Neck pain and dentistry - healthaddiction.co.uk · 1 NASM - Essentials of ... ‘It’s a pain in...
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1 Introduction We live in an age of inactivity and repetitive motions. This is particularly true for dental professionals. Dentists commonly experience musculoskeletal pain during the course of their careers. Pain occurs not only in their lower backs, but also their necks and shoulders. Such symptoms do not occur overnight; they develop almost imperceptibly at first. Then, they become increasingly obvious. You may not be suffering from these symptoms at present but prevention is always better than cure and the earlier you recognise the causative factors, the earlier you can start a prevention regime thus preventing the possibilities of long-term injuries. In this article, a closer look will be taken at the second most common musculoskeletal disorder and complaint amongst the dental team, which is neck pain. Luckily, research has shown that corrective exercises, in the form of neck strengthening, stretching and proprioceptive activities, can significantly decrease the risk and improve the symptoms of neck pain 1 . The cervical spine The neck is a well-engineered structure of seven vertebrae (C1-C7), nerves, muscles, ligaments and tendons. The cervical spine is not only delicate, housing the spinal cord, but at the same time, flexible, allowing movement in different directions. The cervical spine is the weakest and most flexible part of the spinal column and it is also the most susceptible to injuries. Overview of neck pain Disorders related to the cervical spine can present a plethora of signs and symptoms due to the many tissues and systems associated with this region. For instance, the nervous system, including the spinal cord, nerve roots, peripheral nerves and sympathetic chain; the digestive system (the pharynx 1 NASM - Essentials of Corrective Exercise Training , Chapter 16, pg 375 ‘It’s a pain in the neck…’ Neck pain and dentistry Dr James Tang, CES, MBA, BDS, LDS RCS GDP, NASM Corrective Exercise Specialist, Level 3 Personal Trainer (REP registration no R1045463), Sports Nutritionist, & Level 3 Sports Massage Therapist, with special interest in postural dysfunction and lower back problems
Transcript of Neck pain and dentistry - healthaddiction.co.uk · 1 NASM - Essentials of ... ‘It’s a pain in...
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Introduction
Weliveinanageofinactivityandrepetitivemotions.Thisisparticularlytruefordentalprofessionals.Dentistscommonlyexperiencemusculoskeletalpainduringthecourseoftheircareers.Painoccursnotonlyintheirlowerbacks,butalsotheirnecksandshoulders.Suchsymptomsdonotoccurovernight;theydevelopalmostimperceptiblyatfirst.Then,theybecomeincreasinglyobvious.Youmaynotbesufferingfromthesesymptomsatpresentbutpreventionisalwaysbetterthancureandtheearlieryourecognisethecausativefactors,theearlieryoucanstartapreventionregimethuspreventingthepossibilitiesoflong-terminjuries.
Inthisarticle,acloserlookwillbetakenatthesecondmostcommonmusculoskeletaldisorderandcomplaintamongstthedentalteam,whichisneckpain.Luckily,researchhasshownthatcorrectiveexercises,intheformofneckstrengthening,stretchingandproprioceptiveactivities,cansignificantlydecreasetheriskandimprovethesymptomsofneckpain1.
Thecervicalspine
Theneckisawell-engineeredstructureofsevenvertebrae(C1-C7),nerves,muscles,ligamentsandtendons.Thecervicalspineisnotonlydelicate,housingthespinalcord,butatthesametime,flexible,allowingmovementindifferentdirections.Thecervicalspineistheweakestandmostflexiblepartofthespinalcolumnanditisalsothemostsusceptibletoinjuries.
Overviewofneckpain
Disordersrelatedtothecervicalspinecanpresentaplethoraofsignsandsymptomsduetothemanytissuesandsystemsassociatedwiththisregion.Forinstance,thenervoussystem,includingthespinalcord,nerveroots,peripheralnervesandsympatheticchain;thedigestivesystem(thepharynx
1 NASM - Essentials of Corrective Exercise Training , Chapter 16, pg 375
‘It’sapainintheneck…’NeckpainanddentistryDrJamesTang,CES,MBA,BDS,LDSRCSGDP,NASMCorrectiveExerciseSpecialist,Level3PersonalTrainer(REPregistrationnoR1045463),SportsNutritionist,&Level3SportsMassageTherapist,withspecialinterestinposturaldysfunctionandlowerbackproblems
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andesophagus);therespiratorysystem(thetracheaandsuperiorapexofthelungs);aswellastheskeletal,vascularandmuscularsystems.
Neckpaincanbeacute(lastsforlessthanthreemonths),orchronic(lastslongerthan3months).Therearemanystressesthatcanbeplacedontheneck,forinstance,traumatotheheadandneckregionorevensimpledailyactivities;thecervicalspineisthereforevulnerabletoconditionssuchas,degenerativediscdisease,herniateddisc,stenosis,osteoarthritis&musclestrainresultinginapainfulorstiffneck.
Thevastmajorityofneckstrainandstiffneckarerelatedtomuscleimbalancesandformationoftriggerpointsasaresultofposturaldysfunction.Thistypeofneckpainusuallygetsbetterwithtime,evenwithouttreatment.Thereare,however,afewsymptomsthatarepossibleindicationsofmoreseriousconditionswhichrequirefurthermedicalattentions.
• Progressiveneurologicalsymptomssuchasweakness,numbnessorlackofcoordinationinthelimbscouldimplicatenervedamage.
• Ifthepainispersistentformorethansixweeks,isconstantlypainfulorisgettingworse,orthepainisaccompaniedbylackofappetite,unanticipatedweightloss,vomitingorfever,therecouldbeaspinaltumororinfection.
Duetotheimmensecomplexityoftheneckandthehugevarietyofcausesinneckpain,theauthor,anexerciseprofessional,willonlyconcentrateonthemusculoskeletalcausesandhowtonegatetheadverseeffectsofthetypicaloccupationalposturesofdentistryinthisarticle.
Thebasisofmusculoskeletalneckpain
Pleaseberemindedthatthehumanmovementsystem(HMS)consistsofthemuscularsystem,theskeletalsystemandthenervoussystem.Throughoutyourbody,musclesworkinsynchronyandrarelydoesasinglemuscleworkwithoutothermusclescontributing,forinstance,thebonesoftheshouldergirdleprovideanchorsformusclesthatattachtotheheadandneckandtheshouldergirdlemustbeeffectivelyanchoredifmusclesconnectingthecervicalspinetothescapulaaretoexertaneffect.Thisisbecausethefunctioningofthebodyisanintegratedandmultidimensionalsystemandasaresultofthis,impairmentinonesystemorcomponentsofeachsystemcanleadtocompensationandadaptationinothersystems–initiatingthecumulativeinjurycycle.
Inordertoexplainwhystaticposturesarebad,whetheryouarestandingorsitting,youneedtounderstandthatmusclesadapttothepositionsweput
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themin.Thelongerweholdtheminacertainposition,themoretissueadaptationoccurs.Musclescanthereforebecomeadaptivelyshortenedorlengtheneddependingonthepositionyouputthemin.Thisisbecauseourbodiesarenotdesignedtomaintainthesamebodypositionhoursafterhours,daysafterdays,butunfortunately,dentistsoftencannotavoidprolongedstaticpostures.Althoughthebodyisefficientinadaptingtotheneedthatyouplaceonit,theseadaptationswillleadtomuscleimbalances,predisposingtobackandneckproblems.Thesoonerwemastertheeconomicuseofmovements,aswellasaposturethatisfriendlytothespine,thegreaterthechanceofpreventingassociatedmusculoskeletalconditions.
Whyisneckpaincommonamongstdentists?
Dentistryiswellknowntobeastressfuljob;dentistsareconstantlyunderatremendousamountoftime,administrativeandfinancialpressure.Thesituationisworsenedwiththeburdenofdetailedrecordkeeping,increaseinpatients’expectationsandthelikelihoodofcomplaints.Whenyouarestressed,youautomaticallytenseupintheshoulderandneckregion.Wheneveryoutenseup,youextendthecervicalportionofthespinalcolumnforward.Ifyouaredepressed,youholdyourheaddownandbecometoorelaxedinthisarea.Thesepositionscancausemuscleimbalancesultimatelyleadingtomusculoskeletalneckpainorevenspinaldiscproblems.
OthercommoncausesofNeckStrain
• Traumaticcauses-necktraumasuchaswhiplash,orfromafallaffectingtheheadandneck.
• Posturalcauses-toomuchtimespentinawkwardpositions,suchashunchedforwardworkingoncomputersorpatients,orrestingaphoneononeshoulderforaprolongedperiodoftime.
• Lifestylecauses-Unilateralstraincausedbyhabituallycarryingheavyobjectsononesideofthebody.Sleepinginapositionthatstrainstheneck,suchasusingapillowthatiseithertoohighortoofirm.
Commonsymptoms
Mostepisodesofneckstrainresultsinastiffneckand/orpaininuppershouldermuscles.
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Posturaldysfunctionpredisposingtoneckandbackpainthatiswithparticularrelevancetodentistry-Hyperkyphosis
Thespinehas4naturalcurvesinthesaggitalplane(i.e.whenviewedfromtheside),cervicallordosis,thoracickyphosis,lumbarlordosisandsacralkyphosisandthesecurvesareessentialforshockabsorption.
Hyperkyphosisisaresultofexaggerationofthenaturalthoracickyphoticcurve.Thistypeofposturaldysfunctionistypicallycharacterisedwithexcessivethoracicspinalflexion(forwardbendingofthethoracicspine),forwardheadposture,roundedshoulderandinternalrotationoftheshoulder,predisposingtoimpingementofthesupraspinatus(oneofthefourrotatorcuffmusclesoftheshoulder)tendonduetoareductionofthesubacromialspace.
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Muscleimbalancescausedbyhyperkyphosis
Muscleimbalancessimplymeanthatcertainmusclesareshortened/tightandothermusclesarelengthened/stretched.Inbothcases,thesemusclesareweakened.Musclesaremoresusceptibletodamage,fatigueandinjurywhentheyareweak.Characteristicsofhyperkyphosis
§ Lengthenedmiddletrapeziusandrhomboids.
§ Protractedshouldersandshortenedpectorals–sotheybecometight.
• Forwardheadposture-thisoftenresultsinimbalancesbetween
musclesthatsupportandmoveyourneck,shouldersandhead.Themusclesinfrontofyourneckresponsibleforflexing/forwardbendingofyourneck(deepneckflexors–seebelow**)maybecomeweakwhiletheonesintheback(neckextensors)maybecometightandstrainedastheyneedtobeconstantlycontractedtosupporttheweightoftheforwardpositionedhead–resultinginextendedcervicalspinewithshortened/tighteneduppertrapezius,sternocleidomastoid(SCM)andanteriorscalenemuscle.Furthermore,aforwardheadpostureaccentuatestheanteriorshearforceatthecervicalspine,andthispostureresultsinthelevatorscapulaetocontractconstantlytodynamicallyminimisethisforce.Furthermore,forwardheadpostureisalsoharmfultotheinter-vertebraldisksasthispositioncompressesthediskstogetherforward,whilethepulpynucleusmovesoutofalignmentbackward.Thesituationissimilartoapostureinwhichyouholdyourheadtooneside(lateralflexionoftheneck-thisiscommonalthoughyoumaynotbeawareofthis).
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Diagnosisofforwardheadposture-Thepowerfulsternocleidomastoidmusclescaneasilybevisualisedthroughtheskinandcanthereforebeservedasanindicatorofaforwardheadposture.Thegreatertheverticalityofthesternocleidomastoidwhentheneckisviewedfromtheside,thegreaterthelikelihoodthataforwardheadpostureispresent.Thisisbecausebilateralcontractionofthismuscleisresponsiblefortheheadtobetranslatedforward.
§ Posteriorlytiltedpelvisandlumberflexion–Thesepelvicimbalancescanaffectthelength-tensionrelationshipofthemusclesthatareattachedtothelumbo-pelvichipcomplex,e.g.lengtheningofbackmusclessuchastheerectorspinaegroupandtighteningofabdominalmusclessuchastherectusabdominis,leadingtomuscledysfunctionandlowerbackpain.
Furthermore,musclesthataretightandstiffcanrestrictbloodcirculation–resultinincreasemusclefatigueandimpedethemusclerepairprocess.Allthesecangreatlyincreasethechancesofinjury.
Causesofmusculoskeletalneckpain
Themainculpritrelatestotheoperativepositionofthedentist’shead.Thehumanheadis,onaverage,8-10percentofourtotalbodyweight.
Maintainingthe‘natural’cervicallordosisisimportantbutunfortunately,inanefforttoachieveadirectlineofvisionintotheoralcavity,dentistsareoftenrequiredtoleanforward.Forwardheadposturesarethereforecommonamongdentalprofessionalsbecauseitisonlypossibletoperformdentistryina‘neutral’positionifonecarriesouttreatmentusingasurgicalmicroscope.
Inneutralposition,thespineissupportedmostlybythevertebraerestingontopofoneanother.Byholdingtheheadandneckinanunbalancedforwardpositioninordertogainbettervisibilityduringtreatment,thespineincreasinglydependsonmusclesandligamentstomaintainanuprightposition.Forexamples,theuppertrapezius,erectorspinaemustcontract
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constantlytosupporttheweightoftheheadintheforwardposture.Thisresultindevelopmentoftriggerpointsinthesemusclesleadingtoapredictablereferralpainpatterns–suchasthetensionnecksyndromecharacterisedbyheadachesandchronicpainintheneck.
Triggerpointsoftheneckandshoulder
Itisconfusingbutmostneckpainsarecausedbytriggerpointsintheupperback(e.g.trapezius)andinter-scapularmuscles(e.g.therhomboids).Triggerpointsinthenecktypicallyreferpaintotheheadcausingheadache.Forexample,tightnessofthesternocleidomastoiddoesnotcausepaininthemuscleitselfandfrontalheadacheispracticallyasignatureofsternocleidomastoidtriggerpoints.Theycaneveninitiateautonomiceyeresponsesuchaslacrimationandvisualdisturbance.Triggerpointsinthescalenemusclesoftheneckreferpaintotheback,shoulderandarms.Generallyspeaking,triggerpointstendtoreferpaintoadifferentlocationandperformingself-myofascialrelease(SMR)ontheareawhereyoufeelsymptomsusingeitherafoamroller,theracaneoralacrosseballmaynotgiveyourelief.Triggerpointsaretinymusclecontractionknotsanditmustbeemphasisedthattheyarenotthesameasmusclespasm.Musclespasminvolvesthewholemuscleandtriggerpointsinvolvesonlycertainmyofibrils.Youcanconsidertriggerpointsas‘microscopicspasm’.Thesecontractedmusclefibresarenotavailableforcontractionastheyarealreadycontractedleadingtoweaknessofthemuscleinvolved.Furthermore,thesetinycontractionknotswithinthemusclerestrictblood&lymphaticcirculationintheirimmediatevicinity,resultinginaccumulationofmetabolicby-productsanddeprivationofoxygenandnutrients.Thiscrisisofenergyproducessensitizingsubstances,suchasbradykinin,thatcancausepainbecausebradykininisknowntoactivateandsensitisemusclenociceptors.Whatcanwedowiththesetriggerpoints?-SMRisparticularlyusefulinfixingpaincausedbytriggerpointsbecauseitincreasesthecirculationthathasbeenrestrictedbytheconstrictedtissuebybreakingintothechemicalandneurologicalfeedbackloopthatmaintainsthemicroscopic‘spasms’.ThesciencebehindSMRisautogenicinhibitionbyactivatingthegolgitendonorgansthatarelocatedinthemusculotendinousjunctionsturningoffthemusclespindlesthatmaintainthemicromuscularcontractions.
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ItisbeyondthescopeofthisarticletogointothedetailsofSMRandifyourequirefurtherinformation,pleasegetintouchorconsultyourphysiotherapistorexerciseprofessional.PleasedonotattemptSMRtechniquesunlessyouhavereceivedexplicitguidancefromaqualifiedpractitioner.Ifyouhaveanymedicalissuessuchasorganfailuresorcancer,seekadvicefromyourdoctorbeforebeginningSMR.Althoughachesandpainsfromtriggerpointsarecommon,therecansometimesbeanunderlyingpathology.Itisadvisabletoalwaysseekaproperdiagnosisifyousufferfromneckorlowerbackpain.Theauthorsimplyusesthisarticlehighlightingtoyouthediversityofsymptomsthatcanbecausedbytriggerpointssothatyoucanlookoutfortheirinvolvementasadifferentialdiagnosisforyourneckandbackconditions.
Recurrence
Theacuterecoveryperiodforsymptomaticreliefofneckpaincanbeuptoeightweeksbutthelikelinessofitsre-occurrenceishigh–thisisbecausewithouttheeradicationofthecausativefactorsandpropertreatment,triggerpointssimplyturnlatentandcanbereactivatedeasilywiththeslightestoverload.
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Abriefoverviewofthemusclesofthecervicalspine
Deepcervicalflexors**
• LongusColli• LongusCapitus• RectusCapitusAnterior&lateralis
Thesedeepneckflexorsareagroupofmusclesthatliealongtheanteriorsurfaceofthecervicalspinedeeptothesternocleidomastoidandareresponsibleforflexion(bendingforward)andlateralflexion(bendingsideway)oftheneckbutmostimportantly,forsupportingtheweightoftheheadandstabilizationoftheneckduringdynamicmovementsagainsttheeffectsofgravity(theirroleissimilartothatofthetransversusabdominisincorestabilisationofyourtorso).Theanatomicalactionofthelonguscapitisandlonguscolliistonodthechin.Iftherecruitmentofthesedeepmusclesisimpaired,thebalancebetweenthestabiliseronthefrontandthebackoftheneckwillbedisrupted.Thiswillcauselossofproperalignmentofthespinalsegmentsandaposturethatcouldleadtocervicalpain.
Itisthereforeimperativetomaintainthecorrectlength-tensionrelationshipsofthesemuscles(thisreferstotherestinglengthofamuscleandtheforcethemusclecanproduceatthislength).Forwardheadposturepredisposestotighteningoftheneckextensorswhichneedtoremaincontinuallycontractedtosupporttheweightofthehead.Thedeepneckflexorsbecomelengthenedand‘inactivated’duetoreciprocalinhibition,theprocessofmusclesononesideofthejointrelaxingtoallowcontractionofthemuscleontheothersideofthatjoint.Throughtheruleofreciprocalinhibition,whenonemuscleshortens,itsantagonistwillalwayslengthen.Ifyouhaveamusclethatisconstantlyshortenedinagivencontext(inthiscasetheneckextensors),theantagonist(inthiscasethedeepneckflexors)willbelengthenedwithinthatcontext.Thisisonewayofthinkingofhowatightmusclecaninhibitthefunctionofitscounterpart.Thisappliestoallmusclesonyourbody,includingthoseofyourneck.Patientswithposturalneckpainorneckinjurysuchaswhiplashcanshowimprovementinpainandfunctionifthesedeepneckflexormusclesarestrengthened.Asaforementionedthatthehumanmovementsystemisanintegratedsystem,asaresultofunderactivityandinabilityofthedeepneckflexorsand
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cervicalerectorspinaetomaintainanuprightcervicalspineposition,thesuperficialcervicalmusclesincludingtheuppertrapezius,levatorscapula,sternocleidomastoid,andpectoralisbecomesynergisticallydominanttoprovidestabilitythroughthecoreandshouldergirdlecomplex.Thisisbecausemovementoccursthroughthecoordinatedcontractionofanumberofmusclesaroundajointandifthesedeepcervicalflexorsdonotcontractproperly,thenthebrainwilllookforalternativesolutionstocreatethesamemovement,resultinginthesynergists/helpermuscles(thoseglobalmusclesclosertothesurfacesuchasuppertrapezius,sterncleidomastoidetc)takingovertheroleoftheprimemovers(i.e.synergisticdominance).Thesesynergistsarenotdesignedtobetheagonistandtheyarelessefficient(superficialmusclescomposemainlyofType2fibres,theyarestrongbutarequicktofatigueandtheyarenotsuitableforprolongedposturalactivities).Overtime,thiscanleadtodysfunctionalmovementpatternswhichcanresultinneckpainthroughdevelopmentoftriggerpoints.
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Practicaladvicesonhowtoreducetherisksofneckpain
Ifitisnotpossibleforyoutoprovidedentalcareinabalancedposture,whatcanyoudotominimizethedamagingeffectsofprolongedtorqueresistance?
Improvementofyourworkpostures
Firstly,itisimportanttogettoknowyourhabitualheadposture(startbywatchingyourselfinfrontofamirrororevenvideoingyourself)atworkinparticularandprobablyoutsidework.Correctitconsciouslyinyoureverydayroutineuntiltheproperposturefeels‘normal’bylearningtotransformyourharmfulhabitualposturalpatternsintohealthyones.Youcandothisbyconsciouslythinkingaboutyourpostureandbyapplyingyournewknowledgeuntilthenewpostureandmovementpatternsbecomeestablishedasanorm.
Improvementofworkergonomics
Furthermore,regardingworkergonomics,selectionofagoodoperator’schaircanhelpyoutomaintainaneutralspinewhilstyousit.Butitisstilladvisabletoavoidprolongedsittingwhichcanleadtotighteningofyourhipflexorgroupofmusclesandweakeningofyourglutesduetoreciprocalinhibition.Theglutealmusclesareimportantforpelvicstabilisationandtheirweaknesscanleadtosynergeticdominanceofthesynergistmusclesofthebackpredisposingtolowerbackpain.
Itisalsoadvisabletoadjusttheoperativepositiontoacomfortablelevelbecauseifyourchairistoolowandthepatient’schairistoohigh,thiscausesyoutoelevateyourshoulders.Alternately,ifyourchairistoohighandthepatient’schairistoolow,you’llhavetoflexyourneckexcessively,bothscenarioscouldleadtoneckpain.
Alwaystrytomaintainanuprightposture,maintainingthenaturethoracickyphoticandlumbarlordodiccurves.Forinstance,bypositioningyourchairclosertothepatient,youcanminimizeforwardbendingoverthepatient’shead.Yourheadcanbeasheavyasabowlingball,andwhenyouleanandflexyourheadforward,youforceyourneckextensormusclestoworkexcessivelytoholduptheweightofyourhead.Itisalsoimportanttopositionthelightbeamsoyoudon’thavetostrainyourneckexcessivelywhenyoulookintothepatient’smouth.Positionyourinstrumenttrayclosetoyousothatyoudonot
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havetooverextendyourselftoreachforyourhandpiecesorinstruments,thusputtingexcessivestressonyourback,shoulders,andarms.
Alternateworkpositionsbetweensitting,standing,andsideofpatient.Switchingpositionsallowscertainmusclestorelaxwhileshiftingthestressontoothermuscles.Furthermore,itisadvisabletotakefrequentbreaks,especiallyifyouhavetositforaprolongedperiodoftime,evenifitisonlyforshortperiodoftime,togetupandmovearoundorevendosimpleexercisessuchasretractingyourscapulaeasyouawaitanaesthesia,settingofmaterials,etc.
Lifestylechanges
Choosingsupportivecervicalpillowsisveryimportantsincewespendaboutathirdofthetimeofthedaysleeping.Thistimecanbeusedtohelpyourneckposturewiththeproperneckpillowsupport.Pillowsthataretoosoftandtoolargecancauseproblems.Tosupportyourneck,yourheadshouldrestonasmall,hardpillow.Furthermore,toavoidneckandbackpain,itisimportanttoselectagoodmattressthatsupportsyourbody,iselasticateverypointanddoesnotsinkinunderthepelvis,shoulderorhead.
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Practicaladvicesfordentistswithneckpainandforwardheadposture
Introduction
Exercisesareimportantbecauseinter-vertebraldiscscontainnobloodsuppliesandtheyderivetheirnutritionbydiffusioncausedbycompressionanddecompression.Thelongeryousitorstandwithoutmovingorchangingyourposture,theworsethisisforthedisks.
Atthispoint,itisimportanttoemphasisethatyoushouldproperlywarmupyourentirebodypriortoanyexerciseandstretches–thisensuresthatallyourmuscles,joints,tendonsandligamentsyouwanttotrainarewell-suppliedwithbloodandadequatelyprepared.Awarm-upmuscleismore‘elastic’andaloosenedjoint(onethatisadequatelylubricatedwithsynovialfluids)areabletohandlemorestressandlesssusceptibletoinjuries.Itcannotbeoveremphasizedthatcorrectiveexercisesshouldbeperformedinapain-freerangeofmotion.Ifyouexperiencepainwhenperformingtheseexercisesyoumustconsultyourexerciseprofessional,doctororphysiotherapist.
Strengtheningexerciseforthedeepneckflexors:
Sinceweaknessesofthedeepneckflexorsiscommonlyassociatedwithneckpain(similartoweaknessofthetransversusabdominisiscommonlyassociatedwithlowerbackpain),thereareanumberexercisesthatcanbedonetore-activethesetinymuscles.Itisimportanttobeawarethatitistheforwardheadposturethatcontributestodeepneckflexorweakness.Forthisreason,apartfromdoingstrengtheningexercisesforthedeepneckflexors,itisimperativetodevelopgoodposturalhabitsforthenormalfunctionoftheneckandshouldergirdles.
Neckflexorscanbeactivatedbysimpleheadnoddingmotions(chin-tucks),i.e.bymovingthechinclosertothethyroidcartilage(‘Adam’sapple’).Thiscanimproveboththestrengthandenduranceofthesedeepmuscleswhichcanimproveyourposture,thebiomechanicsofyourneck,shouldersandupperlimbs.
Teachingpointsofchintuck:Standagainstawallsotheretractionoftheheadisjustuntilittouchesthewall.Holdthiswhilebreathingnormallyfor10secondsandrepeatthis12-15times.Progression-hold
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forlongerasyoubecomestronger.Youshouldalsofeelsomestretchinginthemusclesatthebackofyourneckatthesametime.
Correctiveexercisesforhyperkyphosis
Dentalprofessionalswithhyperkyphoticpostureshouldavoiddoingexercisesthatcausefurthertighteningofyourpectorals,suchaschestpresses,pressupsandbiking.Pleaseberemindedthathyperkyphosisisduetomuscleimbalances–tightnessofthepectoralsothesemusclesneedtobestretched.Theweakenedbackmuscles(middletrapeziusandrhomboids)needtobestrengthened.
Examplesofstrengtheningexercisesforthemiddletrapeziusandrhomboids:
• Seatedrow
• Single-armdumbbellrows-Holdingadumbbellinyourrighthand,placeyourlefthandandleftkneeonabench.Holdtheweightwithyourarmstraight.Useyourupper-backmusclestopullthedumbbellupandbacktowardyourhip.Pause,andthenslowlylowertheweight.Pulltheweightupsoyourelbowpassesyourtorso.
• Reversefly-usingasetoflightweightdumbbells.Sitontheendofaweightbenchwithyourbackstraightandyourcoremusclesengaged.Leanforward,bringingyourchestoveryourknees.Liftbotharmstoshoulderlevel,squeezingtheshoulderbladestogether.Loweryourarmsdownoneithersideofyourbody.Whenperformingthisexercisemakesurethatyourelbowsareslightlybentandyoudonotraiseyourarmshigherthanshoulderlevel.
Anexampleofpectoralstretch:
• Standinadoorwayornexttoawall.• Bendthearmbeingstretchedat90degreesandplacetheforearm
flatagainstthewallordoorframe.• Stepforwardsandrotateyourbodyawayfromyouroutstretched
arm
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• Holdforbetween10and30seconds.
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Conclusions
Itisadvisablethatifyouareconcernedwithyourneckpain,orifyouarenotsurehowtogetstartedwithaneckexerciseprogram,consultwithyourdoctor,exerciseprofessionalorphysiotherapist.Theywillcarryoutafullposturalassessmentforyouanddeviseabespokerectificationprogrammeforyouaswellasgivingyouguidanceintheexecutionoftheselectedcorrectiveexercises.Theauthorisnotmedicallyqualifiedandisnotattemptingtoofferyouanydiagnosisortreatment;heisprovidingyouwithasimplisticoverviewofmusculoskeletalneckpainpurelyfromtheperspectiveofanexerciseprofessionalandtheviewsexpressedinthisarticleshouldnotbeconsideredasorsubstitutemedicalopinions.
Onlyalimitedvarietyofcorrectiveactivitiesforposturaldysfunctionsthatpredisposetotheneckpain(strengtheningexercisesandstretches)havebeenmentionedandthereareplentyofalternativesavailable.Itisclearlybeyondthescopeofthisarticletodescribethefulllistofactivitiesandthedetailexecutionofeachoftheseexercises.Theobjectiveofthispieceofworkistosimplyhighlighttheharmfulconsequencesofpoorposturetotheneckandthelowerbackduetothepractiseofdentistryandsomeofthewaystocounteracttheseadverseeffects.Itisimperativethatyouengagethecorrectprofessionaltogiveyouadviceandguidancetoensurethatthecorrectactivatesarebeingchosenforyourparticularsituation.Itmustbeemphasisedthatexcisesalonearenotadequate,wemustalsotrainourbodiessothatwecanrecognisewhenweadoptpoorordangerousposture.Ifyourequireanyfurtherinformation,pleasegetintouch–[email protected]
