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Chronic pain from muscular imbalances: How to exercise correctly to avoid pain (part two)

Oct. 12, 2022
Lower back pain is extremely common in dentistry, but there are ways to reduce pain and avoid surgery. Brianne Novaes, CPT, explains how to correct muscle imbalances with appropriate exercises.

Editor's note: This is part two of a series. Read part one here.

Chiropractors seem to be the be-all and end-all when it comes to low back pain (LBP). Well, that or surgery, of course. Many dental pros suffer from LBP due to the nature of their work. As a certified personal trainer, I have worked with hundreds of clients over the years who suffer from LBP, are post-back surgery, or even have degenerative disk disease . . . and I can assure you there is another way. I am by no means a doctor, but often your LBP is stemming from somewhere else in the body. Pain is always the symptom, not the cause.

Back pain

Dental professionals who suffer from LBP know how debilitating it can be. It’s a fear that is constantly on the mind and impacts not only performance but also quality of life. LBP can be the result of muscular imbalances that alter both muscle length and strength of the surrounding muscles. For example, when most of the day is spent sitting in the operatory, the iliopsoas muscle, a muscle of the inner hip, becomes tight from being contracted and the glutes become long and weak from being disengaged or underused. In other words, this muscle imbalance is developed when certain muscles in front of the hip region become overactive while others, in the back of the hip region, become underactive. These are just some of the muscles that are included in a disorder referred to as lower crossed syndrome.

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What is lower crossed syndrome?

Lower crossed syndrome is a musculoskeletal disorder that is related to postural imbalances and is commonly found in dental professionals. It is characterized by an anterior tilt of the pelvis, which leads to an arched low back, also known as swayback. “Crossed” refers to the crossing pattern of the overactive muscles, which tend to be tight and short, with the counter crossing of the underactive muscles, which tend to be long and weak. The short and tight muscles include the erector spinae and the muscles of the hip flexor complex, and the long and weak muscles include the abdominals and the glutes. While exercising with lower crossed syndrome is possible, there are certain protocols that must be followed to correct these postural imbalances and avoid making them worse.

Tips for exercising with lower crossed syndrome

There are a couple of key rules to follow when exercising with lower crossed syndrome. First, keeping the core engaged is going to ensure that exercises are performed safely and efficiently while protecting the lower back. This can also be practiced when seated on a saddle chair during procedures. Proper engagement of the core is done by tightening the stomach as if you expect to be on the receiving end of a knockout punch and keeping the rib cage down. This will not only protect the low back but will also provide stability for the spine.

Second, tucking the tailbone and keeping a flat back will add additional protection to the spine during exercise. Since the core includes the low back, it’s important to focus on keeping the muscles engaged to take pressure off the lumbar spine. In lower crossed syndrome, the swayback is caused by the arching of the spine (figure 1). When weight is added during an exercise, the muscles should bear the weight, not the spine. Tucking the tailbone will reduce the swayback and keep the spine in a more neutral, safe position (figure 2).

Third, pay attention to breathing when exercising. When performing an exercise, inhale on the eccentric portion and exhale on the concentric portion. To elaborate, in a squat, an individual would inhale on the lowering portion of the exercise, the eccentric, and exhale as they stand up, on the concentric portion of the exercise. This is important because when you exhale, you increase core engagement. Over time this becomes second nature.

Strengthening to reduce LBP

With muscle imbalances, following the proper protocol will help reduce pain and improve posture. This first starts with using a foam roller or lacrosse ball to reduce tension in the overactive muscle. Second, stretch the overactive muscles to lengthen them since they are short. Third, activate the underactive muscles to prepare them for exercise. The last step is to integrate strength exercises to improve the body’s movement patterns. This will help the overactive and underactive muscles work together to correct this imbalance and reduce LBP.

In lower crossed syndrome, there are a few key muscle groups that need to be strengthened. One muscle group that requires strengthening is the abdominal complex. Performing core exercises will help strengthen the weak abdominal muscles and reduce or alleviate LBP. However, this does not include exercises such as crunches or sit-ups. Incorporating core exercises that work in different planes must be included to ensure all areas of the core are strengthened. Dead bugs, bird dogs, Pallof presses, and banded rotations are all great exercises.

The glutes are another group of muscles that are weak and require strengthening. The glutes are comprised of three muscles: gluteus maximus, gluteus medius, and gluteus minimus. It’s important to incorporate exercises that strengthen all three of these muscles. Having strong glutes will help stabilize the pelvis and reduce LBP. Exercises such as glute bridges, hip thrusts, step-ups, and banded lateral walks are all great for strengthening.

The hamstrings are also a key muscle group to strengthen in lower crossed syndrome. Like the glutes, the hamstrings are a muscle group that is long and weak due to prolonged sitting. Since the glutes are connected to the hamstrings, they both work together to support the low back. Therefore, having strong glutes and hamstrings is extremely vital for avoiding LBP.

The hamstrings are comprised of multiple muscles including the semimembranosus, semitendinosus, and biceps femoris long and short head. The good news is, there are many types of exercise that work the glutes and the hamstrings simultaneously. This includes exercises such as different deadlift variations and good mornings. These exercises tend to be more advanced, so it’s best to regress or modify the exercise and then work to progress.


While LBP is extremely common in the dental industry, there are ways to reduce pain and even avoid surgery. While chiropractor visits may seem to help temporarily, there is another solution. Just like your teeth have memory, so does your body. Without strengthening the appropriate muscle groups, the body will revert to the poor posture that it is used to. Strengthening the long and weak muscles will fix muscle imbalances to correct posture and reduce LBP for the long haul. 

Editor's note: This article appeared in the October 2022 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.