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Out of balance: Workplace postures, along with digital devices, wreak havoc on clinicians' bodies

Nov. 15, 2016
Anne Guignon, RDH, notes how digital devices influence workplace postures in dentistry.

By Anne Guignon, RDH, MPH, CSP

One key principle in assessing a workspace from an ergonomic perspective is the ability of a worker to perform tasks using a neutral body posture. A neutral body posture creates the strongest, most stable position for the body's spine, bones, discs, muscles, ligaments, and tendons.

Imagine looking at a side view of a person standing upright. Now draw a straight line from the top of their head through the tragus of the ear down through the middle of the shoulder, hip, and the ankle. This is the image of a neutral body posture.

In neutral posture, the head is balanced on the spine, which fully supports the weight. The average female head weighs around nine pounds, which is the only a few ounces more than a gallon of water. Men's heads typically weigh around 12 pounds. Visualize a bowling ball perched on the end of a stick. The spine and torso muscles are designed to support the weight of the head effortlessly. But this only works as long as we keep our head upright, which is an impossible task for all clinicians. Hygienists, dentists, and assistants are all challenged every time we deliver treatment.The business staff is challenged as well when seated at a desk.

Around 50 years ago, sit down dentistry became popular. Dental professionals all over the planet were soon sitting down for most of the day. Initially, it was thought that sitting would prove less stressful to workers, but the exact opposite happened. Clinicians who used to move around the patient now leaned forward to reach the workspace, often with hunched shoulders, twisted torsos, and heads bent forward and rotated, just to work in the patient's mouth.

Since the very nature of most clinical procedures involve moving forward to reach the patient's oral cavity, our positioning creates horrible stress on the clinician's body. Along with awkward, non-neutral body postures, we tend to sit in static postures for long periods of time doing forceful, repetitive procedures. In addition, it was found that seated clinicians took fewer breaks.1

Ergonomists suggest that postures that are within zero to 20 degrees from neutral positioning create the least stress on the upper body musculature and skeletal system. In today's world, it is entirely possible to create a workspace that allows us to work within this range. But we need the assistance of properly fitted magnification loupes with the correct working distance and declination angle as well as a seating system, such as a saddle, that allows us to sit both higher and closer.2

Modern Challenges

Modern lifestyles now include postural risk factors that were unheard of 25 years ago. Cell phones,3-6 computers,7-10 tablets,11-13 backpacks,14 and large, heavy purses are now considered a normal part of everyday life. The stress that these devices and items creates on our bodies is not only dangerous, but measurable. The number of scientific studies about effects of these products on the human body grows larger every day. 3-14 It is quite disconcerting to read studies that describe the impact to the human body using terms like "forward head posture syndrome," "texting neck," and "Blackberry thumb."7,8,12 Most of the research has been conducted on adolescents and young adults and the results are discouraging.

The muscles in the neck, shoulders and upper back are subjected to the force of 49 pounds when the head is positioned forward using a 45-degree head tilt. The actual impact is a physics calculation that takes into account the weight of the head, the length of the head from the top to the bend, and the forward flexion angle. This formula does not include the actual time spent in a compromised posture. People constantly check their mobile devices throughout the day. Take a look at the crazy head postures or have a friend take a photo of where you position your head when you're checking emails, texts, or chatting on your device.3-6,15

Over time, these postures can contribute to neck and shoulder pain,3-5,7,8,10,13 as well as headaches. In addition, device use:

  • Plays a role in distracted driving, walking, and patient care18-20
  • Plays havoc on our gait changes the center of gravity21-23
  • Can lead to addiction,24,25 depression,26 and sleep disturbances.27

The cervical portion of the spine can also be remodeled, resulting in loss of a healthy cervical spinal curvature. Slouching leads to rounded shoulders that compromises blood flow to internal organs and reduces breathing efficiently as much as 30%.28,29

Learn to use a pair of properly fitted loupes. Add a saddle that fits your torso, will keep your spine in line, positions you closer to the patient, and facilitates deep, healthy breaths.

Put your devices on a counter or table at eye level. Use an easel to decrease the screen angle. Have a real conversation with a friend or colleague rather than sending another email or text. Find a Bluetooth headset that works with your cell phone. Use a stylus to type on a cell phone, and slow down the rate and compression on the thumb when typing on those super small screens.

Add the physical impact of practicing dental hygiene to the time spent on the combined number of devices we all use every day. When you factor in the total hours spent working in a dental office and using devices, it is clear that dental professionals are at substantially increased risk for developing potentially life-altering conditions that can have a profound impact on your daily life and your ability to earn a living.

Just like most of you, I, too, have a full array of modern devices. But I strive to work with them, using the least damaging posture possible. It's unrealistic to expect people to quit using devices or to quit working. However, more than ever before, we need to take responsibility for the impact on our bodies and make appropriate adjustments to how we work and how we communicate with each other. RDH


1. Valachi B, Valachi K. Mechanisms leading to musculoskeletal disorders in dentistry. J Am Dent Assoc. 2003 Oct;134(10):1344-50.
2. Valachi B, Valachi K. Preventing musculoskeletal disorders in clinical dentistry: strategies to address the mechanisms leading to musculoskeletal disorders. J Am Dent Assoc. 2003 Dec;134(12):1604-12.
3. Kim SY, Koo SJ. Effect of duration of smartphone use on muscle fatigue and pain caused by forward head posture in adults. J Phys Ther Sci. 2016 Jun;28(6):1669-72.
4. Lee S, Kang H, Shin G. Head flexion angle while using a smartphone. Ergonomics. 2015;58(2):220-6.
5. Xie Y, Szeto GP, Dai J, Madeleine P. A comparison of muscle activity in using touchscreen smartphone among young people with and without chronic neck-shoulder pain. Ergonomics. 2016 Jan;59(1):61-72.
6. Lee S, Kang H, Shin G. Head flexion angle while using a smartphone. Ergonomics. 2015;58(2):220-6.
7. Nejati P, Lotfian S, Moezy A, Nejati M. The study of correlation between forward head posture and neck pain in Iranian office workers. Int J Occup Med Environ Health. 2015;28(2):295-303.
8. Nejati P, Lotfian S, Moezy A, Moezy A, Nejati M. The relationship of forward head posture and rounded shoulders with neck pain in Iranian office workers. Med J Islam Repub Iran. 2014 May 3;28:26.
9. Peolsson A, Marstein E, McNamara T, Nolan D, Sjaaberg E, Peolsson M, Jull G, O'Leary S. Does posture of the cervical spine influence dorsal neck muscle activity when lifting? Man Ther. 2 014 Feb;19(1):32-6.
10. Kang JH, Park RY, Lee SJ, Kim JY, Yoon SR, Jung KI. The effect of the forward head posture on postural balance in long time computer based worker. Ann Rehabil Med. 2012 Feb;36(1):98-104.
11. Chiou WK, Chou WY, Chen BH.Notebook computer use with different monitor tilt angle: effects on posture, muscle activity and discomfort of neck pain users. Work. 2012;41 Suppl 1:2591-5.
12. Young JG, Trudeau M, Odell D, Marinelli K, Dennerlein JT. Touch-screen tablet user configurations and case-supported tilt affect head and neck flexion angles. Work. 2012;41(1):81-91.
13. Chiang HA, Liu CH. Exploration of the associations of touch-screen tablet computer usage and musculoskeletal discomfort. Work. 2016 Mar 10.
14. Mosaad DM, Abdel-Aziem AA. Backpack carriage effect on head posture and ground reaction forces in school children. Work. 2015;52(1):203-9.
15. Gustafsson E1. Ergonomic recommendations when texting on mobile phones. Work. 2012;41 Suppl 1:5705-6.
16. Fernández-de-Las-Peñas C, Cuadrado ML, Pareja JA. Myofascial trigger points, neck mobility, and forward head posture in episodic tension-type headache. Headache. 2007 May;47(5):662-72.
17. Tali D, Menahem I, Vered E, Kalichman L. Upper cervical mobility, posture and myofascial trigger points in subjects with episodic migraine: Case-control study. J Bodyw Mov Ther. 2014 Oct;18(4):569-75.
18. Dossey G.Digital Devices and distracted doctoring. Tex Dent J. 2015 Apr;132(4):244-9.
19. Papadakos PJ. Electronic distractions of the respiratory therapist and their impact on patient safety. Respir Care. 2014 Aug;59(8):1306-9.
20. Weksler ME, Weksler BB. The epidemic of distraction. Gerontology. 2012;58(5):385-90.
21. Agostini V, Lo Fermo F, Massazza G, Knaflitz M. Does texting while walking really affect gait in young adults? J Neuroeng Rehabil. 2015 Sep 22;12:86.
22. Nurwulan NR, Jiang BC, Iridiastadi H. Posture and texting: Effect on balance in young adults. PLoS One. 2015 Jul 31;10(7):e0134230.
23. Lamberg EM, Muratori LM. Cell phones change the way we walk. Gait Posture. 2012 Apr;35(4):688-90.
24. Lopez-Fernandez O, Honrubia-Serrano L, Freixa-Blanxart M, Gibson W. Prevalence of problematic mobile phone use in British adolescents. Cyberpsychol Behav Soc Netw. 2014 Feb;17(2):91-8.
25. Babadi-Akashe Z, Zamani BE, Abedini Y, Akbari H, Hedayati N. The relationship between mental health and addiction to mobile phones among university students of Shahrekord, Iran. Addict Health. 2014 Summer-Autumn;6(3-4):93-9.
26. Ghasempour A, Mahmoodi-Aghdam M. The role of depression and attachment styles in predicting students' addiction to cell phones. Addict Health. 2015 Summer-Autumn;7(3-4):192-7.
27. Sahin S, Ozdemir K, Unsal A, Temiz N. Evaluation of mobile phone addiction level and sleep quality in university students. Pak J Med Sci. 2013 Jul;29(4):913-8.
28. Wirth B, Amstalden M, Perk M, Boutellier U, Humphreys BK.
Respiratory dysfunction in patients with chronic neck pain - influence of thoracic spine and chest mobility. Man Ther. 2014 Oct;19(5):440-4.

29. Dimitriadis Z, Kapreli E, Strimpakos N, Oldham J.Respiratory weakness in patients with chronic neck pain. Man Ther. 2013 Jun;18(3):248-53.

ANNE NUGENT GUIGNON, RDH, MPH, CSP, provides popular programs, including topics on biofilms, power driven scaling, ergonomics, hypersensitivity, and remineralization. Recipient of the 2004 Mentor of the Year Award and the 2009 ADHA Irene Newman Award, Anne has practiced clinical dental hygiene in Houston since 1971, and can be contacted at [email protected].