By Anne Guignon, RDH, MPH, CSP
Imagine spending your hard-earned time off from work in an emergency room trying to get relief from the worst neck and shoulder pain possible. That is how Vanessa spent a recent Saturday night. She started connecting with friends on Facebook, looking for a clue on how to relieve the pain. Three days later, still in pain, she started reaching out to the dental hygiene community on the internet. Here is her story:
"Anyone suffer from a pinched nerve/disc in neck? Ended in ER Saturday and had x-rays. This was my diagnosis along with some arthritis in the neck. I was put on prednisone and Valium. Today is a holiday and I cannot follow up with PCP and get an MRI ordered. What was your outcome? Any suggestions? My left shoulder blade and upper neck are very painful and finding a position to be pain-free is impossible. I'm not a patient patient. So hard to find a comfortable position. I want this gone and to never come back! I feel my failure was ignoring the need for loupes and leaning forward since 1998."
Comments started pouring in. Some talked about years of pain.Others talked about the surgical approaches they had tried, the injections they had, and some were successful and others were not. Hygienists suggested exercise, stretching, yoga, acupuncture, chiropractic treatment, deep tissue therapeutic massage, special pillows, cortisone shots, essential oils, heat, home traction units, and dry needling.
As the discussion continued, Vanessa began a process of self-discovery, saying:
"What's odd to me is that I've been mentioning my neck/shoulder pain for years prior to this episode. Even had an MRI and x-rays, and they never said anything about moderate neck arthritis or pinched anything. I find it hard to believe this is a new occurrence. I graduated in 1998 and find I do drop my head and turn to side to see various areas of the mouth. My posture had always been excellent but now at 46 my shoulders feel a bit more rounded forward. I'm praying for an MRI quickly and will do whatever it takes to get myself in order again. I do work five days per week, which is probably not ideal and need to get some loupes. It's amazing how much stress and strain our bodies endure in dental hygiene. I wish I had been more proactive about caring for myself when I entered the field back in 1998. In our 20s, we feel invincible. In our 40s, the oh-my-goodness eye openers kick in. I'm ready to do whatever it takes to give me 20 more years!"
Vanessa went on to describe her life, which is not any different than many other hygienists. She works five days a week clinically. She spends three of the days working at a community health center seeing a patient every 40 minutes, with only a 30-minute lunch, which often gets cut short.
The other two days a week she drives an hour each way to an office where she does get a longer lunch break. Vanessa has never used loupes, but she does have a saddle seat in one office. However, it is the wrong design for her body. So instead of offering relief, it is another issue.
She is a single parent with a teenage daughter. So she is a personal taxi service along with maintaining a house. She gets a couple of massages every year, stretches occasionally, and has not exercised regularly for a few years.
It was obvious that Vanessa was searching for answers: "Ibuprofen has been my go-to, but long-term I know its not good." She asked colleagues about their experiences with loupes and saddles, and she wanted to know how people fared with steroid injections and exercise routines. Vanessa asked if anyone had had a doctor provide feedback on ergonomic strategies to keep from feeling worse.
The internet makes it possible for people all over the plant to connect, share stories, and seek advice with a few keystrokes. Vanessa's simple question at the beginning launched dozens of comments about what others have gone through-slipped discs, osteoarthritis, ruptured discs, spinal fusions, disc replacements, bone spurs, trigger point injections, time off from work, relentless pain, epidural injections, and sleep disturbances.
Kathi, a seasoned hygienist in the Midwest shared her thoughts: "Posture is everything! I learned too late! After 35 years as RDH, I now have nine herniated discs (four in the neck, one in thoracic and four in lumbar) with spinal arthritis and bone spurs. I was told to quit dentistry, but I love my work so much. I've had physical therapy numerous times, exercise daily, go for deep tissue massage every other week and started working shorter work days. Trigger point injections at physiatrist help with flares in shoulder, under arms, and scapular areas. Fortunately, exercise, better ergonomics with a saddle chair, indirect vision, and shorter days have helped. Had one lumbar spine surgery 15 years ago but will not go that route again. Muscle relaxers at night help for a good night's sleep. I won't do pain meds. If I knew 35 years ago what I know now, I might not be in the spinal situation I am in today. Hopefully this article will help many."
Whether your body is starting to whisper warnings or screaming bloody murder, listen to the messages, and be prepared to make many changes over time.
The epidemic of cumulative trauma disorders in dentistry is downright shameful. I am a dental hygienist, not a physician, physical therapist, chiropractor, or any other type of health-care provider. I am not qualified to diagnose or treat any of the conditions these hygienists are reporting. But I do know the injuries so many of us go through could have been prevented or at least slowed down. We're not human scaling machines; we're people with bodies that need protection. It's time to quit sweeping the silent epidemic of occupational injuries under the rug. RDH
But I do know the injuries so many of us go through could have been prevented or at least slowed down. We're not human scaling machines; we're people with bodies that need protection.
Tips for reducing occupational pain
If you or a colleague is experiencing pain, muscle or joint aches, soreness, stiffness, please don't ignore what your body is telling you. Recognize that you've spent years getting to this point. It will take time to work through what has happened. Here are some step-by-step suggestions:
- Seek pain relief, but remember that medications or devices such a TENS unit are short term. Medications can relieve symptoms, but do nothing to get to the core of the problem.
- Get a thorough medical workup that includes a diagnosis.This will help avoid exacerbating what is already going on. Don't settle for an explanation that includes "You'll just have to live this way."
- Start a physical therapy program or personal conditioning program that is designed to stretch your muscles and ligaments. Work on strengthening your core. Yoga has done wonders for many, but there many other approaches as well. Pilates, tai chi are other examples.
- Consider noninvasive, alternative therapies like chiropractic, therapeutic massage, acupuncture, Alexander Technique, or stress reduction to reduce pain and allow you to proceed with a solid exercise/physical therapy program.
- Maintain a neutral body posture. Invest in equipment that reduces stress to your body.Consider adding loupes, a head light, or a saddle.
- Learn to work differently. Use your mirror more for indirect vision. Rearrange your workspace to minimize twisting, leaning, or awkward reaches.
- Analyze your work schedule. Are you working too many days, seeing too many patients, working without a break, or not having enough appointment time?
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].