The inevitability of neck and back pain (2023)

Are you doomed to a life of pain? Not if you take steps now.

By Jeff Carter, DDS

I am unaware of a retired dentist with 30 or more years in practice who has escaped debilitating neck and back pain issues during his or her career. I would also assume many retired practitioners continue to live with accumulated musculoskeletal damage in specific neck and back areas thanks to the stress of awkward dental operator positioning that is seen as essential to delivering quality dental treatment.

How is this possible with decades of advancements in equipment and clinical techniques? Unfortunately, an ergonomic contradiction in dental treatment delivery will exist until equipment configurations, optical/video systems, seating options, or delivery unit configurations are radically altered to allow operators to gain access to the oral cavity while maintaining neutral or balanced posture. In the last 30 years, loupes are the only significant ergonomic supporting device to impact dentistry. With the decreased teaching emphasis on four-handed dentistry techniques and ergonomics in dental schools, neck and back pain issues for all practitioners are equally if not more prevalent than 20 or 30 years ago.

A quick refresher on physics will help objectively define this issue. Most ergonomic injuries in dentistry result from counteracting torque for prolonged periods of time. Torque or “rotational force” occurs when a system becomes unbalanced (image above).

(Video) The Inevitability of Back Pain

The main culprit in torque generation as it relates to operator position is our own head. The human head is 8 percent of our total body weight. The average man’s head is 14 pounds and the average woman’s head is 11 pounds. For those who participated in diving or gymnastics, you fully understand the influence head weight and head position have on body movements. In the simplest terms, we all have a “bowling ball” affixed to the top of our spine.

In an effort to achieve a direct line of vision into the oral cavity, operators are required to lean or tilt forward in some manner. This is a delivery requirement even when using a mouth mirror and loupes, although both implements can decrease the degree of forward lean or tilt, which is helpful to reduce torque.

Two significant types of operator forward lean or tilt occur commonly in treatment delivery. The first type is often described as head declination with the fulcrum point positioned in the cervical area of the neck (below).

Torque, a rotational force, is measured in foot pounds (or newton meters for you scientific purists). For every second your “bowling ball” head is positioned in a 45 degree forward lean or tilt originating from the cervical area of your neck, 6.56 foot pounds of torque must be resisted to prevent your face from crashing into your chest (below). So what? Consider the following analogy - maintaining your head in this 45-degree forward tilt for 10 minutes requires muscular exertion equivalent to curling a 20-pound dumbbell 92 times!

(Video) Back Pain Facts & Myths

Torque due to forward head tilt is predominantly resisted by your erector spinae which originate on your sacrum and insert into the occipital notch on the back of your skull.

A second type of operator forward lean or tilt produces an even more dramatic comparison. It is common observe operators leaning forward from the pelvis as much or even more than 30 degrees to gain a more favorable vision line into the oral cavity. In this position, the torque formula distance component is greatly increased (below) and 18.62 foot pounds of torque must be resisted by lumbar region erector spinae.

Maintaining your head position in a full upper body lean or tilt of 30 degrees from the pelvis for 10 minutes requires muscular exertion equivalent to curling a 20-pound dumbbell 266 times or curling a 100-pound barbell 53 times!

(Video) Middle Back Pain? Strengthen Yo Shit!

Weightlifting and resistance training can be great exercise with many physiologic benefits. This is not the case with prolonged static contractions required to maintain common operator positions. In fact, prolonged static contractions of muscle groups (such as the erector spinae in the lumbar and cervical areas) can actually result in diminished blood flow into and out of an area due to compression and lack of dynamic movement. Reduced blood flow and prolonged periods of compression often lead to degeneration of muscle, skeletal, and nerve tissue in the affected areas.

Is it possible to practice dentistry in a neutral or balanced operator position and avoid the damaging health consequences of resisting torque? Not really - unless you can deliver treatment through a surgical microscope which allows you to sit in a neutral balanced position due to an optically repositioned vision line to the oral cavity. Younger endodontists are very proficient in the use of the microscope and will benefit greatly from the healthy positioning ergonomics associated with microscope usage. For the rest of the profession, routine use of a microscope during treatment delivery does not appear to be eminent.

If it is not possible for you to provide quality treatment delivery in a neutral or balanced posture, what can help you minimize the damaging health consequences of prolonged torque resistance?

• Assume a neutral or balanced posture at all times not requiring a direct vision line to the oral cavity. Many opportunities exist during treatment to allow back and neck muscles to relax as you await anesthesia, setting of materials, etc.

• Operator stool selection can help support your specific positioning requirements. The moment you lean forward in your stool and create torque, the entire body is subject to rotational force. Often “perpetual leaners” experience pressure points on the underside of their thighs, resulting in numbness and pain at the pressure point as well as lower leg and foot areas. Operator stools such as those manufactured by RGP and Brewer have a forward tilt built into the seat surface to more evenly distribute force along the hamstring area.

(Video) Relieve Back Pain Without Surgery | Ken Hansraj, MD on #IATE with Tami Simon #Backpain #painrelief

For operators with severe lower back pain, an armrest for the non-dominant hand is a good starting point to allow for a portion of the leaning torque force to be transferred from the lumbar region erector spinae and onto the elbow cup of the stool.

There is no magic stool that will eliminate neck and back strain associated with typical operator positions. It would take an operator stool with a chest pad and a chin rest to transfer the majority of the leaning torque stress currently resisted by neck and back muscles to the stool structure. These stools are in development and create many other side issues yet to be dealt with (as you can imagine).

• Dental patient chair selection is crucial as to how far you must lean to gain an acceptable vision line to the oral cavity. The traditional ironing board back dental patient chairs - such as manufactured by DentalEZ - are best for sliding closer to the patient and minimizing forward lean and tilt. The thicker-backed chairs push the operator farther away from the oral cavity and thus require more forward lean or tilt from the operator resulting in more torque and more muscular exertion. I often recommend the A-dec 500 Series chair as a good combination of thin back for operators and contemporary styling attractive to patients.

• Good operatory design can support and promote healthier ergonomic operator positions. For example, one aspect of good operatory design positions the oral cavity, delivery unit, and all supporting surfaces at the same height above the finished floor. This height is typically 30 to 32 inches and height synchronization creates a working plane that minimizes leaning and tilting movements.

• Exercise and physical therapy should be part of every dentist’s routine. Today’s physical therapy regimens are very sophisticated. You tell the therpaist where it hurts and he or she will design a series of exercises to strengthen and rehabilitate the damaged areas.

(Video) Fix Your Posture! Self-Assessment + Stretching (Back pain? Neck tension? Slouching? This is for you!

Awkward and torque producing operator positions resisted by prolonged static muscle contractions are the main occupational hazard to a dentist’s physical well being. If you were a fireman, this would be your time in the fire - get in there, do your job as professionally and successfully as possible, and then get the heck out of there.

Dr. Jeff Carter is co-owner of the Practice Design Group, based in Austin, Texas. PDG specializes in providing architectural, interior design and equipment, and technology integration services to dentists nationwide. Dr. Carter may be contacted by phone at (512) 295-2224, by e-mail at, or by visiting PDG’s Web site at


What is the main cause of back and neck pain? ›

In most cases, back and neck pain may have many different causes, including any of the following: Overuse, strenuous activity, or improper use, such as repetitive or heavy lifting. Trauma, injury, or fractures.

Is it inevitable to have back pain? ›

After seeing what back conditions can arise with age, you may think that back pain is inevitable as you get older, but that's not the case. Not everyone develops these age-related conditions.

When should I worry about neck and back pain? ›

Call your doctor if you have neck pain that: Worsens in spite of self-care. Persists after several weeks of self-care. Radiates down your arms or legs.

Can neck and back pain be serious? ›

Rarely, neck pain can be a symptom of a more serious problem. Seek medical care for neck pain with numbness or loss of strength in the arms or hands or for pain that shoots into a shoulder or down an arm.

How do you get rid of severe back and neck pain? ›

What can I do about acute back or neck pain?
  1. Take it easy. If you think you've hurt your back, ease up on the pressure you're putting on your back. ...
  2. Ice, then heat. ...
  3. Over-the-counter medications. ...
  4. Massage. ...
  5. Don't stop moving. ...
  6. Adjust your daily routine.

How do you fix chronic neck and back pain? ›

Nonsurgical Treatments for Chronic Back Pain
  1. Physical Therapy. Exercise is the foundation of chronic back pain treatment. ...
  2. Mindfulness and Meditation. Chronic back pain is straining both physically and emotionally. ...
  3. Diet. ...
  4. Lifestyle Modifications. ...
  5. Injection-based Treatments. ...
  6. Alternative Treatments. ...
  7. Pharmacologic Treatments.

Why do humans have so much back pain? ›

Humans are more commonly afflicted with spinal disease than non-human primates, and one widely discussed explanation for this is the stress placed on the spine by bipedal locomotion.

Is back pain all in the mind? ›

Study after study indicates instead that back pain is very often caused by our thoughts, feelings, and resulting behaviors. And an exciting new study now demonstrates that treatments aimed at our beliefs and attitudes can really help.

What happens if you ignore back pain? ›

If you ignore your back pain, it could become worse. If the pain goes away, it could easily return. But even in the absence of pain, your body could be experiencing stress, causing it to function poorly without you realizing it. This could cause you to get sick more often or make you more susceptible to injury.

What are red flags for neck pain? ›

Some More Specific Red Flags for Neck Pain:

Unexplained fever and chills. The pounding on the spine is painful. A chronic headache that abruptly appears. Severe headaches, the inability to bend your head, fever, and an altered state of mind are all meningitis symptoms.

What cancers cause back and neck pain? ›

In some cases, lung cancer can inflame the lining of the lungs or, tumours can press on the spinal column causing pain in the back, shoulder, neck or side. Often, we just accept back pain, but it can be debilitating having to deal with it every day.

What kind of doctor treats neck and head pain? ›

Neurologists are the doctors who usually evaluate chronic headaches. Pain doctors can also provide useful input. We help with headaches by addressing pain and sensitivity from problems with your neck as well as your nerves and other parts of the head.

Can you live with chronic neck pain? ›

For patients who suffer from chronic neck pain, it can be difficult to adjust to the changes and maintain a high quality of life. However, with adequate treatment, most people are able to continue participating in normal activities with little interruption to their everyday routine.

What does a neurologist do for neck pain? ›

Every back pain and neck pain patient is unique, with different degrees of problems associated with a bone or disc abnormality. A neurologist is trained to discover the causes of symptoms, as well as using EMG testing to assess the injury to nerves and whether it is reversible in the short and long term.

What is the fastest way to cure neck pain? ›

Hot and cold therapy

Using ice packs or heating pads can help relieve neck pain fast. Ice reduces inflammation, while heat relaxes stiff muscles. For best results, you may alternate the two for about 20 minutes several times a day.

What does a neurologist do for back pain? ›

A neurologist specializes in treating nerves in the brain and spine. This doctor also has the tools available to assess back pain like an x-Ray and MRI. However, neurologists can go a step further. Using tools like an EMG, the neurologist can check nerve health and muscle weakness with fantastic detail.

Can chronic neck pain be cured? ›

Rethinking Chronic Neck Pain Relief

While it would be ideal for every case of chronic neck pain to be completely healed, this is not always possible. In such cases, it makes sense to focus on other areas of wellness, in addition to pain relief.

What is the best treatment for neck back and shoulder pain? ›

Heat/ice—many people find immediate pain relief from the application of heat or ice. Taking a warm shower or applying a heating pad is usually enough to loosen tight muscles and promote circulation. Applying an ice pack for 20-minute periods throughout the day can help relieve inflammation.

Does chronic back pain ever go away? ›

It usually resolves on its own within a few days with self-care and there is no long-term loss of function. Chronic back pain is pain that continues for 12 weeks or longer, even after an initial injury or underlying cause of back pain has been treated.

What is the biggest cause of back pain? ›

A common cause of back pain is an injury like a pulled muscle (strain). Sometimes, medical conditions like a slipped disc, sciatica (a trapped nerve) or ankylosing spondylitis can cause back pain. Very rarely, back pain can be a sign of a serious problem such as a broken bone, cancer or an infection.

What are the three main causes of back pain? ›

Mechanical/Structural Problems
  • Sprain: an injury to the ligaments that support the spine, often occurring from twisting or lifting improperly.
  • Strain: an injury to a muscle or tendon.
  • Degenerative disc disease: aging causes the discs between the vertebrae of the spine to break down.
Jul 1, 2019

What country has the least back pain? ›

Certain tribes in India show no degeneration in the spine, and there is virtually no back pain reported. Esther Gokhale, a researcher who studies the posture of people without back pain, gives us some insight into what can help us enjoy a pain-free life.

What emotion is associated with back pain? ›

Both acute and chronic back pain can be associated with psychological distress in the form of anxiety (worries, stress) or depression (sadness, discouragement). Psychological distress is a common reaction to the suffering aspects of acute back pain, even when symptoms are short-term and not medically serious [35].

How do you mentally deal with back pain? ›

Psychotherapy—particularly talk therapy—can help treat both physical and emotional pain. One of the best-supported, most-researched forms is cognitive behavioral therapy (CBT). Cognitive behavioral therapy can be effective for both back pain and mental health issues.

Can thinking about back pain make it worse? ›

For instance, if you are anxiety-prone, expect the worst, and have catastrophic thinking, this can make the pain far worse. That's because those psychological vulnerabilities can change your brain and intensify the pain.

How can I live with permanent back pain? ›

Slowly increase your activity as you are able. Use over-the-counter and prescription pain relievers for severe pain as directed by your doctor. Get physical therapy to help strengthen muscles and improve your posture. Check with your doctor or physical therapist before starting any exercise routine.

Does walking relieve back pain? ›

Going on walks: Initial research suggests that going on a walk or brisk walking (Nordic walking) can help relieve back pain if done regularly – for instance, every two days for 30 to 60 minutes.

Can you become paralyzed from back pain? ›

With a herniated disc, the capsule cracks or breaks, and the nucleus squeezes out. This can irritate the spinal cord or nearby nerves, causing weakness and numbness in the arms or legs. A severely herniated disc can cause paralysis.

How do I know if my neck pain is serious? ›

As a general guideline, the Mayo Clinic says you should contact a doctor if your neck pain:
  1. Is severe.
  2. Persists for several days without relief.
  3. Spreads down arms or legs.
  4. Is accompanied by a headache, numbness, weakness, or tingling.
Jun 16, 2017


1. What are the symptoms of cervical spondylosis? | Dr Umesh Srikantha - Aster CMI Hospital, Bangalore
(Aster Hospitals, Bangalore)
2. Facet Joint Degeneration: A Common Cause of Back Pain Evaluation and Treatment
(UCLA Health)
3. Cervical spine (neck) assessment through Motion and Palpation
(John Gibbons)
4. Is Facet Joint Syndrome Causing Your Back Pain? EVERYTHING YOU SHOULD KNOW
(360 Pain Academy)
5. Aches And Pains Are Not Inevitable
(Fit For Real Life)
6. Chronic Pain: A New Perspective | Georgie Oldfield | TEDxUniversityofManchester
(TEDx Talks)
Top Articles
Latest Posts
Article information

Author: Allyn Kozey

Last Updated: 03/09/2023

Views: 6752

Rating: 4.2 / 5 (63 voted)

Reviews: 94% of readers found this page helpful

Author information

Name: Allyn Kozey

Birthday: 1993-12-21

Address: Suite 454 40343 Larson Union, Port Melia, TX 16164

Phone: +2456904400762

Job: Investor Administrator

Hobby: Sketching, Puzzles, Pet, Mountaineering, Skydiving, Dowsing, Sports

Introduction: My name is Allyn Kozey, I am a outstanding, colorful, adventurous, encouraging, zealous, tender, helpful person who loves writing and wants to share my knowledge and understanding with you.