Role of yoga and physical activity in work-related musculoskeletal disorders among dentists

Abstract

Work-related musculoskeletal pain is one of the occupational hazards in dentists.
To find the prevalence and severity of musculoskeletal pain in dentists, to compare musculoskeletal pain among dentists practicing yoga, those practicing physical activities, and those without any physical activity, and also to know the effects of sex, age, and workload on musculoskeletal pain.
A self-reporting work-related questionnaire and the Nordic questionnaire for analysis of musculoskeletal disorders were given to graduated dentists attending Indian dental conference in Mumbai, to know the musculoskeletal pain experienced in the last 12 months and feedback was obtained from 220 dentists.
The prevalence of musculoskeletal pain in dentists was 34.5%. Prevalence of musculoskeletal pain was 10.5%, 21.7%, and 45.6% in dentists with regular yoga practice, other physical activity, and no physical activity, respectively. There was statistically significant difference in the prevalence of musculoskeletal pain among dentists who were practicing yoga when compared with those in no regular activity group.
Within the limitations of the study, there was significant role of physical activity on the quality and quantity of work-related musculoskeletal disorders experienced by dentists. Yoga was found to be more effective than other modes of physical activities. More research is needed on musculoskeletal problems in dentists, with an emphasis on larger sample sizes and correlating other factors like age and sex of the dentists, duration of practice, years of practicing yoga, and working hours per week.

Full text

ISSN : 2231-0762
Journalof
InternationalSocietyof
Preventive&
CommunityDentistry
Publication of International Society of Preventive and Community Dentistry
Vol 5 / Issue 3 / May 2015
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Journal of International Society of Preventive and Community Dentistry • Volume 5 • Issue 3 • May-June 2015 • Pages ??-???

199 Journal of International Society of Preventive and Community Dentistry May-June 2015, Vol. 5, No. 3
Role of yoga and physical activity in work‑related
musculoskeletal disorders among dentists
Suneetha Koneru, Rambabu Tanikonda1
Departments of Periodontics and 1Conservative Dentistry and Endodontics, Vishnu Dental College, Andhra Pradesh, India
Corresponding author (email: <konerusuneetha@gmail.com>)
Dr. Suneetha Koneru, Department of Periodontics, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India.
Abstract
Background: Work‑related musculoskeletal pain is one of the occupational hazards in dentists. Aims: To nd the
prevalence and severity of musculoskeletal pain in dentists, to compare musculoskeletal pain among dentists practicing
yoga, those practicing physical activities, and those without any physical activity, and also to know the effects of sex,
age, and workload on musculoskeletal pain. Materials and Methods: A self‑reporting work‑related questionnaire and the
Nordic questionnaire for analysis of musculoskeletal disorders were given to graduated dentists attending Indian dental
conference in Mumbai, to know the musculoskeletal pain experienced in the last 12 months and feedback was obtained
from 220 dentists. Results: The prevalence of musculoskeletal pain in dentists was 34.5%. Prevalence of musculoskeletal
pain was 10.5%, 21.7%, and 45.6% in dentists with regular yoga practice, other physical activity, and no physical activity,
respectively. There was statistically signicant difference in the prevalence of musculoskeletal pain among dentists who
were practicing yoga when compared with those in no regular activity group. Conclusion: Within the limitations of
the study, there was signicant role of physical activity on the quality and quantity of work‑related musculoskeletal
disorders experienced by dentists. Yoga was found to be more effective than other modes of physical activities. More
research is needed on musculoskeletal problems in dentists, with an emphasis on larger sample sizes and correlating
other factors like age and sex of the dentists, duration of practice, years of practicing yoga, and working hours per week.
Key words: Dentists, musculoskeletal pain, yoga
INTRODUCTION
Work‑related musculoskeletal disorders (MSDs) are
one of the most important occupational health issues
in healthcare workers. Musculoskeletal pain can be an
occupational health problem for medical professionals,
particularly dentists, who sit in static postures using
precision hand and wrist movements.[1]
Majority of dentists (87.2%) suffer from at least one
symptom of musculoskeletal diseases at some point
in their life.[2] Patients with occupational diseases
have not only physical, psychological, and social
consequences, but also economic and security impact
when they reach a level of severity that directly
affects the work capacity, causing absences and early
retirement.[3]
A number of studies have found that the mechanisms
leading to work‑related musculoskeletal pain are
multifactorial. This pain can be attributed to numerous
risk factors including prolonged static postures,
repetitive movements, suboptimal lighting, poor
positioning, genetic predisposition, mental stress,
physical conditioning, and age.[4,5]
Basic operating posture is considered an important
occupational health issue for oral health care clinicians.
It is generally agreed that the physical posture of the
operator, while providing care, should be such that all
muscles are in a relaxed, well‑balanced, and neutral
Original Article
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DOI:
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Koneru and Tanikonda: Work‑related musculoskeletal disorders among dentists
Journal of International Society of Preventive and Community Dentistry 200May-June 2015, Vol. 5, No. 3
position. Postures outside of this neutral position are
likely to cause musculoskeletal discomfort.[5]
There is some evidence for the effectiveness of
strengthening exercises in reducing work‑related MSDs.
There is also a growing interest in the use of stretching
exercises to reduce the risk of work‑related MSDs.[6,7]
Yoga is an ancient system of relaxation, exercise, and
healing that has origins in Indian philosophy. As a
system of healing, it takes a primary approach of
prevention or keeping oneself well by the daily practice.
Yoga is often practiced by healthy individuals with the
aim to achieve relaxation, fitness, and a healthy lifestyle.
Yoga has also been recommended and used for a variety
of medical conditions.[8]
The practice of yoga in the Indian subcontinent has been
documented as early as 3000 BC. Yoga is a science of the
mind and soul. Many researchers have found that yoga is
effective for relieving stress and anxiety conditions that
impact many physical and mental health conditions.[8]
Dentists are among the group of professionals who
have been increasingly referred for physical therapy
and seeking ergonomic advice in the recent past.
There is a scope for further decreasing the prevalence
and severity of these disorders by performing regular
specific exercises. In most of the studies, the dentists are
reported to be relatively inactive and very few perform
some form of physical activity and acknowledge the
benefits of the same. Musculoskeletal complaints
have a significant negative impact on the self‑reported
general health of dentists. The best ergonomic working
principles should be taught to the students, and
dental schools should provide a comfortable working
environment to those practicing dentistry.[9]
The aims and objectives of this study were to find out
the prevalence and severity of musculoskeletal pain
in dentists, to compare musculoskeletal pain among
dentists practicing yoga, those practicing other physical
exercises, and those without any physical exercise, and
also to know the effects of sex, age, and workload on
musculoskeletal pain.
MATERIALS AND METHODS
Participants
The study was conducted on 150 male and 150 female
dentists of age from 30 to 70 years, who attended the
65th Indian Dental Association conference in Mumbai
on February 9–12, 2012.
Study design
The design of the study is presented in Figure 1.
Dentists with minimum of 8 years of clinical practice
and 30 practicing hours per week were considered for
this study. Dentists practicing either yoga (under the
supervision of a qualified yoga master) or some other
physical activity like brisk walking, jogging, or aerobics,
for a period of more than 1 year and a minimum
of four times in a week for at least 1 h per day were
considered as the group with some physical activity.
Other dentists were considered as the group with no
physical activity. Dentists with any systemic disease
that can influence the musculoskeletal system, such
as arthritis, osteoporosis, uncontrolled diabetes, and
any neurological disorders, were not considered for
evaluation.
Data extraction
Informed consent was obtained from the participants
after explaining the purpose of the study to them.
A self‑reporting work‑related questionnaire, which
was pre‑tested for its relevance among 10 dentists.[10]
The Nordic questionnaire for analysis of MSDs and
an information sheet were given to the 300 dentists.
Information on MSDs was collected, including
information on the location of MSDs’ symptoms in
the past 12 months, whether it interfered with daily
activities, and whether medical treatment had been
sought in the previous 12 months. The dentists were
also asked whether they had taken sick leave for their
pain in the previous 12 months and, if so, how many
days of leave they had taken. Multiple choice and “fill
in the blank” style questions were used throughout.
Further clarification was given to those dentists who
did not fully understand the questionnaire. Additional
information was requested on age, gender, number
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Koneru and Tanikonda: Work‑related musculoskeletal disorders among dentists
201 Journal of International Society of Preventive and Community Dentistry May-June 2015, Vol. 5, No. 3
of years since graduation, field of dental practice, and
number of hours worked per week.
Assessment
Intensity of pain was assessed by a 0–10 numeric Pain
Rating Scale (0: No pain; 1–3: Mild pain; 4–6: Moderate
pain; 7–10: Severe pain), irrespective of the location
of pain. In cases of mild pain, dentists did not take
any medication. In cases of moderate pain, they used
analgesics for a day, whereas in cases of severe pain, they
used medication for more than a day and sometimes
even hospitalization and bed rest was needed.
Data analysis
The data were entered into Statistical Package for Social
Sciences (SPSS) version 16 software (Chicago IL, USA)
and statistically analyzed with Kruskal–Wallis (H) test,
Z test for two proportions, and Chi‑Square test. As and
when it was necessary, pooling technique was adapted
because of smaller units.
RESULTS
A total of 80 feedback forms were rejected because 15
had poorly controlled diabetes, 28 were practicing yoga
or any other physical activity for a period of less than
1 year, and the remaining 37 had incomplete answers.
Final data collected from 220 dentists were considered for
evaluation, of which 105 were from females and 115 from
males.
The data of prevalence of musculoskeletal pain in
relation to physical activity among dentists is given in
Table 1. Among 220 dentists, 76 had musculoskeletal
pain with different intensities in the last 12 months,
making the prevalence 34.5%. About 61.82% of the
dentists (136) did not practice any physical activity
on a regular basis, 17.27% (38) were practicing yoga,
and 20.91% (46) were practicing some other type of
physical activities. The prevalence of musculoskeletal
pain in dentists practicing yoga was 10.5%, and it
was 21.7% in those dentists practicing some sort of
physical activity. The prevalence of musculoskeletal
pain in dentists without any regular physical activity was
45.6%. Majority of the dentists experienced pain in the
neck and lower back regions.
There was a statistically significant difference (P < 0.05)
between the type of pain experienced by dentists with
yoga practice [Table 2], with other physical activity, and
without any physical activity [Kruskal–Wallis (H) test
value = 8.844, P = 0.031].
We also investigated the role of yoga activity in
musculoskeletal pain [Table 3]. We found statistically
significant difference between prevalence of pain among
dentists who were practicing yoga (Z test value = 3.938,
P < 0.05) when compared with those in no regular
physical activity group. We found statistically significant
differences (P < 0.05) between musculoskeletal pain
experienced by dentists without any physical activity
and those with any other physical activity (Z test
value = 2.86, P = 0.00424). There was no statistically
significant difference between the prevalence of pain in
dentists who were practicing yoga and those who were
practicing other physical activity (Z test = −1.372,
P = 0.17068), which proved the null hypothesis.
A similar trend was found in the musculoskeletal pain
experienced by both male and female dentists [Table 4].
We found statistically significant difference in the
prevalence of pain among dentists who were practicing
yoga (Z test value = 2.586, P = 0.0096 in males; Z test
value = 2.956, P = 0.00308 in females) when compared
with those in no regular physical activity group.
With increase in age [Table 5] (mean age 48.3 years),
there was an increase in prevalence of musculoskeletal
pain experienced by dentists (Chi‑square test), with
no statistically significant difference found in the
prevalence of musculoskeletal pain among dentists of
different age groups.
DISCUSSION
Dentistry is one of the professions that demands
prolonged static position with limited mobility. The
static forces resulting from these postures have been
shown to be much more tasking than dynamic forces.
Repeated prolonged static postures resisting gravity
during their work are thought to initiate a series
of events that could account for pain and injuries.
Sometimes career‑ending problems are seen in dentists
because of these MSDs.[11] Though there are case
reports on the dentists suffering from work‑related
musculoskeletal pain, only limited studies have been
Table 1: Data of prevalence of musculoskeletal
pain among dentists in relation with their physical
activity
Nature of
physical activity
Total
subjects
n
(%)
Pain in relation with
physical activity
n
(%)
Yoga activity 38 (17.3) 4 (10.5)
Other activity 46 (20.9) 10 (21.7)
No physical activity 136 (61.8) 62 (45.6)
Total 220 (100) 76 (34.5)

Koneru and Tanikonda: Work‑related musculoskeletal disorders among dentists
Journal of International Society of Preventive and Community Dentistry 202May-June 2015, Vol. 5, No. 3
published regarding the prevalence of work‑related
musculoskeletal pain among Indian dentists.
In our study, the prevalence of pain was 34.5% (n = 76)
among dentists, with a majority of them having
mild (n = 41, 18.6%) or moderate (n = 32, 14.5%) pain
and very few (n = 3, 1.4%) suffering from severe pain.
This is lesser than the prevalence of musculoskeletal
pain reported among Italian (54%)[12] and
Greek (62%)[13] dentists. This difference might be due
to the differences in perception of musculoskeletal pain,
type of clinical practice, nature of physical activities, and
other non‑standardized variables.
There was not much difference in the prevalence
of pain experienced by male (35.65%) and female
dentists (33.33%) as a whole. A similar trend was
observed in pain prevalence between both genders
irrespective of their physical activity, with the
highest prevalence found among dentists without
any physical activity (males 45.8%, females 45.3%)
and the lowest prevalence found in dentists with
regular yoga practice (males 11.8%, females 9.5%).
Though gender wise there was no difference, these
observations emphasize the role of yoga in minimizing
musculoskeletal pain.
Increased prevalence of pain was found with increase
in age.[14] In our study, there was a little difference
in prevalence of pain with an increase in age up to
50 years in those practicing yoga. Above 50 years of age,
there was an increase in prevalence of pain with the
highest prevalence of 48.6% reported by dentists aged
above 60 years. Higher difference in pain prevalence
between yoga practicing dentists and dentists without
any physical activity was observed in age groups above
50 years than in the age groups below 50 years. These
observations stress the significance of regular yoga
practice to keep physical fitness, especially in higher age
group. In a previous study, with increase in age, there
was decrease in pain because of adaptability to the chair
position.[15] It was hypothesized that more experienced
dentists learn to adjust their work posture to avoid such
problems, or that those dentists with musculoskeletal
problems have left the profession.[16‑18]
There was no significant difference found between
dentists working up to 50 h/week in both the groups
practicing yoga and not practicing yoga. In the group
practicing more than 50 h/week, there was less
prevalence of pain among yoga practitioners than
non‑yoga practitioners. It was also observed that lesser
pain was experienced by dentists who were resting for
more than 5 min between each patient, irrespective of
their age, sex, experience, practicing hours per week,
and yoga practice. Dentists working most of the time
in a sitting position and regularly practicing sports seem
to experience less pain, limitation of movements, and
MSDs.
Length of appointment time appeared to influence
pain in a study,[12] with those dentists providing longer
appointments experiencing more pain. There was
lesser pain experienced by dentists taking off for more
Table 2: Comparison of type of musculoskeletal pain in relation with dentists’ physical activity
Type of
pain
Activity Total Kruskal-Wallis (H) test
No physical activity Yoga activity Other physical activity H test value
P
Severe pain 2 (66.7) 0 (0.0) 1 (33.3) 3 (100) 8.844 0.031 significant
Moderate pain 28 (87.5) 1 (3.1) 3 (9.4) 32 (100)
Mild pain 32 (78.0) 3 (7.3) 6 (14.6) 41 (100)
No pain 74 (51.4) 34 (23.6) 36 (25.0) 144 (100)
Total 136 (61.8) 38 (17.3) 46 (20.9) 220 (100)
Statistical analysis: Kruskal-Wallis (H) test. Statistically significant if P<0.05
Table 3: Pain wise comparison between dentists in
relation with their physical activity
Pain wise comparison
Z P
Yoga activity vs no physical activity 3.938 <0.05 S
Other activity vs no physical activity 2.86 0.00424 S
Yoga activity vs other activity −1.372 0.17068 NS
Statistical analysis: Z test for two proportions. S=Significant, NS=Not
significant. Statistically significant if P<0.05
Table 4: Musculoskeletal pain wise comparison
in male and female dentist groups in relation with
their physical activity
Type of
activity
Pain wise
comparison in
male group
Pain wise
comparison in
female group
Z P Z P
Yoga activity vs no
physical activity
2.586 0.0096 2.956 0.00308
Other activity vs
no physical activity
2.032 0.04236 2.023 0.04338
Yoga activity vs
other activity
−0.932 0.35238 −0.949 0.34212
Statistical analysis: Z test for two proportions. S=Significant, NS=Not
significant, statistically significant if P<0.05

Koneru and Tanikonda: Work‑related musculoskeletal disorders among dentists
203 Journal of International Society of Preventive and Community Dentistry May-June 2015, Vol. 5, No. 3
than one session per week, irrespective of their age,
sex, experience, practicing hours per weekm and yoga
practice.
Using analgesics was a common practice found among
dentists all age groups when they suffered from pain of
varying severity.[13,14] But there was lesser intake of pain
killers, both in quantity and frequency, among dentists
practicing yoga (25%), other physical activity (30%), and
dentists who were not practicing any activity (40.32%).
These results are supported by other studies showing
that 37.5%[13] and 37%[14] dentists seek medical attention
for MSDs.
No dentist below 60 years of age, practicing
yoga or other activity was absent from job due to
musculoskeletal pain. In the 61–70 years age group, two
dentists were absent from work for 2 days, of which one
was practicing yoga and the other was practicing other
activity. In both age groups, the period of rest taken
was 2 days, not more than two times in the last 1 year
period.
In practitioners not practicing either yoga or other
physical activity, a similar trend was found with
different rest periods,[13,15] frequencies, and magnitude.
Eight (7%) were absent from job for 2 days, 3–5 times
in the last 1 year, whereas five dentists above 60 years of
age were absent from job (24%) for 3–5 days, 3–5 times
in the last 1 year. These results are in accordance with
the previous research results reporting that 9–10% of
the dentists with MSDs were absent from work.[13,15]
No dentist practicing yoga was hospitalized for
musculoskeletal problem, whereas only three dentists
were hospitalized for 5–7 days. This lesser frequency
may be because of the fact that as soon as the dentists
developed moderate pain, they decreased their working
sessions or working hours or both [45.7% (16/35)].
The decrease in number of working hours is difficult to
compare, as there are sparse studies comparing yoga and
other physical activities.
It was found that yoga was more effective than other
modes of physical activities like aerobics, brisk walk,
sports, etc., as 89.5% of yoga practitioners were free of
musculoskeletal pain, in comparison with the dentists
with other practices of whom only 78.3% were free of
musculoskeletal pain.
The reasons are multifactorial. Yoga allows the
practitioners to be more regular, irrespective of the
factors such as weather, climate, place, accessibility,
availability of gymnasiums, cost incurred, etc. Yoga
is a more controlled activity, whereas other activities
are controlled not only by the individual but also by
others during the activity of sports. Suryanamaskara
(Sun salutation), which improves flexibility, strength,
and reduces stress and anxiety, was the most commonly
practiced yogic activity in our study (n = 30).
Another important factor is that yoga not only
strengthens the musculoskeletal system but also
decreases stress by releasing endorphins and other
hormones, which is another contributing factor
Table 5: Comparison of MSD pain between dentists of different age groups in relation with their physical
activity
Age group
in years
Activity Nature of
physical activity
Pain in relation with
physical activity
Percentage Chi-square
test value
P
30-40 Yoga activity 10 1 10 1.905 0.386 NS
Other physical activity 14 4 28.57
No physical activity 31 10 32.26
Total 55 15 27.27
41–50 Yoga activity 10 1 10 1.945 0.378 NS
Other physical activity 14 3 21.43
No physical activity 44 16 36.36
Total 68 20 29.41
51–60 Yoga activity 10 1 10 4.515 0.105 NS
Other physical activity 12 2 16.66
No physical activity 40 21 52.5
Total 62 24 38.71
61–70 Yoga activity 8 1 12.5 4.3 0.116 NS
Other physical activity 6 1 16.66
No physical activity 21 15 71.43
Total 35 17 48.75
Statistical analysis: Chi-square test for attributes. S=Significant, NS=Not significant, statistically significant if P < 0.05

Koneru and Tanikonda: Work‑related musculoskeletal disorders among dentists
Journal of International Society of Preventive and Community Dentistry 204May-June 2015, Vol. 5, No. 3
for perception of musculoskeletal discomfort by an
individual.
Physical exercise has been shown to be an effective
preventive intervention for back, neck, and shoulder
pain. Exercise is especially beneficial for dental care
workers in that it prevents and treats MSDs and
stress, and decreases the existing musculoskeletal pain.
Dentists with better endurance of the back and shoulder
girdle muscles tend to have less neck, back, and
shoulder pain.[19,20]
The integration of 30 min of moderate physical activity
into the daily activities of dental care practitioners may
help to address the inactivity of the larger muscle groups
of the legs and trunk and static muscle activity of the
back, neck, and shoulders in a clinician’s day.
One of the limitations of this study is its inability to
correlate between age and sex of the dentists, duration
of practice, years of practicing yoga, working hours per
week, and site of musculoskeletal pain.
Some special breathing and meditation techniques may
have a positive influence on the central nervous system
to increase pain control and pain tolerance. The most
common asanas in yoga like Salabasana, Dhanurasana,
Shavasana, and Suryanamaskara are helpful in the
management of neck pain and back pain.
More research is needed on the musculoskeletal
problems in dentists, with an emphasis on larger
sample size and correlating other factors like age
and sex of the dentists, duration of practice, years
of practicing yoga, and working hours per week to
generalize the results and conclusions, and thereby
formulate some guidelines to prevent or minimize
work‑related MSDs in dentists.
CONCLUSION
Within the limitations of the study, work‑related
MSDs are found to be a significant occupational health
problem among the dentists. The role of some physical
activity on the quality and quantity of work‑related
MSDs experienced by dentists is significant. Yoga is
found to be more effective than other modes of physical
activities because of its more controlled nature and its
positive effect on the psychological stress and strain.
ACKNOWLEDGMENTS
The authors are thankful to all the dentists who participated
in the study.
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How to cite this article: Koneru S, Tanikonda R. Role of yoga and
physical activity in work-related musculoskeletal disorders among
dentists. J Int Soc Prevent Communit Dent 2015;5:199-204.
Source of Support: Nil, Conict of Interest: None declared.