the neck is upright, the dental hygienist should slowly lower his/ her head back into the starting position, in a slow and controlled manner and another repetition may be initiated. Shoulder pain can be attributed to unsup- ported or improper arm positioning during scal- ing as well as the increased usage of computers in the dental setting.2 Lateral raises, front raises, and rows can be used to increase shoulder strength.3,8,9 Figure 4A displays the start position of a lateral raise. Dental hygienists should hold the load, in this case the dumbbells, at their side. To initiate the movement, raise the load(s) laterally, making sure to keep the arm as straight as possible, as demonstrated in Figure 4B. This exer- cise can be done either with one or both arms at a time. Once the weight has reached around shoulder height, the dental hygienist may begin to lower the load down back to the starting position. When introducing resistance training protocols to professionals with neck and shoulder MSD-related pain, participants also experienced a decrease in perceived pain in each of the target areas along with increased measures of strength.8,9 UPPER AND LOWER BACK PAIN MSD-related pain is also common in the muscles of the upper and lower back due to dental hygienists’ need to maintain a static positions for extended periods.2,3,8,9 This pain is compounded by the unilateral bending and twisting of the trunk required during the provision of treatment.3 Rows, hyperextensions, and trunk rotations may help reduce upper- and lower-back pain. To complete a horizontal cable row, dental hygienists should be seated upright on the bench portion of the machine with their feet flat on the stand, a slight bend in their legs, while holding the handle as in Figure 5A. In order to initiate the exercise, dental hygienists should bring the handle close to their bodies by pulling the handle with their arms, while making sure to keep their elbows tucked into their sides and with their backs upright, causing the stack of weights to move upward, ending up in a similar position as demonstrated in Figure 5B. Once the handle is pulled in as much as possible, slowly let the handle return to the initial position, lowering the stack of weights. This movement is more focused on the muscles of the upper-back, and as mentioned earlier, it does help strengthen the (posterior) muscles of the shoulder. 3,8,9 In Figures 6A and 6B, the dental hygienist is using a hyperextension machine to carry out back extensions. When positioning in the machine, individuals should adjust the height of the upper padded area so that the top of their hip is at or slightly below the top of the pad. Both feet should also be secured under the bottom padded portion. To initiate the exer- cise, participants should think about using their hip and the pad as a hinge and extend their lower back and hips in order to raise their torso. Dental hygienists should try to extend their torso so that it is parallel with eral bending while under load.8 In Figure 3A, the dental hygienist is using a neck harness to help ensure the muscles of the neck are responsible for the movement of the load. In this case, the weight is hanging from the harness, requiring the neck to be in full flexion. From this position, the dental hygienist begins to extend the neck in a cranial direction until it is relatively upright, while making sure not to hyperextend the neck. Once 16 Dimensions OF DENTAL HYGIENE • January/February 2024 dimensionsofdentalhygiene.com FIGURE 3A. IN THE STARTING POSITION FOR NECK EXTENSION, A NECK HARNESS HAS A LOAD ATTACHED TO IT. THE NECK IS FLEXED WHILE LOOKING DOWN. FIGURE 3B. IN THE END POSITION FOR NECK EXTENSION, THE HEAD IS UPRIGHT AND NOT HYPEREXTENDED PAST NEUTRAL POSITION. FIGURE 4A. IN THE STARTING POSITION FOR A LATERAL RAISE, HOLD THE LOADS AT THE SIDE OF THE BODY. THIS EXERCISE CAN BE DONE UNILATERALLY OR BILATERALLY. FIGURE 4B. LOADS SHOULD IDEALLY BE AT THE SAME LEVEL AT THE END OF THE MOVEMENT, ROUGHLY SHOULDER HEIGHT. FIGURE 2A. IN THE STARTING POSITION FOR WRIST FLEXION, THE WRIST IS IN A SUPINATED, EXTENDED POSITION, WHILE TRYING TO KEEP THE DORSAL ASPECT OF THE FOREARM AS FLAT AS POSSIBLE. FIGURE 2B. ONCE THE WRIST HAS CONTRACTED AS MUCH AS POSSIBLE, RETURN THE LOAD DOWNWARD TO THE STARTING POSITION.
