My Neck, My Back (Fix Your Posture While Removing Plaque!) – PDP220

Jaz’s Introduction:
Are those posh Bambach kind of chairs. Are they worth it? What’s the number one advice to have a career with longevity and good health from a back pain perspective and as a physio come dentist, what does Sam do? What are the things that he practices? Because he’s a bit like when Christiano Ronaldo rejoined Manchester United.

He was like a, he was a big deal, right? He is the goat. He’s the greatest of all time. I’m a Ronaldo fan. Anyway, when he was in the canteen of Manchester United, he was like eating with all other players. Everyone just looked at Ronaldo, what was on his plate. They wanted to model Ronaldo. So why do I mention that?

Because I’m looking at Sam, whatever Sam’s doing with his posture, with his back, et cetera, I wanna be doing that because he has the most knowledge. He’s musculoskeletal with his physio background. He’s a really good dentist. So let’s see what advice Sam has for us today. Now, after this episode, if you wanna go deeper into back pain, chronic back pain.

We’ve got Ben Physio and Sam Physio come dentist, that was PDP 025, like I said, over 280 episodes ago. In fact, it’ll be good for you to revisit some of the old episodes to see my journey and the journey of Protrusive now that we have team members and whole production line to bring you all this content.

And a special thanks for all of you that member listening to that episode on Spotify all those years ago. There is some new information, applicable information, and Sam’s no longer a baby dentist. He’s really accelerated a fast rate. So I made a big deal over at the beginning of this podcast to talk about his journey.

Because his journey really exemplifies the advice I give to every single young dentist. I get the question all the time, how do I structure my career? How do I grow at the fastest rate possible? How can I find the right clinic? How can I be doing the more of the higher end dentistry? Well, Sam’s playbook is there, and he shares it with us in this episode. So you’ll get some career advice as always, plus how to get more longevity from your career. 

Dental Pearl
The Protrusive Dental Pearl is a nonclinical one, and it’s taken from this episode and it’s just something that you already know, but it’s just important to hear again, and that is motion is lotion. Too many of my dentist friends are talking to me and saying that, oh, I just don’t have time to excise, and oh, I really let myself go.

I’m not prioritizing it, and that is the wrong way to go. Your physical health and mental health is super important, but just focusing a little bit on the physical aspect, spoiler alert, that is the number one way to prevent back pain and to give you a career with longevity. And you’ll hear later in this episode whether deadlifts are recommended or not or what’s the best type of exercise.

But as long as exercise is part of your life, and for many of you, you guys are running or jogging when you’re listening to the episode and you guys are already living and breathing that and more power to you. But so many of you in the car on the train, and maybe the most exercise you get is when you are going upstairs and downstairs of your surgery and you need to really reevaluate life and your life decisions and how you may be neglecting your physical health. 

Again, it’s stuff we already know, but one of the first dental pearls I ever shared with you may actually have been number one and number two was to know something and not actually do it is as good as not knowing it in the first place.

So Protruserati, I’m trying to look out for you here. Are you making time for physical exercise? Are you practicing motion is lotion? I hope you are, and if you’re not hoping, this is gonna give you to kick up the backside to make some sort of regime, some sort of promise to change that by yourself. Because the reason you clicked on this episode is ’cause something piqued your interest about back pain and having a career with longevity. And if you’re not even doing that, then losing out on so many benefits. Anyway. Hope you enjoyed the rest of this episode. I’ll catch you in the outro. 

Main Episode:
Dr. Sam Cope, welcome back again to the Protrusive Dental Podcast. So nice to see you and your growth and your journey and to see you live at the Protrusive events on the app and doing wonderful things on social media, my friend. Welcome. How are you? 

[Sam]
Thanks very much and thanks for having me back on the podcast as well. It’s a real honor I’ve seen, ’cause it was in the early stages that I was on last time and it’s really grown and kind of kicked off. 

[Jaz]
You were about 270 episodes ago, mate. 

[Sam]
Wow. Yeah. Crazy a dinosaur. 

[Jaz]
Well, honestly, you did so well then. But there’s some unfinished business, right? The unfinished business is a little bit of a stir that we created and we talked about being no correlation between bad posture. Back pain. Okay. So we wanna just talk a little bit about that, little finer points about that, and also just revisit your journey from physio to dentistry.

But now that you’ve been in the game for a bit longer, right? How do you feel? Do you have any regrets and that kind of stuff. And I hope you like the title of this podcast, My Neck, My Back Fix your posture while removing plaque. I just wanted to go into some sort of a funny theme, but Sam, for those who didn’t listen to that episode, looking at back pain, it was two guests I had at the same time. And so for those who haven’t listened to that, please do check it out, but just remind us about your journey and where you practice today? 

[Sam]
Yeah, so I started off, I did physiotherapy at King’s from 2011 to 2014, and I actually met some, I was on a course this weekend and met somebody that was there at the same time who was doing dentistry at the same time.

And we were kind of reminiscing because we were in halls and every time you’d go into the kitchen in great Dover Street apartments, which is where we were. You’d see the shard being built a little bit more every time you went for breakfast. So yeah, so I started off at Kings. I did physiotherapy, really enjoyed it.

And after I finished physiotherapy, so when you do physio, you do respiratory, neurological physiotherapy, and musculoskeletal. The musculoskeletal element is the bit that most people know that physios do. And whenever somebody says, oh, are you a physio? You’d say, yes. And then they’ll say, how good are you at massages?

And you’d say, you’d roll your eyes and think, oh God. But yeah, we are actually pretty good at massages. I remember the very first, like when we got into physiotherapy, like the icebreaker, they just said, right, everybody get your tops off. Then we’re gonna do some massage. And I was like, Jesus, here we go.

Like this is what’s gonna happen. But I did physiotherapy. That was really good. And then once I finished, I realized that there was a bit of a ceiling effect with musculoskeletal physiotherapy. So whilst I was doing physiotherapy at Kings, I was also doing physiotherapy for the London Irish Gaelic football team and Mill Wall rugby team.

And it was really cool because you’d be doing first aid on the pitch, but when the players are coming to you, they’re coming to you because they need help or because in almost like a negative way, because obviously it’s their career almost at risk for them having to come and see you, even though you are part of the team.

I would’ve rather have been actually playing with them, like on the, you know, being part of the team that way. Especially once I started  Musculoskeletal physiotherapy, if I really wanted to progress, I’d have to start being with a football team or something like that. And that comes with connotations in terms of, it’s difficult to have a family because you’re lying around the world all the time.

And I just thought, hmm, is this really for me? And then I looked at dentistry and I had looked at dentistry for many years before. My uncle and granddad are both dentists, so I thought, do you know what? Actually, this is gonna be the only chance I’m ever gonna have to kind of do dentistry. So I luckily got on the four year program at Liverpool, did the four years of dentistry.

I didn’t leave the physiotherapy behind because I didn’t want to be a poor student again. So I was doing physiotherapy Monday, Tuesday nights and Saturdays. And that was great because not only was I getting experience from the dental field, but I was also seeing a very diverse patient range. And I was doing quick, quicker consults and examinations and learning about communication, which I think that’s probably, 90% of dentistry, I’d say at the moment is communication.

[Jaz]
Well, I see you now in your evolution into a private practice doing aesthetic work. Everyone has to, at some stage who those who want to, those who wish to get over some imposter syndrome, get their communication gear, get their skills in gear, and then make that jump to private practice should you wish for that to be part of your career.

And I’ve seen you do that and we can talk about that in the podcast, but I think your skills of the University of Life in the real world, in your physio as you were studying probably helped you being able to speak to people, get those reps in so to serves you well later in your career. Would you agree with that? 

[Sam]
Yeah, definitely. It’s definitely helped. It helped me progress faster too, so I found that, yeah, so once I’d finished physio and dentistry, then I went on to do my foundation years, and then I went and worked at the dental house in Liverpool with Stuart Garton. He’s a lovely guy, and I found there it was a little bit different.

So when I was doing NHS dentistry, I’d have half an hour for my checkups so that you can sell more private dentistry, but there was a dental therapist model there where any fillings I would send, well, simple fillings or child extractions and things I could send to the dental therapist. So it meant that I built my skills more with preps and also eventually going on to more I could do preps, veneers, composite veneers and things. And the only way that I got confident doing that was by, I mean, in the early days I’d be doing like five, six days a week and on the days off I would be shadowing different dentists from like orthodontists. There were of quite a few restorative dentists that were there as well be shadowing them.

You’d gain loads of techniques and you’d gain lots of communication. There’s some things that are hard to do to communicate to patients, and sometimes you’ll hear a clinician say something and you’d be like, wow, like they’ve just summarized maybe like three paragraphs of communication into about three sentences.

So that was really, really helpful. And then I went on the postgraduate diploma. Then with Monik Vasant, I did the totally composite course first, and after that I remember being on the train, coming back thinking like, wow, that was the best course I’ve ever been on. And the reason was just because he’s so charismatic.

He’s a good guy, and there’s the way that he can teach. When you finish a course, you want to feel like on Monday you can deliver that exact thing on a patient. And when you come back from a course, especially with the composite, you want to look at your model and think, wow, that’s the best posterior composite, the best anterior composite that I’ve ever done.

And that’s what you get from a course like that. So I did his yearlong course after that. He then was, must have been looking at my work, but he asked me to be his apprentice after that. So I worked as his apprentice for a while. And then- 

[Jaz]
What was that entailed? Because this is new to me, right? So you watch the show with the apprentice, right? You think, okay, this is what or there’s apprenticeships. So just delve into that model and before you delve into that model, I just wanna highlight something for those listening and watching, right? If you look at Sam’s career and the way he’s describing it, there’s a few prominent themes that you should not go unnoticed, which is drive.

You had the drive and the hunger, right? Who else? Okay, so I look at people, right? And they’re like, oh yeah, I wanna be successful. I wanna be this kind, and someone do that kind of work. Okay? But then they’re not putting the hours in. They’re not as hungry. Basically, they’re choosing to spend their weekends watching Netflix rather than doing what you’re doing, working five, six days a week.

And then they’re also shadowing on top. Now, some people might say, you know what? That’s obsessive. That’s too much. But if you don’t do it in your first five years, when you’re gonna do it, you’re not gonna do it. When you have kids, you’re not gonna do it when some sort of health crisis happens later on, kick us, as you’ve learned, that can happen, right?

So what I love about you is you had the drive and you played the season of life, my friend. You had that season. You got your reps in, you had mentors, not only the ones you shadowed, but the ones that courses you went on, and you obviously had this wonderful thing about you that you connected with him and then you opened yourself to allow Monik to take you under his wing. But just tell me now more about what an apprenticeship looks like nowadays? 

[Sam]
Yeah, so I mean, it was very new to me and it was very new to Monik at the time. He’d taken will on to start off with and it was basically where I was helping him out on the course. So on the year long course I was helping him out on the course. And then as you got more confident, then you would do more things in the clinic. 

[Jaz]
So you’re working in his clinic, so you are an associate of his, is that right? 

[Sam]
You are salaried. So the start, you’re basically helping out on all his teaching courses. And then you are also seeing patients as well, maybe like once or twice a week, but the majority of it, just because of the sheer volume of courses that he’s doing, he really needs you there to kind of help and kind of mentor some of the dentists and you gain more experience from that than you would.

On a patient. And the reason is because say on the totally composite course, people are doing composite veneers. You’ve got 20, 30 people that are doing composite veneers that are making mistakes. You are going round, fixing those mistakes. Things that you’d think could never have even happened. And it’s quite nerve wracking ’cause you’ve gotta be confident enough to fix it in front of them.

But it’s very, very good ’cause then you’ve done that day, but it’s almost like you’ve just completed 20 separate composite veneer cases and you fix those mistakes. So then when you come into the clinic. And something like that happens, you’re just like, oh, well yeah, I know how to fix that ’cause I’ve done it 20 times, or I know a fast, efficient way of doing it.

And it was great meeting so many dentists because you would gain so much experience from them just talking to them about different things. I was even on a course this weekend. And we were talking about doing a trial smile, and he was saying, yeah, well, the key thing with a trial smile is when you first place it in, you know it’s really important to block out the black triangles.

And he said what a key thing is you can get some orthodontic wax palatally and place that in. And then I said, actually I’ve tried doing those things, I find wax a bit fiddly, so I usually get a really small tip and then place it on the palatal, and I just use light body and just eject a very small amount just into where the black triangles are.

Then use my finger to kind of smear it over so that I don’t get any bulbous points. And then when you do your trial smile, you get a lovely trial smile, and then when you take it off, you can just tear all of the like body off in one go. And he was like, oh yeah, that’s an interesting way. But it’s great how we can all learn from each other.

And just little tweaks and techniques ’cause we’re figuring things out. As dentists, we are problem solvers, so we’re always trying to problem solve how to do things. And something that you do all the time and take for granted can be a real nugget for another dentist. So yeah, learning from all of those different dentists was great ’cause you’re picking up nuggets. All the time. So it really helps your practice. 

[Jaz]
Well, again, I just wanna highlight, and I’m not here to make you blush or anything, but people always ask me for advice, right? They come to me, they see me. Okay, Jaz has been in the game very long time, especially those who are a couple years qualified, they look up to me and then they message me and I would love to point him to an episode like this and say, look, listen to Sam’s got the playbook, right?

Like, this is how you do it and so, I’m proud of you because again, the another thing that you exhibited is again, you just said you are in a course this weekend. Okay. Now eventually that will stop ’cause the season of life will change. And now you are doing more teaching as well, which is wonderful.

It’s a great way to learn. It’s like the taxonomy of learning. When you teach something, that’s when you really learn something. But you had to get to a certain level to be able to do that. I’m sure you would’ve had some imposter syndrome going for that. But having the faith and the guidance of Monik must have really meant a lot to you.

I mean, I don’t wanna talk about money too much, but let’s just face it that when you do an apprenticeship thing, right, like apprenticeship post, am I right in saying that you could earn more as an associate than it just side by side? Earning more as an associate than an apprentice? Would you say that’s correct?

[Sam]
A hundred percent, yeah. You take a salary cut even, you’d probably earn more on the NHS than you would as an apprentice, but it’s not, but then the experience is more valuable than any money. 

[Jaz]
So I’ve said this story before and a few times, and those maybe are new to the podcast. I was once in a situation where I got offered a very lucrative position on Harley Street, or just out of town, a really lovely principal and again, a fairly, affluent area.

Like it was a day and night difference in terms of my future earning potential. Okay. But with one practice, it was there. I was gonna learn a lot. It was very clear the principal was gonna be there. I’ll shout him out. Dave Winkler legend, he was gonna be there. Okay. And I learned so much from him. And then the other Harley Street practice, I knew it would just be me on my own.

And so I took the pay cut. When you are young, work to learn, not work to earn. And I just wanna highlight, you’ve got the playbook my friend. You got the playbook, so, well done. I think you make some great decisions. Speaking of decisions, did you ever, ’cause I see the trajectory you’re going in, mate.

You’re doing some fantastic aesthetic work. I can see that lights you up which is great. So people are finding niche, in fact, someone messaged me on the app recently on the Protrusive Guidance community, I think it was James, James Murray. He said he’s a young dentist, few years qualified and he’s feeling a bit nervous.

Or unsure about the following thing, where he’s like, I don’t enjoy endo so much, and I enjoy these things. Am I too young to drop those things and focus on this? And you know what? He’s getting some wonderful advice on there from people like Sandra Hulac and stuff. It’s like, listen, you do you right? Yes, it’s good to get your footing and as a young dentist be good at everything before you choose a niche.

But sometimes when you have, you identify your strengths and identify your passions, it’s okay to say, you know what dentures are, refer, endo are refer. And I’m gonna focus on these two, three things. And I think that is really a key recipe to niching and flourishing. Even Pascal Magne had a session with him recently.

His advice to the young dentist was, don’t try and be good at everything he actually said, just pick a few good things. And so I see that you are focusing Sam on aesthetic dentistry. It obviously lights you up, but did you ever consider with your physio background that you are in a great position to be that TMD guy, right?

You could be the TMD guy. Right? Because I prefer so many of my patients to physio, especially Krina Panchal in London. We get together, we get far better results alone. Did you ever get tempted by that path? 

[Sam]
I did, and I did a few courses as well, ’cause at Liverpool they have kind of physio courses on TMD. I think it was a similar struggle with Ben. So me and Ben were trying to put together a back pain course. And for those that don’t know Ben, he is an extremely good physiotherapist and he deals a lot with chronic back pain. And he said, Sam, I dunno how you get the time to kind of do dentistry and do this, but I can’t do my job and then help you with this big course.

And the reason is because when he’s at work, when you are dealing with chronic back pain, these people need a lot of help and they need a lot of kind of TLC and pain is such a multifactorial component that it is not just about the tissues, but it’s also about the psychosocial- 

[Jaz]
Psychosocial wellbeing. 

[Sam]
Wellbeing. Yeah. And some of these people have had really traumatic pasts that you almost need to help them with to get over the pain. They say you shouldn’t take your work home. You can’t not take that home. And I felt that there was a very similar pathway with regards to that and TMD and I think hats off to any dentist that deal with patients with TMD. I just felt like I probably wasn’t the best person to deal with that. 

[Jaz]
I think you’re very intelligent, my friend. I’ll tell you why. Look, you know you set hats off. I’m living that at the moment. There’s a reason why I’ve limited my TMD days to Mondays only. Like I only do TDS on Mondays ’cause you’re so right.

Like I was sat next to someone at the BACD conference, right. And he’s a young dentist and he was there with his partner and she was a therapist, like a psychological therapist. And she told me that all therapists. Have a therapist and I’m like, oh my God. Immediately I was like, I’ve never resonated with someone so much.

‘Cause we were talking, I was like, oh my God. Like, and you’re so right. TMD patients need that TLC, they need that whole holistic package. And I could tell you some really sad stories and obviously I won’t for patient confidentiality and it does affect me. Psychologically it does affect someone and so it takes a certain type of person and I appreciate where Ben’s coming from. Dealing with chronic pain patients takes its toll on you.

So what I’ve done is create some boundaries. Like I only do emails on Wednesdays to my patients. ‘Cause I just can’t deal with chronic pain emails every single day. I can’t, it would just break me. Okay. I only see A TMD patients on Monday. So I’ve set boundaries to be able to help these patients, but also make sure it doesn’t affect me and my family and my mental wellbeing.

And certainly I see therapy being part of my future as well. So I think you’re a smart cookie. So if everyone’s wondering why I didn’t go into that, I respect that and I appreciate that ’cause it needs to be right for you. 

[Sam]
Yeah, exactly. I remember the last time we were talking. The different books that you read and a lot of the self-help books, and there’s a reason why I think dentists go into that because our lives are so fast-paced.

We’re seeing lots of patients, but also we’re living in a 21st century environment, which our genes and our brains just aren’t geared for. I’m living in London now. And walking past like, hundreds of strangers every day, that’s not normal. 10,000 years ago before the agricultural revolution when everybody was hunter gatherers, you’d be living in a tribe and you’d know everybody.

And there’s a reason why people want to be famous and things in society because back then, everybody knew who you were. So then people want to be famous because people want people to know who they are and things. But yeah, it does take it, I think subconsciously it does take its psychological toll.

So I always think, if you want to be stronger, then you should get a personal trainer. So why would you not get a therapist to help with your psychological well being? That’s not gonna just help you with problems such as family traumas or if you are depressed or something at the time.

But why not get them when you’re feeling normal so that they can help maximize how you can live and how you can use your brain. ‘Cause your brain is a tool and a lot of therapists can help you unlock that tool and help you become more resilient, especially when you do face challenges in the future. I dunno what you think about that.

[Jaz]
Totally. Ah, a hundred percent. We had Mahurkh Khwaja on the podcast as well. We had Simon Chard recently. They said, we need to put the prevention back into mental health, especially for dentists. We do such a tough job. So to try and get some regular mental toughness, resilience training is totally worth it.

Now, I’m gonna make a little analogy, right. When Christiano Ronaldo rejoined Manchester United for a second spell, there was this famous thing I remember reading where all the other players, they stopped like eating what they’re usually eating. They’d all look at Ronaldo’s plate, right? Because they’re like, okay, I wanna be like Ronaldo, right?

So I’m gonna make this comparison that you are the Ronaldo in a way, because you have this edge. Okay? You are the Ronaldo of posture and physio of dentistry. Okay, so you own it, my friend own it. Okay. Because you are so much more than that. But in this realm, like, I’m gonna be looking to you as like, what’s Sam doing with his posture?

How’s he sitting in his clinic? Okay. Because whatever Sam’s doing, I wanna be doing that ’cause you can’t unlearn what you’ve learned. You can’t unlearn the years of physio. I’m sure you treat your body like a temple. How many times a week do you work out? 

[Sam]
Usually like, yeah, three, four times a week. 

[Jaz]
You look in great shape. I’m sure you do more stretching than the average dentist, et cetera, et cetera. So let’s talk about best practices, right? So let’s start with, am I naughty if, am I naughty if I make an expensive purchase of ergo loops in the promise from the marketing that it will help my neck pain, stroke, back pain? What’s your stance and analysis of these ergo angled loops? 

[Sam]
I love them. I’ve got ergo loops as well. And I think having ergonomic loops is great because you are sat in a position where you are having the least amount of muscles strain, and I find it a lot more comfortable now. Some people might not find it comfortable, but I’d say probably in the majority of people you would.

And the reason is because when you are doing longer procedures and you are looking down, you are going to be under a bit more muscular strain than usual, and you might not be able to hold that position for as long. I think the key thing is that your body is completely adaptable. So if you train your body to do something, you want to train your body to hold your arm out for four hours, you can train your body to do that.

If you started to do it straight away, that’s gonna feel uncomfortable. If you’ve spent your whole life with a certain loop set and you’ve had your head over a patient, you can train your body to hold you in that position and not get uncomfortable.

[Jaz]
I’ve never thought about it that way. It makes so much sense ’cause the thing I was gonna add here is. I was skeptical about when I made the switch to ergo loops, I was skeptical. But when I started to wear them, okay. I didn’t feel immediate benefit. I’ll tell you why I didn’t feel immediate benefit, because then when I put my ergo loops down and then I went back to my normal loops, that’s when I felt like, holy crap, my neck’s on fire.

Do you see what I mean? Because exactly I’d adapted to that. It’s a bit like going from somewhere like, hot to warm and then hot again, and then warm. Now you feel that heat basically. It’s a terrible analogy, but like, yeah, I only felt it when I had that neck declination again with the normal loops and now I very much prefer my ergo loops.

Obviously, I’m sure there’s no double blind trials, systematic reviews on this because it’s a difficult thing. It’s a bit like musculoskeletal. It’s like a difficult thing to study, but I think the message is if it feels good to you, okay, then do it. But I think musculoskeletally, it does make sense, doesn’t it?

[Sam]
Yeah. I think the basic principles are research to kingdom come. We know that the stronger you are, the more able you are to be in one position. And I think you have to take those principles and then apply common sense to those principles. It’s like there’s no double blind research trials to say that jumping out of a plane with a parachute or without a parachute.

So if we can apply common sense to these things maybe we don’t need, it’s only anecdotal evidence that jumping out of a plane with a parachute is actually beneficial. But yeah, I mean everything is about muscle adaptivity. Like if you look at a cyclist, if you look at their posture, like that flexion posture and that head tilt up, you would argue that is a terrible posture.

[Jaz]
Same with hockey players, also hockey players. A few times I’ve tried to play hockey, I was like, what the hell is happening in my back? I don’t wanna play hockey anymore. 

[Sam]
Yeah. But, and also if you look at a chimp’s posture. It’s terrible. Like if you were looking at that kind of Victorian ideal of how posture should be, because I think posture in the past has always reflected kind of status and sex appeal and then it’s kind of been linked into this is how you should sit because this is good for your pain.

But sitting up in an upright position with your head at a certain angle. Or even standing up in a very upright position can be comfortable for some people because everybody’s back and the way that people sit and stand are very, very different based on their own anatomy. Some people might find it extremely comfortable, some people might find it extremely uncomfortable.

So it’s about figuring out where you are on that spectrum. If it feels really comfortable to sit up really straight, then doing that. In terms of the Ronaldo play, I don’t care about what posture that I’m in. And the reason is because there’s lots of long-term trials that say that if you do care about what posture you’re in, it create almost a fear of what posture you should be in and therefore you actually end up being in more pain.

[Jaz]
I’m getting deja vu, I’m getting deja vu from our episode, 270 episodes ago. I think you must have the same thing ’cause I then made the exact same comment. This like patients obsessing about their occlusion. And how their bite feels in a way. 

[Sam]
Exactly that. Yeah. 

[Jaz]
Okay. That’s very fascinating. So it makes sense to have ergo loops. I get it. Okay. And it’s amazing what we talk about. You can train your muscles to adapt to a certain posture. I think you, you made that point really well. What about these bambach chairs, and I think Brian have got this no bad or something, novic or whatever chair as well. Are they worth it? They’re not cheap. So ergo loops, I think is a big tick from Sam. Where do you think about these postures? 

[Sam]
I think with these chairs, in terms of the trials that are out there, they say that it can improve your posture, whatever that means. So it can put you into that more ideal posture, whether that reduced or even increases. Pain is set to debate, but in terms of are they good for you as a dentist, that will solely depend on your own anatomy and the positions that you prefer. 

The crazy thing is if you believe that it will be good for you. You will almost train like the same way with your loops, Jaz. If you train yourself to sit in that position, eventually you’ll get to a point where you don’t wanna sit on any other chair, but a saddle chair or one of the Brian chairs because you’ve adapted to that chair, whereas you can adapt to other chairs.

It’s just trying to figure out which one is the most comfortable for you. And people hate this because I’m not giving it one size fits everyone, but it’s because that isn’t really, I mean, that’s why with dentistry, we’ve got millions of teepees because there isn’t one size that fits everything and it can change.

[Jaz]
So if it feels right to you, get it. But maybe if you’re happy in your chair and you believe your own chair is working, then you know it’s fine as long as you are feeling good. But perhaps if you’re looking for change and you’re gonna buy one those chairs and you can also make that work. The human body is a very adaptable. But would you say that someone’s absolutely fine? Like I don’t get much back pain, touch wood? I don’t at the moment. And so would it make sense for me preventatively, as a strategy to improve my career longevity? Would it make sense? I mean obviously we’ll never know ’cause you don’t have the evidence for that, but what’s your gut telling you?

[Sam]
In terms of my gut, I don’t think it would make a massive difference. In terms of what chair you were going to get, but if you wanted to try them out, I think it’s a great idea. You might find that once you sit in it, you’d feel more comfortable. So I’d probably recommend when you’re at one of these dental shows, go and sit in one of those chairs and if you feel like, wow, this feels really, really comfortable, then I’d say for you, yeah, get it.

But if you went to one of those shows and you sat in the chair and thought, wow, I feel really strange in this position, then it’s not to say don’t get the chair because your body will most likely adapt, but you might find that it takes a bit of time to kind of get used to it the same way as if you went from using ergo loops to go back to your loops, you would get used to it.

Like you said, you get that kind of bit of burning pain in your neck and all that is is muscle fatigue. But you would get used to being in those position. So yeah, that’s what I’d recommend. I think it is just taking everything on an individual basis because every single person’s back and neck is completely different to the other person’s, just in terms of how it all works.

[Jaz]
And so before we pivot then to some aesthetic dentistry type stuff, I wanna just then tackle that unfinished business, right? So overall we’re suggesting, okay. If a chair feels right, go for it. Ergo loops. Probably will help you, but what are your like top three bits of advice that you wanna give to dentists that you follow, that perhaps we should be doing more to look after our bodies that may be with a physio hat on. 

[Sam]
Help us prevent back pain in the future.

[Jaz]
How can you guide us? Because we made that bold statement, that posture, back pain are not really well correlated. A bit like occlusion and TMD is not well correlated, but in some individuals it could be the cause in some individuals the bad posture could be the cause of their back pain. I think you mentioned about acute and chronic. Do you wanna just talk a little bit about that? 

[Sam]
Yeah. I think in terms of what we were talking about last time and this time with posture. Say if I was doing a difficult procedure, say I’m quite stressed, I’m doing a composite veneer procedure. It’s taken about three or four hours to complete, which sometimes they do.

I’ve seen dentists take 10 hours doing a 10 unit case. Say if you’re doing that procedure, you start to get a little bit stressed. You are kind of in a position that is unnatural for you. You’ve got your head down and you are in that position where it’s quite, you’re putting a lot of strain on your muscles and you get some pain from that.

Then if you were to get some back pain and the next day you wake up and you’ve got some back pain and you’ve got some neck pain, then there’s specific things that you can do to help that. I think the key thing, firstly, don’t worry because there is a massive between feeling pain and actually getting an injury.

There is a massive kind of space between that. Your brain is very, very protective. It’s almost like a very sensitive car alarm system. So the alarm will go off. Before it causes injury ’cause evolutionary, it wouldn’t make sense for you to get pain once you’ve given yourself a serious injury. So firstly, like if you do start to feel pain, then that’s what I do.

And we can delve into that a little bit more later in terms of what to do with acute and then we can delve into chronic pain in terms of preventative strategies and what I do. 

[Jaz]
I think, Sam, let’s talk about prevention, because in that episode we did with Ben, actually, yourself and Ben, we talked a bit about just chronic pain and the signs behind that as well and how your best postures, your next posture and motion is lotion. All those wonderful things we talked about. So maybe talk about prevention before we pivot to some of the composite veneer stuff. So tell me about prevention. 

[Sam]
Yeah. So in terms of prevention of back pain, all the evidence is geared around exercise almost everything, even though there is evidence to say that some postures can be more uncomfortable for others in, in dentistry and for different things. It doesn’t really make any sense because we did a survey a while ago looking at dentists in Liverpool, and we found that almost like 30 to 50% believed that having a good posture would prevent you getting lower back pain.

That just simply isn’t the case because let’s take the common sense principle again. If you want to be in a position for a long time, your muscles have to be very conditioned to do that. If I said to you like, oh, you’re going skiing next week, you wouldn’t be practicing your posture. You’d be practicing, you’d be doing squats against the wall.

You’d be kind of getting your legs conditioned, if you’re going to do a sport. You’re gonna want to condition your muscles to be ready for that sport. And that’s exactly the same for dentistry. You can be in those long positions, you can sit for more than 30 minutes, and it’s not a problem. You just have to condition yourself for that.

So say if you are a student. You’ve not really done any long procedures before, and then you go into doing dentistry and all of a sudden you’ve gone from being on your summer holiday to then starting your foundation dentistry, and all of a sudden you’re seeing 20 patients and you’re sat on the chair and you’re a bit stressed.

You are much more likely to get a back or neck pain ’cause you’re just not conditioned to do that. But after a period of time, after say, a month or two or something of doing it, it’d be much less likely for you to get back on neck pain because you have conditioned yourself to be in that kind of routine.

And that’s the same with the gym. If you were conditioning yourself and you were started to do, a hundred pages squats or something, and then you took a six week break and then you went back to doing those same squats with the exact same weight, you are much more likely to injure yourself doing that.

And that’s the same from if you were going from lots of short procedures and then you decide, actually I’m gonna start doing more composite veneers, and you spend three or four hours doing a composite veneer session, you’re more likely to feel a bit of pain ’cause you, again, you’re just not conditioned. So I’d say in terms of what I do, if I do start to feel pain- 

[Jaz]
Go, Ronaldo, what’d you do? 

[Sam]
I’m just thinking like, what has caused that pain? What’s going on? But then in the gym, all I do is I just do normal kind of exercises. I’m doing running and things a couple of times a week. I’m just doing the exercise that I enjoy- 

[Jaz]
Because I’ve heard on like random BDA posters that Pilates is supposed to be superior and recently Simon Chard came on the the podcast and he said, deadlifts, he’s actually recommending deadlifts for dentists.

He’s saying that’s good. But he’s not physio. So I’ll take your the Ronaldo a bit. So what do you think about deadlifts? Should we be doing deadlifts or, ’cause I know some dentists who avoid deadlifts ’cause they don’t wanna mess up their back for dentistry. But actually, should we be doing deadlifts to sustain what we do?

[Sam]
Yeah. I don’t see why not. Yeah, I mean, it is just keeping yourself stronger and keeping yourself active. You could do deadlifts if you want to, but some people don’t like going to the gym. And especially when I was at uni, I know a lot of girls didn’t really like doing deadlifts because sometimes they’re in like the kind of the weighty male section of the gym and they feel a bit intimidated- 

[Jaz]
Or that grunting.

[Sam]
Yeah, yeah, yeah. So like it’s just doing the exercise that you enjoy. If you are doing lots of running or if you enjoy that or swimming- 

[Jaz]
It’s a concept of gamifying, right? It is gamifying your exercise and actually fulfilling and enjoying it. I think you’ve hit the nail on the head because if you do stuff because Jaz or someone said in the podcast or do deadlifts and then you don’t really enjoy it and it’s awkward for you and it doesn’t really work out in your schedule or your environment. Then it’s not gonna be applicable in a daily world. You can’t make a habit out of it. But if you love swimming, you absolutely love swimming. Okay? And then you can take your kid swimming at the same time, whatever, and it works in your life, then that’s the way to go, right? 

[Sam]
I think a good analogy is if you are sat down for a long period of time, imagine if you’ve got a machine and you are keeping it still for all that time, or even when you ask. Still, you can find that, when you pass, you can click your fingers or you can click your neck because you’ve kept still for that amount of time. So with a machine, you would oil the machine and that would help lubricate the joints. And you can do that with your body just through exercise.

When you run, swim, do or do deadlifts, you will be compressing the spine. You will be releasing sign over your fluid, you will be lubricating your joints, you will be getting everything supple and moving. 

[Jaz]
Motion is lotion once again. 

[Sam]
Exactly. Yeah. 

Jaz’s Outro:
Well I’m really pleased we covered all the back prevention stuff. That’s so, so a lot of the CPD questions for this episode will be linked to that, but I know one of your passions is composite veneer. Right? And then you mentioned about using stents. Let’s just pivot to that. So I think, just to summarize, previously ergo loops. Great chair. See how it goes for you. You made some great points about muscle adaptivity and making sure that as dentists, the most important thing we can do to protect our longevity is make sure that we have exercise.

And I think it’s something that we all know. But sometimes hearing it like this, people, like one of my good buddies, message me saying, look, I’m really out of habit. I need, I need to, everyone says I need to get back in the gym. And it’s about actually taking that action and getting to it. And that could be gym for some people, it could be paying basketball.

For some people it could be whatever it is, but making sure they have exercise regime and that will support them having a long career because it means your muscles, your core muscles are conditioned and primed to do what we do, which is very challenging physically. But you mentioned composite veneers and how that can take its physical toll on you, and I think you mentioned about using stents, so different ways of doing composite veneers.

Freehand. Then there’s different, the smile fast kind of ways. Then it’s injection molding. What kind of techniques do you like, case by case, obviously it varies, but what are you favoring? 

Well, there we have it guys. Thank you so much for listening all the way to the end. This one is eligible for CPD or CE credits. We are a PACE approved provider, and if you’re watching the podcast on the app, Protrusive Guidance, just scroll down, whether it’s the web app or the actual mobile phone app and answer the quiz. If you get 80%, you can get your certificate emailed to you by our CPD Queen Mari.

And interesting on the chat the other day, Ben, who used the app a lot, and I see him on our little community, almost 4,000 strong community that we have on the app and could be way more than 4,000. But I try and keep it within the podcast ’cause I really want to attract the nicest and geekiest dentist in the world.

The quality of the dentists that we have on our little platform is far more important than the quantity. And so what Ben said was that he didn’t actually know, he wasn’t aware that there are premium notes for the episodes and there are transcripts for the episodes. So all these episodes we have like a cheat sheet you can download.

And the way we are sort of redesigning the cheat sheets now, or the premium notes as we call them, is we’re gonna have a PITC section right at the top. So what does PITC stand for? Okay, it stands for Patient in the Chair. So this part of the notes is basically you’ve got a patient in the chair and you urgently need something from the podcast.

You remember listening to a really important gem that’s gonna help you with your patient that’s in the chair right now. I need to find that piece of information. I know that people have done this before when they have a resin bonded bridge to fit and they’re frantically going through my resin bonded bridge course before they fit that bridge.

And so in the same vein, PITC, the patient in the chair, I’m gonna give you the top five or six most actionable tips right at the top from all the future notes including this one. Obviously it wouldn’t be relevant for this one ’cause he wouldn’t have like a patient with back pain in the chair. It’s more to do with you.

But you get the idea. It’s a new thing that we’re starting, but the whole, all the episodes of the past have got premium notes and transcripts and some of you absolutely swear by them. Shout out to Kostas and Harpardeep who’ve been absolutely pivotal in our little community. I know you guys enjoy the premium notes and the transcripts.

I wanna take a moment to thank all the team that responsible for this episode. That’s Gian, Krissle, Nav. And of course our CPD Queen Mari. And thank you once again, listener, watcher, whether on YouTube or on our very own app. I really appreciate you. Thank you so much, and do not miss the next episode. The next episode is just full of so many gems.

It’s a short but punchy episode on composite veneers and namely how and why Sam does not like the flowables like a Gaenial injectable for composite veneers. He likes to use the paste compule, find out which exact brand that he names drop. And they’re different companies, right? Different companies. He names drop these brands, which ones he’s using that he’s tested and are suitable for injection molding.

That’s right. Compule composite, not flowable. Compule Composite for injection molding. What kind of stents he goes for? Who makes the best stents in his opinion? Because Sam himself has been on so many courses related to injection molding and composite veneers that he shares everything he gives away so much.

So tune into the next episode where you pivot with Sam more into the composite veneers theme and a really interesting story of how things didn’t go to plan and what he learned from that, and the lesson he wants to pass on to us. So don’t forget to hit that subscribe button so you get notified for the next episode and catch you same time, same place next week.

Bye for now.