their 10 lbs noggin. Whether you’re sitting or standing, bring the phone up to your face level. If there is somehwere to rest one or both of your arms while you do it, all the better. This could be as simple as leaning one arm and shoulder up against a wall. Just remember to keep your shoulders relaxed while you do this.
- I saved the best for last. If we think of your dental procedures as a workout, and it certainly is for your neck and many other things as you well know, then it only makes sense that you need a proper recovery! For the neck, nothing is better than lying down. That’s right, lie down flat on your back for 5 to 10 minutes. The sooner you lie down after you’ve stressed it, the better. On workdays, you may only be able to do this during a lunch break and right after work. If you can get this in RIGHT after a procedure, then do it! Getting your spine out of gravity for a brief break does wonders.
I know, “team accountability” sounds like some sort of terrible HR group exercise that your least favorite corporate chain would put on. But this is a little different…I promise.
Many of the changes we discussed here are simple, and you likely have thought of them yourself or even tried a few of them. The key is to implement these small changes with everyone involved. Encourage your team to keep each other accountable and be consistent.
The hardest part is often just stopping and making the easy changes. You get going on a procedure, and you forgot your step stool, and instead of asking someone to grab it, you figure it’s fine to just plow through.
An hour of shoulder shrugging, neck-craning work later, and your head is starting to ache. Gross.
Review these important positions and what changes will make the most impact in your practice with your team, and invite everyone to keep each other accountable.
It’s not like you’re calling someone out in a spiteful way, you’re trying to save them from experiencing avoidable pain later!
Experience the pain-free life for a change
If you want to experience the relief of living and working pain-free, I urge you to put these strategies into consistent practice.
If you need more help resolving your neck pain, schedule a free 15-minute phone consultation with us today. We want to help you stop dreading your workday and instead enjoy a pain-free life!