Got Your Back – Physios and Dentists – PDP025

[Ben]
Most definitely. If there’s one thing to take from this podcast, is that

[Jaz]
Surely being like this, like surely just like, you know, you when you see those photos on people on Phantom head courses, and they’re like, they’re like this, and they’re like, polishing something. And they’re like that. I mean, granted, we won’t be probably not like that for longer than a couple of minutes at a time, you know, when you’re doing the distal lingual of a six or a seven. And you just have to do it. I think after listening to today, and listen to you guys, I’m gonna feel less guilty about doing that. And I’m just gonna just move along afterwards.

Jaz’s Introduction: Hi, guys, it’s Jaz, again. I want to ask you a question. How much money do we spend as a profession, on our practices, on our chairs, on the service and maintenance of our equipment, on scanners, hand pieces, and generally just making sure that we have our favorite kit available? What is the most valuable piece of equipment, or maybe not equipment, but most valuable asset in your practice? It is your health, your hands, your mental health, your physical health. And of course, when you consider that 94% of dentists will retire with backache. And apparently 100% of nurses will retire with backache, it makes you really wonder about our priorities do we actually look after our health as much as we should be? And combine that with a stressful position with a sort of confined environment and the different postures that we have to adapt? Now I mentioned postures but one of the most profound things about this podcast episode is that I learned that actually, the posture is really overrated in dentistry. I could not believe it. You hear my reactions through the podcast. This podcast episode is done with two physiotherapist, Sam and Ben. Sam is actually a physiotherapist turned dentist so he can give us the view from sort of both sides of profession, physio and dentistry. So this is a quite unique episode if you’d like I picked up quite a few nuggets about my own personal health. The Protrusive Dental pearl, I want to give you today is a reading list. Ben actually shared one of his favorite books in the episode and the book is called ‘Why we sleep?’ And so that got me thinking. And I had a few messages from people asking about my reading list after I’d mentioned those Brian Tracy books on a few episodes ago. So basically, I’ve put together a little book list, you can find that on the website, protrusive co.uk/books, and you can access that I’m going to stick it on the Protrusive Dental community Facebook group as well. So I’m gonna just my basic recommended books are read, I’m very much a disclaimer is that the books that I put on there are very much my own taste and the kind of books I’m into is self help, self development, productivity, social sciences, things, you know, things like Malcolm Gladwell, for example. So those kind of books I’m into also personal finance. I’ve got two personal finance books on there as well, which is you know, what time during COVID to consider things something reading into something like that, how to actually learn about looking after your personal finances something I’ve taken interest in last couple years. I’ve got that on the protrusive co.uk/books, and we’re going to jump straight to the episode. I’ll catch you in the outro.

Main Interview: Guys, we’ll just dive right in, as I say, and we’ll start the Protrusive Dental podcast guys, for those of you who are listening. I haven’t met Sam and I certainly haven’t met or emailed Ben before, but we’re having the first ever Protrusive three way.

[Ben]
Excellent. Wow. Yeah.

[Jaz]
Let’s start with Sam. Sam, tell us about your, because we started connected by email you listen to podcasts, and I think you can add some great value to the listeners today. Tell the listeners about your background in terms of you know, your dentistry but before your dentistry which makes you in a position to be able to talk about the sort of things that we’ll be talking about today.

[Sam]
Yes, why I qualified from Kings in 2015. Then I worked as a locum physiotherapist in the Northwest and that’s where I got good interest in musculoskeletal physio. Then after that, I decided that I wanted to do dentistry so I was on the dentistry course and the four year program. And then while I was there, I was an associate for a private company where I saw NHS private patients. I was also the physiotherapist for Merseyside Fire and Rescue in the Philharmonic Orchestra. So lots of perks there. [Jaz] Wow. Very nice. [Sam] And then, but I found that when I was working, I was seeing a lot of dentists. And I was also seeing a lot of students as well. And that’s what kind of got me and me interested in you know why is dentistry such a high risk profession for lower back pain, neck pain, and that was what the majority of that was coming in was lower back neck pain, upper back pain. And it also found that when I was going on placements as well, I’d ask, you know, the principals, you know, why do you work, you know, why don’t you work four days a week? Why you work reduced hours? and most of them would say, Oh, it’s because of my back pain or because of my neck pain. So it does have quite large impacts on dentist life I found.

[Jaz]
Absolutely. And when you said so you qualified 2015 that was not in dentistry there right? What was it?

[Sam]
That was in physiotherapy so then I qualified dentistry last year.

[Jaz]
Amazing. And then when you were doing your locum that was a locum physiotherapist, right? [Sam] I was like in physiotherapy [Jaz] I’m about to say, you’re on this accelerated four year program, you’re able to practice dentistry as students of that year. Sam definitely was not doing that if anyone’s listening have that sort of nature. But no that’s pretty interesting story. And now you’ve developed an interest in that obviously, because of your very unique background, I think, do you know anyone else who’s had a physio / dental background like yourself?

[Sam]
Well, I was speaking to Ben about this before, but I actually know that well, it was a physiotherapist that had gone on to do dentistry that helped me get into into dentistry. [Jaz] Also at Kings? [Sam] Also at Kings Yeah.

[Jaz]
Cool. Very, very good. It’s good to have that four year program actually. Which helps, I think just to shorten the know, the five year degree. Ben, tell us about yourself. Your background, I believe is in musculoskeletal pain.

[Ben]
Yeah, absolutely. I mean, well, before I introduce so Jaz, I just want to say a huge thanks for having me on the podcast really. Also, I really appreciate what you’re doing for dentists. I think it’s really important to ask questions, you know, whether it’s dentists, physios, doctors, you know, it’s really important that we stay current that we stay evidence based and that and we’re learning all the time so yeah, kudos to you for putting this on really. I must say that, you know, I probably wouldn’t be the clinician I am today without podcasts. I mean, shout out to the physio podcast out there says choose health. There’s a NAF physio podcast, there’s Physio Edge, Strength Physio. And honestly, without that their input, I wouldn’t be the clinician I am today. Certainly. So

[Jaz]
I actually listened to one of the physio podcast says Sam. Oh, yeah, I think it was the physio edge. Right? You sent me an episode?

[Sam]
Yeah,

[Ben]
Yeah, it was with David Pope.

[Jaz]
I think it was,

[Ben]
Honestly, if I was a patient, I would want David Pope to be my physio. He just sounds like the nicest man. But you’d want to tell him about your pain, you’d want to because he’s got this really soft Australian accent. And as I say, if I could pick a physio I’d pm him every day.

[Jaz]
It was a very good and smooth listen. And it was great to open my eyes to that well, you know. So tell us about how do you two know each other?

[Sam]
So we qualified from Kings together? So we went through right the way through physio school, in the sense, and then we just kept in contact ever since.

[Ben]
Yeah. So I didn’t even introduce myself. Did I? Yeah, let’s go back to that bit. Sorry, I went off track. So I’m Ben. I’m a physio. I’ve been working in the NHS for a number of years. Currently, my role, I see a lot of GP referrals. So if we go to like, a GP with neck, back, shoulder, knee pain, you probably see someone like me. My, I’m doing work in pain management at the moment, which is slightly like a more specialist area. So essentially, it’s for patients that have had pain for longer than six months. So it’s become a little bit more ongoing, a bit more persistent. And the goal isn’t necessarily to reduce their pain, but in fact, be more functional and live better with it. So we it’s not just exercise, it’s stuff like sleep, stress, diet, medications, doing a setback plan, thoughts, feelings, emotions. So it involves a bit of psychology training as well. So yeah, that’s kind of my current area of work. I think that’s probably why Sam reached out to me because, you know, as I say, and what Sam said is dental practitioners seem to be a high risk group.

[Jaz]
Yeah, I mean, I had something like 94% of the dentist. I don’t know where I got this figure from, you know how they say 66% of all figures are made up. It could be one of those but 94% of dentists will retire with back problems, and 100% of nurses apparently will retire [All] 100% [Jaz] Yeah, apparently so that I don’t know where I got this from. But, tell us how prevalent is it? We’re, over the run both of you. And, you know, we’ll just dive right in in terms of making it valuable for the listener. What do dentists, hygienists, therapists, and nurses need to do to make sure we don’t end up retiring with or due to back problems?

[Ben]
He laid on that.

[Sam]
Yeah. So the prevalence is, it’s 60% to 94% of dentists will experience [Jaz] See! 94. [Sam] But they experienced some sort of musculoskeletal pain at some point in their life. That’s from a systematic review that one. Well, the prevalence of lower back pain is particular is massive. It’s the leading cause of long term disability. 7% of GP consultations as well are from lower back pain. For dentist, lower back pain is the most common, then it’s the neck and then shoulders. In terms of what causes it, I think, whenever I speak to dentists, if you say, oh, I’ve got lower back pain, they’ll instantly say, you know, what your posture like? How do you sit? Do you use loupes? And if you spoke to a physiotherapist, exactly the same thing, they’d be saying, how much exercise are you doing? You know, are you moving around a lot? And it is, it goes from, you know, almost like 1985 physiotherapist, we’re changing people’s postures and making sure that we’re sitting right. Whereas now on the most current things are just to keep you moving. So I think, the reason why I’ve got Ben on here as well, it’s because you’re like, whenever I have any physio questions, and [Ben] Thank you, mate, for saying that. [Sam] yeah, I like is one of the best things that Ben ever taught me or led me to was the best posture is the next posture. And that,

[Jaz]
Okay, tell me about that. And again, at the back. Oh, as in get you moving? I like that.

[Sam]
Yeah, exactly. So if you’re in one position for a long period of time, then you’re going to get pain regardless of its, you know, bolt upright, elbows at 90 degrees with loupes on if you’re in that position for a long period of time, eventually, you’ll get pain.

[Jaz]
We’re saying that is even though we’re using magnification, which is keeping our head away if we’re the problem is not necessarily the posture. The problem, are you trying to say is that the lack of movement?

[Sam]
Yeah, exactly. I mean, they did, there was a systematic review, very recent one that looked at saddle chairs and loupes. And they all agreed that loupes could improve your posture, that it would improve your dentistry, you do get better crown preps and things, but they never, not once did they say it will reduce your pain because no studies seem to look at it. And one of the reasons for that is because they never find that the posture, links to pain and I think Ben’s very good at talking about posture so

[Jaz]
Tell us Ben about posture. So have we as a dental industry over playing the role of posture.

[Ben]
Most definitely. If there’s one thing to take from this podcast, is that

[Jaz]
That is for me, I mean, that I think that’s going to send the shockwaves I think this is crazy to think that

[Ben]
I’m probably gonna upset a lot of loupe and scope companies with this. And I am aware of that, but yeah, so essentially, if you know, asked a physio, maybe 30 years ago, how important is posture they probably say you know this much. Now with thinking it’s probably this if that I mean, there was a paper came out 2011 it was a systematic reviews and there was an association, a link with posture and back pain, so and that’s the awkward postures, manual handling, prolonged setting, all those things I just simply not linked with back pain. It’s because back pain is essentially a medically unexplained symptom. It’s, you know, you can have all the scans under the sun and it’s going to show some change there but we’ve got absolutely no idea what is actually causing it. It is going to be multifactorial, when it’s gonna be individual. A lot of what we understand about pain now is that it’s about the tissues. It’s about the nervous system. We interpret the feedback from our tissue, if, you know if our nervous system is heightened somehow, which includes our brain, etc, then it’s going to be super sensitive to stimulus. So if you’re in an awkward posture at work say you’ve got a really busy clinic, you might be what running 15 minutes late. You know, I’m aware that I was gonna sweat and but if you mess it up, I’m not sure if I’m allowed to swear. So I call myself

[Jaz]
on Apple podcast, I put myself as explicit. So it’s fine.

[Ben]
Yey, I’m off the hook. But yeah, so I’m aware that if you guys mess it up, you know, you’ve got litigation and stuff. So that’s obviously presence, though, it’s almost, you’ve got a couple of things there that are kind of risk factors stuff like this

[Jaz]
So the fact that Yeah, the stress is heightened in our profession. It’s fast pace. So that’s messing with our sort of the neuroscience part, which, you know, I think I appreciate it. It changes your perhaps it changes, what in dentistry, we have something called adaptive capacity. Is that something that’s relevant in physio as well?

[Ben]
Mate 100%. You’ve nailed it there. So when pain has been going on for longer than six months, it’s not about the tissue. It’s about the nervous system. And so if you’ve got pain for like, longer than six months, your nervous system, it’s neuroplasticity? So [sign up to Genesis,] stuff like increased transmitters. You have more neurons. It’s a bit like if you have an amateur violinist, yeah, that their cortical mapping in their brain is going to be for that hands is going to be fairly small. But if you get an expert violinists, the cortical mapping is gonna be huge, right? If you remember, not sure if you guys go through like the homunculus in the brain and stuff like that in your training, but the mapping is a lot more so your nervous system changes to stimulus. So that’s the same thing happens with pain. Once you’ve had it for a long period of time. It’s not about the tissue. It’s about the nervous system. And that’s what that’s how we kind of want to target back pain. it’s not postural, it’s not tissue focused as such is more about looking after yourself, sleeping while, doing some form of exercise that you enjoy, eating well. Not worrying about things especially about posture. And yeah, I suppose I’ve listened to a couple of your podcasts, Jaz, as I say I think I like how you look for the Dental pearls you know, the the bits of wisdom to take away. Unfortunately, I can’t really give you like a big answer in terms of like a quick hack, but it’s simply is just looking after yourself, mate. Really.

[Jaz]
That’s fantastic. Sam, you probably listened to more episodes than what Ben has it being in obviously a dentist now. Do you, can you see the similarities in terms of what Ben is saying? And what Barry Glassman says in terms of the role of occlusion and parafunction because what everything you’re saying is very much echoed by what Barry, Barry Glassman, Ben if you don’t know is an oral facial pain specialist, right?

[Ben]
He’s the one you spoke about bruxism on your communication in bruxism was that?

[Jaz]
That was no, that was Episode 11. But he’s also similar count they prescribed the similar appliances these are you know anterior only appliances but what Barry Glassman also says that it’s very similar to you guys saying. So you guys’ saying okay, no, it’s not posture. It’s, andd you also mentioned about, you know, neuroplasticity, but in Barry and his over philosophy, which I very much agree with it, it’s not the bite, it’s not the fact that the bites messed up. It’s the fact that we’re parafunctioning, it’s our muscles, you know, contracting purposely, that leads to all the tissue damage, and then also that pain becomes chronic. And then that becomes, that changes the neuroplasticity. It was him who introduced me to that term neuroplasticity a few years ago. So I’m just drawing these parallels in what you’re saying. And I’m always apologetic, but yet not sorry. At the same time to bring it always back to occlusion, which is one of my favorite things to talk about. But it’s true. Sam, what do you think about that?

[Sam]
I think that’s really similar to TMJ pain and how you treat that and especially with bruxists, because you’ve always got to take Yes, you have the physical symptoms of bruxism which is the tooth damage and wear, but then you’ve also got the psychological factors of, you know, they’re not getting enough sleep at night or they’ve got children is really hard to look after or social problems where they’re having problems at work or they haven’t gotten back access to hobbies that they used to like to do and things and just building on the stress. So I think really the main thing is, you know, in terms of from that, but also linking it to back pain is that if you are feeling back pain, is it because, you know, don’t always think, Oh, it’s because of my posture is because of some sort of physical entity, think about the social things that are going on in your life. Now, whether you’re having lots of family problems, your girlfriend’s broken up with you, you’ve been then like Ben was saying before, you know, if you’re running late, and things like that, you know, all those things will impact on your back pain. And I think like the psychological and the social factors are probably, you know, probably the reason why you’re getting the back pain rather than, you’ll always find that the back pain or being the worst when, say, you know, you run in, you know, half an hour late, and then your crowns not fit, or you’ve got a screaming child in the chair that won’t take the fluoride varnish.

[Ben]
Yeah, but also is kind of always separate in mind and body there in the sense of, I call it [inaudible], where, you know, the tissues are here and the psychosocial was over here. But you know, in the day, when we’re treating a person here, you know, that they’re one on the same, if you’re having pain, you’re gonna have, you’re gonna probably be a bit irritable with your partner, you’re gonna be a little bit more stressed than normal. Pain is quite complex like that, you know, it kind of permeates into all facets of our lives. So kind of, unknowingly, or knowingly, but yeah, so apart

[Jaz]
As a much more profound effect, then at the surface level

[Ben]
100%. And patients tell me all the time, you know, it’s really frustrating, because it’s invisible, you can’t see it, you know, so, on the surface, I look like, I’m fine. But actually, I, you know, the secondary suffering as a result of this pain is quite profound. So yeah, that’s part of my role is talking about how to, how can people be more functional and live better with it. You know, okay, the pain’s there, it’s pissing, I’m sorry, I’m gonna swear, it’s pissing them off. And it’s permeating the facets of their life. But can they control stuff like sleep? Can they manage their stress? Can they get a little bit more active? Can we give them a plan for when they do have a setback of their pain? So it’s a fairly holistic and comprehensive approach to the management really, rather than just a tissue

[Jaz]
Well, both of you, if you can just cover a couple of scenarios then is that the dentist or hygienist or nurse who has not started maybe because they’re early in the career started to show signs of back problems? What advice can you give preventatively, and maybe a few minutes later, you can then give some advice to those who are now suffering, you know, dentists, nurses, therapists who are now suffering with pain. Is your advice essentially the same for both of them? Or can you tweak it to make it tailored to that individual under those circumstances? So please, who would like to touch on that first?

[Sam]
Yeah. So in terms of preventative advice, the best thing to do is to keep as active as possible, the NHS guidelines, say to do 150 minutes of moderate intensity exercise, or 75 minutes of vigorous intensity exercise. And, you know, a lot of people think, oh, I’ve got back pain, so I need to do planks or core or, but if you’re running, swimming, doing an any exercise that you enjoy, you’re going to be improving all of those structures anyway. And a famous Aristotle quote, is that ‘Excellence is not an act, it’s a habit.’ So you have to do the exercise that you like, because that’s the exercise that you’ll continue to do. And then you’ll keep yourself strong and enjoy a more fruitful career or on a longer career as well. And then in terms of if say, of a hygienist or a dentist would get in pain. I think Ben’s probably the best for this.

[Jaz]
Yeah, I think that’s a good way. So Sam, you’ve covered prevention, some tips about prevention, doing exercise and the importance of that. So Ben, now we have the dentists, hygienists, therapists, or whoever who is now suffering with lower back pain and they think, Oh, yes, because I’m a dentist. I’m like this all day long. They might then buy a microscope for their practice, and they might still say Actually, no, I’m still suffering. And they might come and see someone like you, what would you do? What would you advise?

[Ben]
Yeah, I think I suppose it kind of depends on the individual and how long they’ve had it. But I suppose it’s if you’ve been suffering for a long time. And I think the first thing is to get a good physio. There’s a lot of kind of non evidence based kind of care out there. And you want to be seen a physio that is evidence based, it’s current. There’s movement in the MSK professional at the moment called MSK Reform and the big Rs. And essentially, we’re trying to lobby like government and our governing body to improve the standard of practice, and to get us better regulated. But yeah, see a really good physio, because it’s really difficult to do on your own. Pain is a tough thing to manage. And it’s a tough obviously getting a good physio, probably a good start, but I think with back pain, neck pain, etc, that it’s doing some form of movement, and that’s going to be quite scary. Because when you’re in pain, you should rest, right? No, it’s actually the flip side, you need to move more and you’re not going to be making your back pain any worse by moving with pain, as long as you can tolerate it. Pain does not always mean damage. A good example is I’ll get my examples out here, but a hangnail, paper cut, stubbing your toe, you know, treading on Lego, all these things are super duper painful. And how much damage is there?

[Jaz]
It’s not proportional to the pain.

[Ben]
It’s not. It’s a very unreliable message of tissue damage. And people around you will say, No, you shouldn’t be doing that, because you’re in pain. But actually you should be because that’s going to desensitize your nervous system, it’s going to give you the confidence to move more, which is going to help you condition so yeah, pain doesn’t always mean damage. And so find a level of activity that you can do, that you can tolerate, and slowly, slowly, slowly build it up over a period of time.

[Jaz]
Is Pilates supposed to be a good one? Pilates?

[Ben]
It’s a very popular one. And the reason it’s popular is it’s quite low level when it’s very social. So I mean, you could do that in any class really, essentially, a paper came out in like the 80s. That suggest the link between core stability and back pain and physios at the time went absolutely bananas about it. And there’s and that’s why today you see so many Pilates classes, since it was only one paper. So since it has been debunked. And it’s also like, Sam was saying, it’s just important to do any form of exercise no matter whether it’s Pilates swimming, running classes, yoga, whatever, really. So yeah, it’s important to kind of realize that. Pilates, I mean, I’m not pooh poohing Pilates at all. I think it’s a really good start. Because, I mean, I’ve done Pilates classes and bloody hard work to be honest. But yeah, it’s not the be all and end all is what I’m saying. And it’s a great start to get people moving. And plus, with a class, it’s socials. I mean, we’re social animals. And today, and if you haven’t exercised before, I would say find something as simple as I’m saying that you’d like that social and is led by a professional because they’re going to be on it. Yeah, you know, do this, do that. And after a couple of weeks, you’re going to be seeing the same faces and you’re going to be chatting to your classmates. And as I say, we’re social animals, so and you’re not doing it on your own. Yeah, you know, another initiative is powerful run. I love powerful run at the moment. Get your local path and run for free in the community. What a great idea.

[Jaz]
Brilliant, so you’re all you’re saying is find a good physio who is evidence based and focus in that and I completely agree. No, I used to think many years ago that everyone qualifies in any profession when I was younger, like my teens, I think okay, all dentists are the same, or doctors are the same on any profession are the same. And I still, you know, you learn over time that actually no, not everyone is as evidence focus. Not you know, and I know some plenty, let’s not get into I’m not gonna give any examples, but yeah, I think you know, where I was heading there, but

[Ben]
Yeah, if I dive in with non evidence based stuff, I think that would probably be a good shout. So stuff like manual therapy. I mean, it does have some evidence, but it’s very short term. So stuff like, like massage, some are actually a really popular one. The way it works isn’t how people think, it doesn’t change your muscles at all, because there’s no friction, right? So when you rub the skin, I mean, you could rub it all day, every day, you know, you’re not going to change the muscles in terms of their health, but what it will do, because you get the massage is going to release the body’s natural painkillers, desensitizing that nervous system for, if it’s a crap massage a couple of hours, if a good massage, you know, week, two weeks. So yeah, that’s not going to be good for long term management of the back or neck pain. I probably put mobilizations and manipulations in there as well. So that they’re some people might have had those before where people were treating joints, getting a click that kind of thing. The effects of those are fairly short term as well. So okay, if you’re looking for short term relief, but not for long term relief, and stuff about like, biomechanics and getting in souls and stuff like that, you know, the evidence for that is kind of fairly low. Acupuncture is another one. And acupuncture has been taken off the back pain guidance for the NHS, the nice guidance, because versus placebo, it’s a [inaudible] It has equal effects, same with ultrasound. So, if any, if your physio starts getting those kind of treatments out, you probably want to question whether they’re the physio for you basically.

[Jaz]
That is really, really good, useful insight. Honestly, like, you know, you don’t get this sort of insight in terms of what’s a good physio, what’s not. And I think by getting that information that you did, it will help a lot of dentists who may already be seeing a physio thinking actually, is this really working or not? Sam, can I ask you a couple of questions in terms of, you know, obviously, you’re full time dentist at the moment?

[Sam]
Yeah, so I’m in my foundation year at the moment. Yeah.

[Jaz]
How do you finding it? We’re about to do it, man.

[Sam]
Good. I’m in the Meols actually at the moment, which is just near Liverpool. As you can probably tell from my accent.

[Jaz]
Yeah, I was in the Meols, actually, this weekend. I wish I’d known I would have invited you to do this in person. But and this is probably the best Coronavirus situation actually.

[Sam]
Yeah, even at the practice I’ve been, I’d say I’ve given advice or even treated every single person in the practice now say,

[Jaz]
Well, you know, you’ve got an added skill set. Well, what I want to ask you is, as a wet fingered dentist now, can you tell us some things that we could be doing at work? So obviously, Ben covered very nicely about physios and the role of movement? What can we do while we’re at work nine to five, to help the cause? And also one question, I really want to get that is there any evidence that we’re probably not any evidence because probably never been studied, but doing checkups while you’re standing up? I heard Oh, yeah, that’s supposed to be good. But then that’s really relating to the posture theory, right? But you tell me.

[Sam]
So what I use loupes all the time, and I do find that helps. But when I’m doing my examinations and things, I’m never in one position. So at university a lot of the time, they always tell you to, you know, to sit down and to make sure you know you’re in a good position, you stay in that one position. But I remember I’m going to name drop, but I remember Ian Dunn came around and he’s great. He’s one of the Perrier guys, and he was saying, you know, you got to keep moving around, your patient to be able to do the best dentistry and that’s really true. And that’s, you know, if you’re moving around the patient, even when you’re doing a checkup, or, or anything, that’s absolutely great. I’d say that to keep yourself moving rather than the nurse going to get the patient. You know, even just walking out to go and meet your patient and bring them back in is good. And that’s also good to help build rapport with your patient because you’d have a little bit of chitchat before you come in and you get your exercise and, or a better you know, getting your steps on your watch. And yeah, those are the two main things that that I say in terms of the sitting into standing. You know, if you find that sitting down when you do your dentistry is is good for you then that’s what you should continue doing. If you find that standing up, you find that the pain is less or you enjoy standing up more than, do that. To keep yourself moving, sometimes it’s good to have every other patient you could stand up because if you stand up, you end up putting more pressure on your back. Whereas when you sat down, you put more pressure on your upper back. But everybody sits different. And it’s really an individual approach that you have to take. This is why in terms of posture, and you know, it’s easy to prescribe posture because there’s just a one size fits all, when really, it’s a one size fits no one.

[Jaz]
That’s really interesting. One thing that reminds me of is that in every single practice I’ve ever been to, that everyone’s got that same poster, the BDA poster, and tells you about all the stretches you have to do in between your patients that might help. So the role of stretching? Is it overplayed? Or is it is stretching, good for preventing back pain?

[Ben]
I could go on that one time. All right. So yeah, stretching is an interesting one, actually. So there’s a bit of debate in the research in terms of what it does. We used to think it changes tissue length, right? So if you stretch, you know, the muscle, it increases in sarcomeres in series, so you get a longer muscle to then when you stretch it. You know, it’s Yeah, you get more range, basically. That’s still there. But that was quite a while ago, what they’re starting to learn now is it’s actually to do with stretch tolerance. So your muscle doesn’t really change. But actually your tolerance to that movement changes. Which is why you can get changes fairly quickly, you know, you probably might have noticed if you stretch every day, not that I would ever do that, because I’m not a fan of stretching. But if you do that everyday, you get changes fairly quickly. And that’s not necessarily because of changes in the tissue, which, you know, if you go to the gym, you know, you might get a buffer three months ahead. But with stretching, it happens in a very short space of time. And that’s because it changes in the nervous system rather than changes in the muscle. To answer your question directly Jaz, is it important that you do those stretches? I would say, you know if they help you then yes, but you’re probably far better off just doing something you’re like outside of work.

[Sam]
You have time to do what it is just between patients as well.

[Ben]
Yeah, God, you guys are busy enough. You don’t want to put like an extra thing on your plate, man. Don’t do that.

[Jaz]
That has been so enlightening. Honestly, learning about the power postures overplayed was crazy. And I actually really love how both of you have constantly every couple of minutes mentioned some evidence base as well. You know, massive respect for that.

[Ben]
No fair play. I think, as I said in the start, like it’s important, we are current an evidence based. Otherwise, that’s how we deliver the best care for our patients. I mean, you guys must notice it in dentistry, you know, it changes every five or 10 years. So if you’re not up to date, then you know, well, the stretch example is a great example. You know, we’ve kind of flipped it on its head completely there. And I’m

[Jaz]
I’m still mind blown about posture. Honestly, I was gonna, I don’t know, maybe Sam, do you think everyone’s gonna be surprised? Listen to this, or, am I just late to the party? And I didn’t know

[Sam]
Yeah, I’ve given some presentations at Liverpool University to all the lecturers and it was a shock to them. It just blew me like, I was speaking to like, some of the professors and like, even sometimes you hear, like, as I’m given the lecture, you hear people gasp. But it doesn’t matter. Because you see everybody looking at each other as you get into it, and they’re like, Oh, yeah, he’s gonna talk about I’m gonna sit right. And then the next minute, you say, oh, it doesn’t matter. And everybody’s shocked.

[Jaz]
That’s really cool.

[Ben]
It’s interesting, because there was a paper that me and Sam threw it was, they got this thing called biofeedback in English, it’s where they, it basically shocks you to put you in a good position. If you’re not in a good position. And it made people’s pain worse. So in fact, you know, there’s evidence that focusing on posture too much actually makes it worse. And it makes sense, right? So if pain is perceived in the nervous system, and you’re thinking about your posture all the time, you’re like, you’re in a position, whatever position you’re in and you’re like, Oh, shit, I need to. So you’re thinking about it, you’re re registering those messages, you get in those neurons firing by thinking about it. So actually, you just need to change you’re position for symptom relief and do all those bits I mentioned outside of work so

[Jaz]
I say the same thing to the people who overcomplicate and my patients who think much about their bite, or think too much about the position of their tongue, that you know, just relax. And you know, it’s the same thing with people who focus too much about their posture, people who focus too much on the position of their anatomy and their bite and stuff. I was drawing parallels in my head, as you said that

[Sam]
I think one of the one of the facts that I quite like getting in is that for the last 84,000 generations of homosapien, we’ve been walking or running for 10 miles a day. For the last few generations, the average amount of walking or running is less than a kilometer a day. And our genes are geared to move that amount. And then as soon as you’re moving so much less, you know, you can’t change your genetics, our bodies are meant to move. So as soon as you’re putting that static position, or if you’re not exercising outside work, that’s why you get in these problems, because we’re just not designed to be static and immobile. We’re designed to move. And that’s why Ben’s saying all the time, you know, the thing that’s gonna get, the better is movement, when you’re in pain, you need to move. And that’s because our body that’s what your body’s screaming out for. And also, when you do get back pain, you know it a lot. You know, we were saying before that it’s not due to physical injury, but a lot of the time feeling a bit of back pain is a preventative mechanism that your brain uses to tell you to move on as soon and and, you know, dentists will say oh, what position should I move in, but we even me and Ben speaking the other night, and we were saying that it’s okay to slouch. If you find that slouching is comfortable, then perform your dentistry in a slouched position. And then, eventually, over time, like we said, if you’re in one position for a long period of time, you’re most likely going to get pain. So if you’re in pain when you’re starting, then move to a different position. But don’t ever be afraid to slouch. And you’re fine. I mean, one of my friends is doing the FD. And their TPD was budging, and telling them not to slouch and to sit up straight. So yeah.

[Jaz]
Did you have to bite your tongue for that one?

[Sam]
Well, yeah, you’ve got too many.

[Jaz]
But surely being like this, like surely just like, you know you see those photos on people on Phantom head courses. And they’re like, they’re like this, and they’re like, polishing something. And they’re like, I mean, granted, you won’t be probably not like that for longer than a couple of minutes at a time, you know, when you’re doing the distal lingual of a six or a seven, and you have to do it. I think after listening to today, and listen to you guys, I’m gonna feel less guilty about doing that. And I’m just gonna just move along afterwards.

[Sam]
I think we know that, you know, if you put your arm out in front of you, for a small amount of time, it’s not painful. But if you look after there for like, you know, a couple of minutes, it would start to get tired and painful. And that’s the same with lean and over with the Phantom heads, you will only be able to physically be able to stay there for so long before you can’t bear and you have to bend change to the other side. So

[Jaz]
Listen to your body.

[Ben]
Yeah, I mean, we’ve talked a lot about moving here. And you know, I suppose that when we talk about movement, we refer to the tissues I think if we zoom out as well, like it’s important we look after ourselves, like, exercise is a component of that. But you got to also focus on stuff like sleep. I mean, if any of you guys are a science geek, so you’re definitely I mean, I know that Sam’s read it, but if you ever read ‘Why we sleep?’ by Matthew Walker, it’s an absolute blockbuster, honestly, it’s like the Forgotten pillar of medicine, in my opinion. So getting a good night’s sleep in is really important. You know, managing your stress, however, that’s a very tough thing to do, but try to mitigate that as best possible. Eating well. And yeah, just all those things that you might have come across. Dr. Rangan Chatterjee, he was on the tele GP at home, he talks about the four pillars of medicine, which are lifestyle medicine, and that is exercise, diet, sleep, and, and being more relaxed and less stressed, and most people are missing one or two of those. So if whatever the low hanging fruit is the one of those that you feel like you could probably address because at the end of the day, we’re healthcare professionals and clinicians and we need to look after ourselves and we can look after others, you know, question self care is quite a big thing at the moment. So yeah, just sometimes it’s, I mean, we’ve all done it. We just get caught up in worrying too much. And we take a lot on, we’ve got family, we got kids, we got all these responsibilities, and sometimes you got to kind of take a step back and think right, what can I do to look after myself, and that’s gonna motivate the nervous system, which is going to help your back pain.

[Jaz]
I’ll definitely download the book, the ‘Why we sleep?’ Obviously, I’m going to definitely download the book, the ‘Why we sleep?’ And I’m definitely gonna download it for another reasons because, Ben, you’ve got all these books behind you, but I am certain you’re someone who’s read these books. So that’s the message I got today.

[Ben]
I yeah, I mean, I don’t profess to be like a I don’t have any investment in Matthew Walker’s books or whatever by for like, at least 10 people buy things that are off the back of

[Jaz]
I think about 500 people will purchase this, now that you recommended it. So

[Ben]
I’ll let Matthew Walker know. I did tweet him.

[Jaz]
Sam, sorry, Sam, you’re gonna say something there?

[Sam]
Yeah, I was gonna say me and Ben was speaking the other day. And we were saying, you know, Why do you Dentists have such a high risk of guests in back pain, neck pain and all these other pains? No, we’ve already said that. It’s not to do with posture and things. So we were saying that the one thing that Dentists have that most of the, you know most of the professions don’t have is the map stress that we’re under. And I think a lot of dentists work, you know, work alone, which at the moment, I think it is changing, where dentists are talking to each other a lot more. And it’s great that like in foundation year, you every week here with colleagues, and you speak about different things that go on. And I think that’s probably the most important thing to prevent back pain. And general well being is to listen to things like headspace, calm, to even meditate and just try and stay stress free that way. But another way is, you know, keeping really social and joining things, I think you’ve gone on quite a few times about Dentinal Tubules, which I think is really good and connecting people and go into as many conferences and courses as possible so that you can interact with different dentists so that you know that you’re not alone when you get your first complaint letter or when that dreaded GDC letter comes through your door or if it ever comes through your door.

[Jaz]
It’s so true, man I was on. I know Ben had listened to Episode 11 Communicating with Bruxist. But Barry Oulton also done communication courses for Dentists. And when I went through this course, I learned that 17%, according to a survey of dentists had considered taking their life at one stage. So then that just reflects Yeah, it’s crazy, Ben. I mean, it just reflects the stress that we do have in our profession. But I think you two, the way you’ve covered it today have debunked a lot of myths that are out there, which really, really shocked me, honestly. And I’ve learned so much from that. Is there anything any final comments you’d like to add?

[Ben]
You first Sam?

[Sam]
Yeah. So Well, we’ve, we really want to promote kind of self help and strategies for dentists and we, me and Ben at the moment, currently putting forward something called the Tooth Physio, which is on Twitter, and Instagram at the moment. And we’re thinking or we’re going to see whether we can try and put a course together as well, where we can go through case studies and go through exercises and different things like that, that can help specifically aimed at dentists to help dentists. But I think the main things to take away from today would be that the back is really, really strong, tons of muscles, ligaments, fascia that are protected. The reason why it’s painful, won’t be to do with posture, it will be because of other psychosocial factors that are going on in life as well. And if you are in pain, that the road to recovery is never a positive correlation. It’s always got pitfalls and things. But if you are in any worry about your back pain, the best thing to do is to seek help from, like Ben said, and evidence based healthcare professional, and to go from it that way. And they’ll be able to give you self management strategies and help to manage the pain getting back to activity faster, and I’ll give you a paced exercise program that you can work with just to get you back to activity and get you back working as well. That’d be the messages I’d give.

[Jaz]
Can I just intervene, Ben, before you go is that on the last episode, I just published it the other day. One of my pearls I shared was to go on the ACP TMD website, which is the charted sort of physiotherapist in TMD. So those physiotherapists who have got a special interest in TMD. And I found that really helpful to connect with my local physiotherapist who has done further training in TMD. And I had lunch with him and I learned some stuff from him. Some, where can dentists go if they want to find a physio like you who’s obviously evidence based and cares very much to Give up an evenings Come on a podcast like this? Where can we find you? Obviously, I’ll put your contact details for those in London but if someone, somewhere is there like an association that you think are a bit more clued on than others?

[Ben]
Yeah, I would say if your area is under Connect health where I work for, and then you definitely get an evidence based care there. If you feel like you’re not I think as I say, see if you can find, if you go on Twitter and you go to MSK Reform, there’ll be a bunch of physios on there that have in high regard, they will guarantee you there’ll be able to recommend a good evidence based physio locally for you and anyone that follows #thebigrs which is also part of that movement so anything like that and I suppose I mean there’s obviously thousands of really good evidence base NHS physios on there so yeah, I think I think yeah, seeking there for MSKR, never seen the reform. But yeah, if not,

[Jaz]
I’ll put your details in there and anyone in London and I’ll put your

[Ben]
Our Twitter handle is at ben_FYS. Fys is spelt F-Y-S. There was a lot of Ben physios as you can probably imagine. So FYS that will do

[Jaz]
I like it. Guys, thank you so much for giving up your evenings come and teaching us so much. One thing I have to mention before we go though, is to do with you, Sam, is that it’s interesting, he said how having the loupes or the scope because of the change of posture will not necessarily mean that you have a better back. But I love the fact that you still have loupes because we both value the importance of magnification and dentistry, right? I mean, I don’t want people to get the wrong message. And they actually know people on the cusp who are about to purchase magnification, they should not then be put off by what you said they should still go ahead and buy the loupes.

[Sam]
Oh, 100% Yeah, and I use loupes not because it helps my back pain but just because you get you know, you get the magnification in your it’s, you know, the systematic review the set didn’t say anything about it helping back pain said that it does 100% improve your dentistry. And also the light is if you do get it with a light, the lights about four times stronger than the headlight. I use the headlight now and I can’t see a thing when I’m looking at the tooth whereas I put my light on and it’s literally like it. I feel like doing, me and Ben was speaking the other day and he said that dentistry is like he was on one of your podcasts when you talk when somebody was talking about. It’s like working for a letterbox in the dark. Well, why don’t you work for a letterbox with the lifetime?

[Jaz]
Absolutely. I’m just hoping to go through one episode with someone without having to mention some a gem from that Episode Episode 10 Zak, that was Zak Kara episode. Every bloody episode we’re having to refer back to that one episode. So Zak, I know, you listen to this. Bloody good you are, One more thing I forgot to ask which I can just cut in is foam rollers yay or nay?

[Ben]
Nice. So if it feels nice. Absolutely. I mean, I like a bit of foam rolling to be fair. But that’s what you’re doing it for is because it feels nice, it’s not going to, it’s going to give you that short term relief, just like the massage. It’s not going to change the health of your tissues.

[Sam]
And we will say in a good, like pain relieving strategies as well, or what we, what me and Ben used to do but still, it does still really help. So if you’re a dentist and you do have some back pain is getting, say a hot water bottle on it for 20 minutes to use a tennis ball against the wall and kind of rub around the back that can really help to relieve off that acute pain. But it won’t help to get you better, but it will help to reduce the pain. The only thing that will get you better is the exercise and the progressive exercise that you do. But

[Jaz]
I have never moved so much while recording a podcast because you guys

[Ben]
With ice and heat. So interestingly like again, it doesn’t change the tissues below. You’re a mammal. So it doesn’t matter whether you’re in Antarctica or in the Sahara, you’re going to maintain an internal homeostasis no matter what. So you’re doing it for that pain, that difference sensation and some people prefer heat some people for ice. Ice basically reduces the neuron firing. So that’s why it’s less painful. It doesn’t reduce inflammation and swelling because it doesn’t for it to do that. It has to be like your skin would have to, well your tissues, it has would have to be like 27 degrees, and there is no way you’re going to get your tissues below the skin to 27 degrees with ice, it’s just not going to get through. So that’s another myth with ice and heat as well.

[Sam]
That’s unless Rose doesn’t let you on the door.

[Ben]
And you gotta get a titanic reference in there if you can. Jaz, you’re talking about parallels? Right? So I so I had a little dive into your podcast, right? And I expected I expected like physio to be here and dentistry to be here. Right? And I was completely like, you were talking about stuff like communication, how important that is, like developing rapport. Trust, when you get in patients to self manage with like brushing their teeth, flossing, changing diet, stuff like that. I mean, that’s it. I’m basically an exercise salesman, right? So like I was quite amazed at how actually two different professions and working in different kinds of areas. Yeah, we’re providing the same kind of thing being being trustworthy, being honest, coming up with a shared decision with the patient, you know, informed consent, you know, going through their options and the risk versus benefit analysis of this, that and the other and blew me away. I just thought that actually, yeah, we’re actually very much the same.

[Jaz]
I think so. And I missed that physio edge when I also thought about that. I mean, that went in depth about some physio aspects, which I didn’t understand about certain techniques. But yeah, in terms of the overall themes, trying to be evidence base and trying to, you know, essentially it’s healthcare so yeah, it was it was very interesting.

[Ben]
Yeah. And, like Zak Kara Yeah. Like you say, you mentioned him. That was, some of the stuff he mentioned. And I think I took a couple of bits. I think you mentioned about a late patient about how to address that

[Jaz]
How to address, How the reception so cater. Yeah, that was a gem. Honestly, that episode is still one of the you know, the gem, the number of gems per sentence is phenomenal from that one. So it’s as quiet as that. But, guys, thank you so much for coming on. I’ll put all your Twitter handles and Instagram handles on so people can follow the advice that you’re giving. And yeah, really appreciate you coming on.

[Sam] and [Ben] No worries, man.

Jaz’s Outro: Thank you very much for watching all the way to the end. I really appreciate it and if there’s any other topics that you think I should cover, let me know I’ve got loads of episodes sort of edited already, including Complete Dentures with Mark Bishop, Cracked Teeth with Krina Patel, Composite versus Ceramic with none other than the legend Chris Orr. I’ve also got our one of the favorites, Protrusive favorite Zak Kara back on to discuss Presenting Treatment plans and communicating with patients yet again. Don’t forget to hit subscribe on the YouTube and if you also want to stay in tune with the email content that I’m sending out recently, I put a YouTube video up how I take occlusal photos, and only those on social media would have seen it. So if you want that something like that in your inbox, you head over to protrusive.co.uk type in your name and email stuff like that will be coming to your inbox as well. So keep in touch. So anyway, I’ll catch you in the next episode. Thank you so much for listening.