Dr. John Besharse on injury prevention, ergonomic fluidity, and why dental professionals need to stop chasing perfect posture

This month, we're breaking down on how to do dentistry right without taking a toll on your body. The tips from Dr. John Besharse may surprise you.

quip: Many dental professionals don’t think about physical therapy until they’re already in pain. What are the earliest signs that something is off ergonomically?

Dr. John Besharse: It’s different for everyone, but there are some common denominators such as  slight muscle fatigue, needing to stretch often, aches or strains on one side of the body, holding your breath, fine motor fatigue, procedures that use to be of no issue and now are showing signs of difficulty - anything that takes your mind off the procedure at the moment.  

quip: From your perspective, what are the most common musculoskeletal injuries you see in dental professionals? What causes them?

Dr. John Besharse: Research shows various injuries occur due to repetitive strain and or static postures. Some common injuries that can be seen include carpal tunnel syndrome, shoulder impingement, non-specific low back pain, neck pain, rotator cuff pathology, and cervical disc herniation/lumbar disc herniation.  

quip: If a hygienist or dentist could fix just one thing about their ergonomics tomorrow, what would make the biggest difference?

Dr. John Besharse: Be fluid in your ergonomics. Know that perfect ergo isn’t to be sustained all day, every hour. Perform a micro activation reset immediately after a long procedure. There are various forms of ergo. I don’t like to think of ergo as a static perfect position. This way of thinking creates a 2 dimensional perception when we are 3 dimensional people. It also limits variability in which the body craves.  

quip: What role does operatory setup play in preventing injury, and what small adjustments can make a big impact?

Dr. John Besharse: Traditional ergo promotes “perfect” alignment of joints and static positions to reduce stress on joints, however static postures cause musculoskeletal strain. My suggestion is to understand the body is dynamic and try to be in optimal posture, but also be fluid in your posture. With that, I would say spinal alignment is of the utmost when it can be achieved, from a structural stand point.  

quip: How can practices better support ergonomics and long-term health for their providers?

Dr. John Besharse: Dental practices should have biannual or at least annual in-house chairsided ergo training. 

 

quip: You’ve said “dentistry is a static sport and your body pays the price.” Can you break down what that really means for providers day to day?

Dr. John Besharse: It means your body is made to move… It's dynamic and fluid. It’s 3 dimensional. Dentistry doesn't allow for large amplitude movements in the op. You have to combat that with movement and begin to adopt better habits to give you the best chance to prevent repetitive strain injuries. 

quip: What’s an ergonomics trend you’re seeing among dental pros that might actually be doing more harm than good?

Dr. John Besharse: Passive stretching of muscles, promoting static posture, and “perfect alignment” when “perfect posture” is virtually unachievable.