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How to look after you while you look after your patients

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Burnout, back pain and repetitive strain injuries are just some of the outcomes of working as part of a dental team. Added to that, there may be other issues that can make your chosen career less of a joy and more of a millstone. It's such a tragedy when highly trained professionals are prevented from enjoying their jobs by chronic pain or stress through their work, and doubly so if they have to leave their career early, unable to truly capitalise on all the hard study, training, commitment and CPD hours. And let's face it, the resulting poor health and pain are hardly conducive to a happy approach to retirement.

In terms of prevention, however, there's an effective skill that dental care professionals can add to their armoury. Recommended by NICE and now by Dentists' Provident, this skill can help combat the physical and psychological problems which may occur in your working life. Recent studies have highlighted its effectiveness, with strong evidence of sustained benefit to chronic pain sufferers1, increased self-control, awareness, confidence, and presence in the world2, and lowered levels of stress. This skill is called the Alexander Technique.

The Alexander Technique is especially appropriate for dental professionals for four practical reasons:

  1. It doesn't require any equipment

  2. It can be practised whilst you're at work - and no-one will notice

  3. You don't need a physio, massage therapist, chiropractor or osteopath

  4. There's no effort required - you don't need to start rolling around on blue rubber balls, contorting yourself in doorways, or working up a sweat, either at work or the gym.

Let's take chronic back pain as an example. It's well known that as hygienists, therapists, dentists and dental nurses, you commonly suffer back and neck problems, due in no small part to bending forward at work and working within a static, limited range. As the equipment, dentist or patient are typically lower than and in front of you, there's a tendency to pull down the front of the body, to round the shoulders, and rotate your skull back and down a bit, into the neck. This can end up causing bad posture and ultimately chronic pain. Some people simply get away with it, but if you're like the majority, you may well be feeling some discomfort by now. This lack of control over your own well-being can lead you to worry about the future, your job security and longevity. What's more, if you are tired, stressed or sore you get much less job satisfaction and risk having to stop work entirely, potentially letting the rest of the team or your family down.

Working through chronic pain increases your likelihood of injury, not to mention increasing your levels of stress, anxiety and dissatisfaction. And it does nothing for your appearance either! When you feel stressed, in pain or anxious, your patients are more likely to feel that way too. When patients feel anxious during their treatment, their pain tolerance thresholds are reduced considerably. There's no reason why you shouldn't simultaneously help to keep yourself free from stress and anxiety, whilst helping your patients feel the same. When patients praise a dental team, their manner and personality are often just as important as the quality of their work!

As an Alexander Technique teacher, I'm no stranger to seeing large numbers of nurses and therapists, whose job often involves paying good attention to other people, often at the expense of their own well-being. In fact I'd say the majority of people I see day-to-day care for other people, one way or another. Workers in manually skilled, caring professions really do care about their patients and invest a lot of time, attention and energy ensuring they feel safe, comfortable and at ease. But it's often at the expense of the professionals themselves. Did you know that counsellors receive counselling to help them in their job? Massage therapists and physios often work on each other to keep them from burning out. But as a dental care professional, you don't receive any such support. During the rush of the day it's so easy to overlook your own well-being. Getting the job done comes first. Looking after yourself comes second. We all know this is completely the wrong way round – and often ignored! If you can create a healthy balance between looking after yourself and looking after your patients, everyone wins!

My job as an Alexander Technique teacher includes teaching professionals to recognise and take stock of their posture, tension, and levels of stress. You can learn to reduce physical and mental stress by releasing tension, and then continuing to release tension as you go about your work and daily lives. It's an application that happens in the moment, a form of active mindfulness. By placing you, the individual, rightfully back at the top of your list of priorities again, rather than the procedure or the colleague being the focus of all of your attention, you can experience less pain, and less stress, with people often reporting feeling lighter and in better balance. It's a bit like when you're on a plane as the oxygen masks are demonstrated. You're advised to look after yourself first before looking after the people around you. This technique is like that. There's no need to worry, as people can't see that you're paying just as much attention to yourself, as to them!

You'll no doubt remember being taught the importance of good posture, good lighting and magnification, and good ergonomic equipment. These are without a doubt vital to your well-being and career. A whole ecosystem of companies thrive on providing ergonomic equipment, lighting and seating. But unless you take the time to work out at the gym, or perform long stretching sessions in front of your patients, there's little or no time to look after yourself. By refining your kinaesthetic sense, your 'sixth' sense of your body's tension and movement in space, you can start to learn to avoid all the old, bad habits that cause you pain. For example, are you leaning down and in, as you read this? Sitting or standing badly? Here's a bad posture habit for starters! The Alexander Technique teaches you to be much more aware of how you're using your body over the course of a day, so you won't keep finding yourself with bad posture or in painful positions.

We all have the best intentions, and no doubt you remember being told to 'sit up straight', but all that advice goes out of the window once you're paying attention to something else. So while you're busily working away on that important job, how on earth are you supposed to remember to keep your bone 'A' at so many degrees whilst your bone 'B' is at another angle and all the time keeping 'this many' inches away from the dentist or patient? By contrast, the active form of attention that's taught in the Alexander Technique helps you move with more poise and comfort, and much less tension, so you don't end up rigidly fixed in static, tiring postures. Paying attention to the 'how' you do things is just as important as paying attention to 'what' you do. This way you can learn to look after yourself whilst you work, rather than having to spend your free time trying to recover.

Alexander teachers are used to helping people with back pain, repetitive injuries, and stress. A recent randomised controlled trial, published in the British Medical Journal, saw those who took a good course of Alexander lessons with a qualified professional drop their days with back pain by an average of 86%. The results were still that good a year later. A study of surgeons found they increased their postural endurance and comfort whilst simultaneously reducing the time taken to perform complex tasks.3

Dentists' Provident have seen the benefit and are keen to promote the technique to their members: 'Some dentists know very little about the Alexander Technique and how it can help their practising and personal lives, including pain control, prevention and stress relief. All of which can occur in a dentist's life and even cause them to take early retirement. Dentists find themselves in awkward positions trying to maintain maximum comfort for their patient, who may not want to be there at all, but dentists could be causing themselves unnecessary long term problems. In fact in 2012 35% of female and 26% of male claims paid were for musculoskeletal disorders (Dentists Provident claims statistics 2012).'

There are some great benefits to be had from the Alexander Technique, including less pain, stress and anxiety, better posture, and happier patients. All of these can only be good for dental care professionals. If this contributes to your long and happy career, all the better.

References

  1. 1.

    , , et al. Randomised controlled trial of Alexander technique lessons, exercise and massage (ATEAM) for chronic and recurrent back pain. BMJ 2008; 337: a884.

  2. 2.

    , , et al. Patients views of receiving lessons in the Alexander technique and an exercise prescription for managing back pain in the ATEAM trial. Fam Pract 2010; 27: 198–204.

  3. 3.

    , , et al. The impact of the alexander technique on improving posture and surgical ergonomics during minimally invasive surgery: pilot study. J Urol 2011; 186: 1658–1662.

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Author information

Author notes

    • James Crow

    James Crow works with everyone from dental professionals to professional athletes and musicians, helping them make the most of their skills and reduce their pain. He describes the technique as a user's guide to the human body. He runs www.thecomfortabledentist.co.uk, a company devoted to improving skills, reducing pain, and helping the effortless enjoyment of work. James has developed a programme specifically for dental team members that you can easily squeeze into your day. He is based in Manchester but you can also find a good Alexander teacher at www.stat.org.uk.

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