Chronic back pain

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chronic back pain
Being aware that as humans we were never meant to sit in a rigid position all day is key to  combatting chronic pain. Photography: Marcin Balcerzak – 123RF

Chronic back pain is endemic in the dental profession. Former dentist Dr Penelope Jones knows why—and how to fix it. By Sue Nelson

Dr Penelope Jones knows dentistry well—and she recognises the chronic pain associated with hunching over patients all day, both as a clinician, and now, as an expert who works with dentists to help free them from work-related pain and discomfort.

Dr Jones was a general dentist, and then an endodontist, for over two decades, before she started working to relieve chronic pain in dentists through her workshops, Working Posture

“People came in to see me because they had pain, but I was also in pain,” she recalls. “I had constant pain in my upper back and neck, and headaches.” Some research into a range of modalities that might explain and treat this ongoing pain told her that there was a better way. Crucially, she discovered that neuroplasticity from the Feldenkrais method, which is a physical relearning process that includes how we think and feel, and the patterns we form around these thought processes, might hold the answer. 

A bad car accident compounded Dr Jones’s pain and strengthened her resolve to find answers.

“When we grow up we learn how to move by interacting with the environment,” she says. “We start to build up more complex patterns of moving, thinking and feeling, based upon what we learn about the environment we interact with.

 “If you have an accident during this time of development, the muscles brace around that area to stop you from moving it until it gets better. But those holding patterns can get programmed into your nervous system—plumbed into your neurological development.” 

People came in to see me because they had pain but I was also in pain. I had constant pain in my upper back and neck, and headaches.

Dr Penelope Jones, Feldenkrais practitioner

These ways of moving, designed to protect us from pain or injury, start to get in the way of good and effortless functional movement. We unconsciously activate these muscles and they keep our bodies in this holding pattern. These are often the muscles that become tight and cause pain.

Forming bad habits

For dentists, the journey begins at dental school, where bad posture becomes habituated and hardwired into the way they move. From there, years of practice can lead to chronic pain.

Common posture complaints from dentists stem from the focus and concentration they need to do their jobs well. “One of the things that happens when you’re concentrating very hard is that you hold your breath and constrict your diaphragm—the torso becomes tight,” Dr Jones says.

“Core muscles become affected. The pelvis moves into slouching, and you completely lose support of the spine. Certain muscle groups try to correct for this lack of support but they eventually become tired and painful.”

Commonly, these muscular issues result in upper back, neck and shoulder problems. In her Working Posture workshops Dr Jones helps clients to become aware of their pelvis—if it is slouching, this causes muscle tension further up the torso. 

The ‘startle reflex’ 

Another thing that causes chronic tension comes from an old neurological reflex called the ‘startle reflex’. When we are shocked or very stressed it is activated. It causes shoulders to tighten and rise up and creates tightness in the chest as well. Stress activates this reflex unconsciously and raising the shoulders. 

“When your shoulders are raised they become tight and eventually spread to the rest of your body. They’re not helping you to do the work—they’re impeding you. If you learn how to use your body well you actually get stability rather than rigidity.” 

When your shoulders are raised they become tight and eventually spread to the rest of your body. They’re not helping you to do the work—they’re impeding you.

Dr Penelope Jones, Feldenkrais practitioner

Dr Jones teaches dentists how to organise the pelvis so that the spine is balanced and the muscles don’t have to work hard to hold you up. “It’s about finding the sweet spot,” she says.

In the lessons of Working Posture Dr Jones encourages her clients to slow their bodies down, encouraging them to move differently and experience where those long-term holding patterns are located in the body. “I take them through better patterns of movement,” she says.  “You identify those old patterns that have become like a neurological strait jacket and pull you out of good alignment, and learn better freer movements that with awareness can becomes normal and easier to do.”

Aim for prevention

Dr Jones derives enormous satisfaction from helping dentists to reprogram their bodies. “I’ve got dentists back to work,” she says. “It’s a modality which helps you improve the way you sit and the way you function, but it’s up to the individual and their own good alignment and stability.” She acknowledges that we humans were never meant to sit in a rigid position all day long—an awareness of this limitation is key to combatting chronic pain. 

Like most solutions to pain, prevention is so much more important than cure. It involves understanding your body and moving well. “You can go to the gym and exercise, but that pattern will always come back until you learn to recognise it,” Dr Jones says. “We use the same thing for those who don’t have pain as for those who already have the problems. It’s a learning modality—becoming more aware of how you do what you do.”

How far can ergonomic technologies assist dentists with better posture? “If you have ergonomically good chairs etc, it does make it harder for you to activate those old restricted patterns,” says Dr Jones. “but it’s not always the full answer—you can sit badly in the best of chairs.” 

Dr Jones aims to ensure that dentists’ posture is so supportive and correct that they don’t need such supports: “I look at the structure and function of your body to get it to the most ideal position so that you can work on an ordinary flat chair.” 

Dr Jones is delivering a one-day conference for dentists on 4 April in Sydney. Find out more at www.adansw.com.au/CPD/Courses.aspx  

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