By Cathy Mook, RDH, NTP, RYT
Figure 1: The placement of the Roll Model Therapy ball is on the supraspinatus muscle.
Figure 2: The placement of the Roll Model Therapy ball is on the infraspinatus/teres minor muscles.
A career in dental hygiene will inevitably land you in the office of a chiropractor, or several sessions of physical therapy, or perhaps weekly trips to a massage therapist. Maybe you're popping NSAIDs to diminish your pain. Holy liver toxicity!
All of these solutions are temporarily beneficial in making you feel better, but at what cost?
Pain certainly affects your wallet, our health-care system, career longevity, and your personal activities outside of the office-not to mention your overall well-being physically, emotionally, and mentally. When we are in pain, it affects all aspects of our lives.
As a dental hygienist, I spent a great deal of time seeking all types of treatments without a positive outcome. I made the decision to leave private practice. I took a position as a certified public health dental hygienist in a local school district, where I assist and help coordinate the program. I began to focus on nourishing my body through a clean diet, functional movement, and became certified as a nutritional therapist and a Yoga Tune Up teacher.
Yoga Tune Up (YTU), which was created by Jill Miller, is a blend of yoga, breath work, therapeutic self-massage techniques, and corrective exercise principles combined with various stretching modalities designed to highlight joint mobility and stability. The results are immediate relief from chronic tension, increased power through a greater range of movement, increased strength, and healthy joints. I so wholeheartedly believe in my new adventure that I decided to bring YTU to the dental profession through workshops offered both in the office and out.
The repetitive motions, static positions and the sitting required in the dental field are all a recipe for disaster for our musculoskeletal systems. This system consists of the bones, cartilage, muscles, joints, tendons, and ligaments-all of which provide form, support, stability, and movement to the body.
Musculoskeletal disorders (MSD) are injuries of the muscles, nerves, tendons, joints, and cartilage. Unfortunately, MSDs in dental hygienists are quite common and the majority of the symptoms occur in the upper back, neck, and arms. The prolonged exposure to repetition, force, vibration, and awkward postures contribute to these injuries. Yeah, you aren't kidding that your body resembles a pretzel as you excavate into the oral cavity for tenacious calculus on your third periodontal patient of the day! Whew! Those poor exhausted shoulders of yours, always elevated, and ready for duty.
YTU uses the Roll Model Therapy (RMM) Balls of various sizes that are grippy, pliable, portable, and affordable. They can be used from head to toe. Some come tote-bagged and can be used in and out of the tote, targeting just the right muscles and getting into areas that foam rollers cannot reach. They won't resolve every ache and pain you encounter, but they provide the ability to handle a wide range of myofascial issues. The goal is to keep you out of the doctor's office and ward off future problems.
The therapy balls empower you to take your care into the palm of your hands, eradicate your aches and pains, and re-form your body from the inside out. They give you enormous potential for healing and fixing the issues in your tissues. Therapy balls awaken your body's sense of awareness, and help identify your body's blind spots. Those blind spots are areas that are overused, underused, misused, and abused.1
The Layer of Fascia
The balls also function to keep the fascia supple. Fascia is a thin, strong, stretchy web of connective tissue that supports us and keeps us stable. It is a three-dimensional web that connects us from head to toe. I know what you're thinking: "I thought the skeleton supported us and kept us stable." Think back in school to your classroom skeleton in anatomy class. Sir Bone Apart was held together by wires; he was missing his fascia. Every structure in the body-organs, muscles, nerves, and blood vessels-is covered in a layer of fascia.
Fascia connects bone to bone and assists the body to move with ease, much like the oil in your car's engine. It allows everything to run smoothly and the soft tissue layers to glide upon one another. If the fascia fibers are healthy and hydrated, our body works better. When we overly stress the muscles with habitual poor posture, repetitive movements, or other trauma, the body starts to re-form into that shape, which, in turn, causes the fascia to lose its elasticity. The range of motion shrinks, and layers of fascia can be torn.
When these tears don't heal properly, the various layers of fascia in the body can adhere together in spots called adhesion. These "trigger points" cause pain and discomfort, and restrict proper blood flow and nutrients to the area. Trigger points keep your muscles from working the way they should, which keeps your body from living up to its full potential and inhibits natural movement. Trigger points maintain a hard contraction in the muscle fibers, often causing symptoms in adjacent joints and muscles.
When you roll with the YTU balls, you stretch stiff and overtight tissues, improving the flow of fluids and body mobility. Muscle strength comes back quickly when trigger points are deactivated.1
Part of our job as dental hygienists is to provide oral hygiene instruction to our patients to educate them about proper dental care. We too need to do a little body hygiene on ourselves to release the "boulders in our shoulders" and to loosen the "noose in our neck" from hours bent over patients. Those boulders are trigger points/knots (our calculus of the body).
Yoga Tune Up Therapy balls are rubber instruments (scalers) used to remove that area of tension in the body. YTU therapy balls fit right into the pocket of your scrubs, readily available to roll out areas of the body that are tense, tight, or sore. The balls give you on-demand pain relief wherever you are. All you need is a little wall space, counter top (hands, forearms), or a door jamb, and you're set to roll between patients, at lunch, or after work.
My hope is for all dental professionals to be able to carve out a little time in their workday for some body rolling. These self-massage movements will rejuvenate you throughout your day by improving posture, eradicating pain, and enhancing work performance.
Let's explore a few shoulder muscles using YTU therapy balls. We will begin with the supraspinatus muscle. It is one of the four muscles of the rotator cuff. It is located at the top of the shoulder above the scapular spine (bony protrusion on the scapula). It runs from the medial border of the scapula to the outer side of the top of the humerus (arm bone). This muscle assists in abduction of the shoulders, moving the arms out to the side.
Many hygienists suffer from supraspinatus tendinitis. This muscle becomes exhausted due to static contraction while performing dental treatments without any elbow support. Referred pain can be on the outside of the shoulder and outer elbow (tennis elbow). Some outside activities can additionally cause strain, such as working with the arms overhead for long periods (painting) or walking an eager dog on a leash.
An easy way to locate this muscle is to cup the left hand placing the heel of the left hand on the right clavicle. Your finger pads will be resting on the supraspinatus muscle. If you reach your right arm out to the side you will feel the muscle bulge into your fingers.
Place your YTU therapy ball there. The first technique is “sustained compression” (applying consistent pressure) of the ball into the muscle against the wall. At this time, you might think of the balls as internal eye balls (much like dental X-rays for the mouth), scoping the area for an adhesion, trigger point, or area of tense tissue (see Figure 1).
We are looking for a “tolerable discomfort” coupled with slow, deep abdominal breaths to aid the balls in releasing the tension in the muscle. Applying consistent pressure sends a message to the muscle spindles to release the grip on the tissue. Hold the position for 90 to 120 seconds.
We will then move to “stripping.” This is done by sliding the ball side to side along the grain of the muscle (from the base of the neck out to the shoulder), much like combing out fine knots from tangled hair, lengthening the myofascia from end to end. This brings back the resting length of the muscle.
The next technique is “cross fiber,” rolling the ball up and down, going against the grain of the muscle. This breaks apart the dehydrated adhesions and stimulates the production of collagen, reestablishing healthy fascia.
Moving south of the scapular spine (bony protrusion on the scapula) is the infraspinatus muscle. It is a thick, triangular muscle that covers all of the shoulder blade. The muscle originates at the infraspinous fossa of the scapula. At its outer end, the infraspinatus inserts at the greater tubercle of the humerus.
Right below the infraspinatus is the teres minor. It runs from the upper two-thirds of the lateral border of the scapula and attaches posterior to the humerus. Together, these muscles give the ability to rotate the arm outward and stabilize the shoulder joint. The infraspinatus is one of the most frequently afflicted muscles of the body. Jobs that require keeping the arms overhead (painters), out in front, or winged out without elbow support (dental hygienists) for long periods of time are very abusive to this muscle (see Figure 2).
Symptoms of infraspinatus pain will most often present itself elsewhere other than on the muscle itself. The most common source of referred pain is in the front of the shoulder and may travel down the biceps. Pain can shoot down the outside of the shoulder, as well as the back of the neck, inner border of the shoulder blade, down the upper arm, the forearm, and even into the thumb.
You could spend many hours rubbing these areas (especially the front of the shoulder) with no relief, when your attention and healing would have been better spent on the infraspinatus muscle itself. The longer the discomfort continues, the more weakness and stiffness occurs in the shoulder and arm. The internal and external rotation of the shoulder is restricted, causing other muscles to tighten in an effort to compensate, which tends to overload them too. This can lead to a condition called “frozen shoulder.” Once something in the body gets out of whack, it is a slippery slope.2
Again, YTU Therapy Balls to the rescue! Since the infraspinatus muscle is on the outside of the shoulder blade, it is an easy muscle to treat with self-massage. To position the ball, take the ball into your left hand (as we will work on the right side) and bring the ball under your right armpit to the outer edge of the scapula. Lean your weight into the ball up against the wall, locate the trigger point, holding sustained compression for a second or two. Allow the ball to sink into your tissue, coupled with deep breathing to release the tension to create a “ball sandwich” with your body pressure and the wall.
Now move the arm that is close to the pinned area in every direction. This technique, called “pin and stretch,” has the ball tack down the tissue in place while the nearby joint movements will pry apart and loosen the myofascial fibers that are under the ball. After removing the ball from each area you roll, pause for a breath or two to let the integration of your self-massage take effect.
This article is an introduction to Yoga Tune Up Therapy Balls and the benefits to the dental community. The entire body can be rolled out from head to toe! I recommend rolling daily. You can feel a change in as little as two minutes. Not only does ball-rolling erase pain and enhance mobility, it also helps to relax the body. The balls help you find your tension and hopefully give you a little reprieve from the outside world. So keep some Yoga Tune Up balls in your good-health tool box. I’d encourage you to visit www.yogatuneup.com to find a teacher and Yoga Tune Up classes in your area.
You will feel un-ball-ievable! RDH
Cathy Mook, RDH, NTP, RYT is a certified nutritional therapy practitioner and a certified Yoga Tune Up teacher. She can be contacted at [email protected].
1. The Roll Model by Jill Miller. p 293.
2. The Trigger Point Therapy Workbook by Clair Davies, NCTMB, with Amber Davies, NCTMB