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Short Commentary: Reaching and Twisting

Reaching and Twisting




It's easy to fall into poor ergonomic positions and develop chairside habits that lead to pain. Townie AnnieB925 asked for help on the Hygienetown.com message boards hoping to alleviate her chronic back pain, and Bethany Valachi, author of Practice Dentistry Pain-Free responded. Just like dental disease, the best solution is prevention rather than treatment. 		AnnieB925: By the end of the day my lower right back is killing me and the pain lasts well into the night. I need to overcome some bad chairside habits I've developed that lead to this pain. My room is set up with a rolling cart at the 1:00 spot behind the patient. I tend to work from 11:00 and roll up to 12:00 and sometimes down to 9:00. I think it's when I'm at some of these positions and am reaching for my instruments and twisting my torso too much that causes the pain. I knew twisting my torso is wrong, so for a while I started reaching with the non-dominant arm and it caused lateral epicondylitis (aka tennis elbow). Any suggestions?

bethanyv: Hi Annie,
By the time pain is experienced, microtrauma to structures, whether it is teeth, gums, muscle, ligaments, or facet joints, has usually already occurred. You hopefully teach this prevention concept to your patients on a daily basis – they must brush, floss and have regular exams to help prevent oral "microtrauma," i.e.: small carious lesions or early periodontal attachment loss, which could later result in larger problems such as pulpal inflammation or advanced bone loss. It is not appropriate to treat the problem only after it has developed.
Likewise, by the time pain is felt in the low back, structural damage at a cellular level has frequently already occurred, oftentimes irreversible. There are numerous effective strategies you can implement in the operatory to prevent and reduce disc compression and muscle imbalances that lead to the muscle spasms and back pain. Your concerns regarding the rear delivery retrieval are likely the problem. Studies show that twisting repeatedly in one direction is a risk factor leading to low back pain. Technically, there should be no difference between reaching with your left (non-dominant) arm for the delivery system versus your dominant arm. However, since dental professionals are prone to specific muscle imbalances, two ideas come to mind as to why this might have happened:
  1. Poor shoulder girdle strength. Among dentists and hygienists, the non-dominant shoulder tends to be more susceptible to pain than the dominant shoulder. Clinically, this might be a reflection of poor muscle strength and lack of ability of the shoulder girdle to stabilize on the left side compared to the right, due to excessive retraction of soft tissue, arm abduction, etc. Experts state that this poor stability can result in injury to the distal joints, especially tennis elbow.

  2. Reaching/gripping with the elbow extended. This is a risk factor for developing tennis elbow. If you are too far away from the rear delivery and repeatedly reaching/gripping with an extended elbow, this could be the culprit.
Editor's note: Click Here to visit the Online CE Course: "Low Back Pain in Dentistry: Bridging the Gap Between Ergonomics and Work-Related Pain," presented by Bethany Valachi, MS, PT, CEAS. Or, it might be a combination of the two. The primary risk factor for developing tennis elbow in dentistry is repeated upward/inward twisting of the forearm against resistance, and I have seen too many chronic lower back injuries from repeated trunk twisting. Therefore, I still feel that proper retrieval of instruments and handpieces with the non-dominant hand is better in the long run than repeated trunk twisting. Bethany Valachi, MS, PT, CEAS
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