Ergonomics For Dental Hygienists

Ergonomics: Health Implications for Dental Hygienists www.ProSpineRehab.com

Overview: Ergonomics and Health Implications for Dental Hygienists Increase awareness Decrease work-related pain and injuries Heighten productivity Improve musculoskeletal health Increase comfort Improve quality of life Extend careers

Increase awareness

Decrease work-related pain and injuries

Heighten productivity

Improve musculoskeletal health

Increase comfort

Improve quality of life

Extend careers

What is Ergonomics? Ergonomics is the study of workers and their relationship with their occupational environment How you position yourself, your patient, how equipment is utilized, how the workplace is designed and how it impacts your health ERGONOMICS is a way to work smarter, more efficiently with less effort and discomfort to the human body

Ergonomics is the study of workers and their relationship with their occupational environment

How you position yourself, your patient, how equipment is utilized, how the workplace is designed and how it impacts your health

ERGONOMICS is a way to work smarter, more efficiently with less effort and discomfort to the human body

Ergonomics in the Dental Health Field Studies show work-related pain in the dental field is not decreasing Over half of all dental professionals continue to experience work-related pain Why?  The physically challenging nature of the work with numerous risk factors   Risk Factors Prolonged Static Postures Repetitive Movements Working in a confined space Challenges with positioning yourself or the patient Limitations with the tools and equipment used ©2008, Valachi from “Practice Dentistry Pain-Free”

Studies show work-related pain in the dental field is not decreasing

Over half of all dental professionals continue to experience work-related pain

Why?  The physically challenging nature of the work with numerous risk factors  

Risk Factors

Prolonged Static Postures

Repetitive Movements

Working in a confined space

Challenges with positioning yourself or the patient

Limitations with the tools and equipment used

Reasons for Early Retirement Among Dental Health Professionals Musculoskeletal Disorders (29.5 %) Cardiovascular Disease (21.2%) Neurotic Symptoms (16.5%) Tumors (7.6%) Diseases of the Nervous System (6.1%) ©2008, Valachi from “Practice Dentistry Pain-Free”

Musculoskeletal Disorders (29.5 %)

Cardiovascular Disease (21.2%)

Neurotic Symptoms (16.5%)

Tumors (7.6%)

Diseases of the Nervous System (6.1%)

Ergonomics: The Human Factor People Are Different We come in different shapes and sizes yet the workplace is often set up for “ one size fits all ” People Have Limitations We have physical and mental limits for working - The wrist cannot tolerate excessive extension - The back cannot tolerate excessive bending or twisting - The neck was not meant to be in constant flexion - Muscles will fatigue if under constant tension ©2008, Valachi from “Practice Dentistry Pain-Free”

People Are Different

We come in different shapes and sizes yet the workplace is often set up for “ one size fits all ”

People Have Limitations

We have physical and mental limits for working

- The wrist cannot tolerate excessive extension

- The back cannot tolerate excessive bending or twisting

- The neck was not meant to be in constant flexion

- Muscles will fatigue if under constant tension

Consequences of Poor Ergonomics Fatigue Pain/Discomfort Illness/Injury Missed days at work Errors Lower productivity Patient dissatisfaction

Fatigue

Pain/Discomfort

Illness/Injury

Missed days at work

Errors

Lower productivity

Patient dissatisfaction

Poor Ergonomics: Signs and Symptoms Physical Signs Decreased range of motion Deformity Decreased grip strength Loss of muscle function Symptoms Pain Numbness Tingling Burning Cramping Stiffness ©2008, Valachi from “Practice Dentistry Pain-Free”

Physical Signs

Decreased range of motion

Deformity

Decreased grip strength

Loss of muscle function

Symptoms

Pain

Numbness

Tingling

Burning

Cramping

Stiffness

Poor Ergonomics = Musculoskeletal Disorders The World Health Organization definition: Musculoskeletal Disorder is “a disorder of the muscles, tendons, peripheral nerves or vascular system not directly resulting from an acute trauma or instantaneous event” Two Most Common Causes for Musculoskeletal Disorders in the Dental Health Profession Cumulative Traumas Prolonged Static Postures ©2008, Valachi from “Practice Dentistry Pain-Free”

The World Health Organization definition:

Musculoskeletal Disorder is “a disorder of the muscles, tendons, peripheral nerves or vascular system not directly resulting from an acute trauma or instantaneous event”

Two Most Common Causes for Musculoskeletal

Disorders in the Dental Health Profession

Cumulative Traumas

Prolonged Static Postures

Cumulative Trauma Repetitive Movements like Scaling and Polishing are Cumulative Traumas Vibrations transmitted by dental handpieces or mechanical scalers are Cumulative Traumas Cumulative Traumas add up These microtraumas cause “ wear and tear ” on the muscles, tendons, and nerve tissue

Repetitive Movements like Scaling and Polishing are Cumulative Traumas

Vibrations transmitted by dental handpieces or mechanical scalers are Cumulative Traumas

Cumulative Traumas add up

These microtraumas cause “ wear and tear ” on the muscles, tendons, and nerve tissue

Prolonged Static Postures Human body was designed for movement Dental hygiene procedures means practitioners must maintain static postures Hygienists hold postures that require more than 50% of the body’s muscles to contract to resist gravity Muscle overload leads to decreased blood flow and increased pressure on the muscles and joints ©2008, Valachi from “Practice Dentistry Pain-Free”

Human body was designed for movement

Dental hygiene procedures means practitioners must maintain static postures

Hygienists hold postures that require more than 50% of the body’s muscles to contract to resist gravity

Muscle overload leads to decreased blood flow and increased pressure on the muscles and joints

Flowchart: Static Overload PROLONGED STATIC POSTURES Muscle Fatigue and Muscle Imbalance Muscle Ischemia, Trigger Points, Muscle Substitution PAIN Protective Muscle Contraction Joint Hypomobility, Nerve Compression, Spinal Degeneration/Herniation MUSCULSKELETAL DISORDERS ©2008, Valachi from “Practice Dentistry Pain-Free”

PROLONGED STATIC POSTURES

Muscle Fatigue and Muscle Imbalance

Muscle Ischemia, Trigger Points, Muscle Substitution

PAIN

Protective Muscle Contraction

Joint Hypomobility, Nerve Compression, Spinal Degeneration/Herniation

MUSCULSKELETAL DISORDERS

Static Postures leads to Muscular Imbalances Muscles responsible for rotating the body to one side become tighter (shorter), while opposing muscles become weaker (longer) Right handed hygienists repeatedly assume NECK ROTATION TO LEFT with SIDE-BENDING TO RIGHT to gain better visibility Problems with NECK ROTATION TO RIGHT with SIDE-BENDING TO LEFT ©2008, Valachi from “Practice Dentistry Pain-Free”

Muscles responsible for rotating the body to one side become tighter (shorter), while opposing muscles become weaker (longer)

Right handed hygienists repeatedly assume NECK ROTATION TO LEFT with SIDE-BENDING TO RIGHT to gain better visibility

Problems with NECK ROTATION TO RIGHT with SIDE-BENDING TO LEFT

Static Postures = Muscle Ischemia As postures deviate from neutral, muscles contract harder to maintain working postures During static muscle contraction, the vascular supply to muscle and surrounding tissues is restricted Results in depleted nutrient and oxygen supply ( ischemia ) Lactic acid and other metabolites accumulates causing pain and tissue damage

As postures deviate from neutral, muscles contract harder to maintain working postures

During static muscle contraction, the vascular supply to muscle and surrounding tissues is restricted

Results in depleted nutrient and oxygen supply ( ischemia )

Lactic acid and other metabolites accumulates causing pain and tissue damage

Cumulative Traumas and Prolonged Static Postures Lead to Musculoskeletal Disorders Trigger Points and Myofascial Pain Disorders of Neck Degenerative Joint Disease (Arthritis) Thoracic Outlet Syndrome Tendinitis Carpal Tunnel Syndrome Trigger Finger Nerve Entrapment Syndromes Lower Back Pain Sciatica

Trigger Points and Myofascial Pain Disorders of Neck

Degenerative Joint Disease (Arthritis)

Thoracic Outlet Syndrome

Tendinitis

Carpal Tunnel

Syndrome

Trigger Finger

Nerve Entrapment Syndromes

Lower Back Pain

Sciatica

Myofascial Pain: Trigger Points Trigger Points : groups of muscle fibers that are in a constant state of contraction inside a tight band of muscle Feels like a knot or a small pea in muscles, and when pressed on can refer pain to distant parts of the body Ischemic areas are susceptible to the development of trigger points

Trigger Points : groups of muscle fibers that are in a constant state of contraction inside a tight band of muscle

Feels like a knot or a small pea in muscles, and when pressed on can refer pain to distant parts of the body

Ischemic areas are susceptible to the development of trigger points

Myofascial Pain: Trigger Points

Myofascial Pain: Trigger Points

Static Postures: Degenerative Joint Disease Synovial fluid, which lubricates the joints, is produced each time a joint moves Lack of movement and contracted muscles from static postures reduces the synovial fluid production, resulting in joint hypomobility This loss of mobility leads to degenerative changes and more musculoskeletal disorders

Synovial fluid, which lubricates the joints, is produced each time a joint moves

Lack of movement and contracted muscles from static postures reduces the synovial fluid production, resulting in joint hypomobility

This loss of mobility leads to degenerative changes and more musculoskeletal disorders

Static Postures: Degenerative Joint Disease Symptoms Intermittent/chronic pain and stiffness “ Creaking” or “cracking” of joints Swelling in the joints Loss of motion in the joints Increased pain with activity or use

Symptoms

Intermittent/chronic pain and stiffness

“ Creaking” or “cracking” of joints

Swelling in the joints

Loss of motion in the joints

Increased pain with activity or use

Neck and Shoulder Disorders Thoracic Outlet Syndrome Condition resulting from compression of the nerves, arteries, and veins as they pass through from the neck to the arm (thoracic outlet) Possible causes: tight scalenes, cervical rib, tight pectoralis muscle, traumas Often misdiagnosed

Condition resulting from compression of the nerves, arteries, and veins as they pass through from the neck to the arm (thoracic outlet)

Possible causes: tight scalenes, cervical rib, tight pectoralis muscle, traumas

Often misdiagnosed

Neck and Shoulder Disorders Thoracic Outlet Syndrome Symptoms Pain in the neck, shoulder, arm or hand Numbness and tingling of fingers Muscle weakness/fatigue Cold sensation in the arm, hand or fingers

Symptoms

Pain in the neck, shoulder, arm or hand

Numbness and tingling of fingers

Muscle weakness/fatigue

Cold sensation in the arm, hand or fingers

Cumulative Trauma Injury: Tendinitis When tendons slide back and forth through their sheaths friction is created As with any other moving part, enough friction can cause wear and tear along with inflammation When tendons or sheaths swell, and there is pain and tenderness

When tendons slide back and forth through their sheaths friction is created

As with any other moving part, enough friction can cause wear and tear along with inflammation

When tendons or sheaths swell, and there is pain and tenderness

Wrist Tendinitis Pain, swelling and inflammation on the thumb side of the wrist Made worse with grasping and twisting activities (polishing and scaling) Occasional “catching” or snapping when moving thumb

Pain, swelling and inflammation on the thumb side of the wrist

Made worse with grasping and twisting activities (polishing and scaling)

Occasional “catching” or snapping when moving thumb

Shoulder Tendinitis Elevated arm postures cause shoulder impingement Leads to tendinitis in the rotator cuff Pain is usually felt in the front or the side of the shoulder Worse with activity

Elevated arm postures cause shoulder impingement

Leads to tendinitis in the rotator cuff

Pain is usually felt in the front or the side of the shoulder

Worse with activity

Carpal Tunnel Syndrome Compression of the Median Nerve as it passes through the Carpal Tunnel Caused by pinching and gripping activities with the wrist bent Made worse with repetitive flexion and extension activities at the wrists

Compression of the Median Nerve as it passes through the Carpal Tunnel

Caused by pinching and gripping activities with the wrist bent

Made worse with repetitive flexion and extension activities at the wrists

Carpal Tunnel Syndrome Symptoms “ Pins and needles” in the hands and fingers Pain in the thumb, index and middle finger Limited range of motion at the wrist Pain radiating up the arm Decreased grip strength More pain at night

Symptoms

“ Pins and needles” in the hands and fingers

Pain in the thumb, index and middle finger

Limited range of motion at the wrist

Pain radiating up the arm

Decreased grip strength

More pain at night

Trigger Finger (Tenosynovitis) Sustained forceful grips and repetitive motion irritates the tendon and tendon sheath (tenosynovium) Nodules form in tendon causing warmth, swelling, tenderness of the tendon Pain occurs during movement that place tendons in tension Fingers lock in “Trigger Position”

Sustained forceful grips and repetitive motion irritates the tendon and tendon sheath (tenosynovium)

Nodules form in tendon causing warmth, swelling, tenderness of the tendon

Pain occurs during movement that place tendons in tension

Fingers lock in “Trigger Position”

Cubital Tunnel Syndrome Prolonged use of the elbow while flexed or trauma from overuse can compress the Ulnar Nerve Pain, numbness, tingling and impaired sensation in the little and ring fingers, side and back of hand Loss of fine control Reduced grip strength

Prolonged use of the elbow while flexed or trauma from overuse can compress the Ulnar Nerve

Pain, numbness, tingling and impaired sensation in the little and ring fingers, side and back of hand

Loss of fine control

Reduced grip strength

Compression of ulnar nerve in Guyon’s canal at the base of the palm Caused by repetitive wrist flexing or excessive pressure on palm/base of hand Pain, weakness, numbness, tingling, burning in the little finger and part of the ring finger Symptoms may worsen at night or early morning Guyon’s Syndrome

Compression of ulnar nerve in Guyon’s canal at the base of the palm

Caused by repetitive wrist flexing or excessive pressure on palm/base of hand

Pain, weakness, numbness, tingling, burning in the little finger and part of the ring finger

Symptoms may worsen at night or early morning

Upper Crossed Syndrome Tight Levator Scapulae Upper Trapezius Scalenes Pectorals Weak Middle/Lower Traps Rhomboids Serratus Anterior Deep Neck Flexors Elevated shoulders Forward head postures Jutting shoulder blades Neck Pain and Upper Back Pain

Tight Levator Scapulae Upper Trapezius Scalenes Pectorals

Weak Middle/Lower Traps Rhomboids Serratus Anterior Deep Neck Flexors

Elevated shoulders

Forward head postures

Jutting shoulder blades

Neck Pain and Upper Back Pain

Low Back Pain Low Back Pain is the leading cause of occupational disability in the dental healthcare profession Studies show that low back pain is clearly related to seated postures and sitting duration

Low Back Pain is the leading cause of occupational disability in the dental healthcare profession

Studies show that low back pain is clearly related to seated postures and sitting duration

Low Back Pain We often think of a back injury as caused by a single event, like lifting a heavy load The lower back is vulnerable to Cumulative Trauma More lower back injuries result from the cumulative effects of bending, twisting, or excessive sitting Working continuously in a seated position places tremendous static load on the back muscles, discs, and joints

We often think of a back injury as caused by a single event, like lifting a heavy load

The lower back is vulnerable to Cumulative Trauma

More lower back injuries result from the cumulative effects of bending, twisting, or excessive sitting

Working continuously in a seated position places tremendous static load on the back muscles, discs, and joints

Low Back Pain: The Problem with Sitting With seated postures, pressure in the lumbar disks increases by 50% from standing Unsupported sitting causes 2x more axial loading in the spine than standing During forward flexion and rotation (a position often assumed by dental hygienists) the pressure increases by 200%

With seated postures, pressure in the lumbar disks increases by 50% from standing

Unsupported sitting causes 2x more axial loading in the spine than standing

During forward flexion and rotation (a position often assumed by dental hygienists) the pressure increases by 200%

Low Back Pain: Disc Degeneration, Bulge and Herniation Spinal discs provide for flexibility shock absorption Discs are composed of tough outer layer (annulus fibrosis) and gel-like center (nucleus pulposis) When weight is applied to the disc, the nucleus expands outward and puts pressure on the annulus fibrosis

Spinal discs provide for flexibility shock absorption

Discs are composed of tough outer layer (annulus fibrosis) and gel-like center (nucleus pulposis)

When weight is applied to the disc, the nucleus expands outward and puts pressure on the annulus fibrosis

Low Back Pain Disc Degeneration and Herniation Sitting while flexing forward compresses the discs in the front Uneven pressure on the disc leads to disc bulging and herniation When the disc bulges or herniates backwards the nerves can become pinched

Sitting while flexing forward compresses the discs in the front

Uneven pressure on the disc leads to disc bulging and herniation

When the disc bulges or herniates backwards the nerves can become pinched

Low Back Pain: Sciatica Pain from lower back or hip radiating to the buttocks and legs Leg weakness, numbness, or tingling Commonly caused by prolapsed intervertebral disc pressuring the sciatic nerve Worsened with prolonged sitting or excessive bending and lifting

Pain from lower back or hip radiating to the buttocks and legs

Leg weakness, numbness, or tingling

Commonly caused by prolapsed intervertebral disc pressuring the sciatic nerve

Worsened with prolonged sitting or excessive bending and lifting

Low Back Pain: A Vicious Cycle People with back problems seem to be faced with this vicious cycle There is considerable evidence that bed rest and passive treatments have limited value We now know that activity and the right kind of exercise are critical to treating back pain Stop Moving Back Pain Hurts to Move Stiffness Weakness

People with back problems seem to be faced with this vicious cycle

There is considerable evidence that bed rest and passive treatments have limited value

We now know that activity and the right kind of exercise are critical to treating back pain

Lower Crossed Syndrome Tight Hip Flexors Lower Back Muscles Weak Abdominal Muscles Gluteus Maximus Swayback - excessive curve of the lower back Anterior Pelvic Tilt - hips tilted forward Lower Back Pain

Tight Hip Flexors Lower Back Muscles

Weak Abdominal Muscles Gluteus Maximus

Swayback - excessive curve of the lower back

Anterior Pelvic Tilt - hips tilted forward

Lower Back Pain

What is the best position to sit in? Traditional 90 º Sitting Is not It Problems with Traditional 90 ° Sitting Looks nice but it’s just not comfortable Natural curve of the lower back collapses Leads to muscle tension and misaligned vertebrae Increases static load on the discs Decreases circulation in lower extremities

Problems with Traditional 90 ° Sitting

Looks nice but it’s just not comfortable

Natural curve of the lower back collapses

Leads to muscle tension and misaligned vertebrae

Increases static load on the discs

Decreases circulation in lower extremities

What is the best position to sit in? Leg Balanced Sitting Allows for forward and upward postures to transfer some of the body’s support to the feet Hip angle of 100 ° to 120 ° Knee angle of 110° to 135° Forward seat tilt of 45° to 55° from horizontal Opposing muscle groups are balanced and curve in lower back is maintained

Allows for forward and upward postures to transfer some of the body’s support to the feet

Hip angle of 100 ° to 120 °

Knee angle of 110° to 135°

Forward seat tilt of 45° to 55° from horizontal

Opposing muscle groups are balanced and curve in lower back is maintained

Chair Selection Saddle Seat Design True waterfall design is an essential feature Hydraulic piston assembly for the widest range of motion Seat should be adjustable so hips can be slightly elevated beyond parallel without restricting blood flow to the legs

Saddle Seat Design

True waterfall design is an essential feature

Hydraulic piston assembly for the widest range of motion

Seat should be adjustable so hips can be slightly elevated beyond parallel without restricting blood flow to the legs

Ergonomics for Dental Hygienists Workstation Layout Clutter threatens the safety and cleanliness of the dental operatory Allows convenient positioning when required Provide a clear line of sight to the oral cavity and all required equipment

Clutter threatens the safety and cleanliness of the dental operatory

Allows convenient positioning when required

Provide a clear line of sight to the oral cavity and all required equipment

Ergonomics for Dental Hygienists Workstation Layout Optimize space for work from 7 o’clock to 1 o’clock position for right handed Hygienists (11° to 5° if Left Handed) Instruments should be accessible while seated (within 20 inches of the front of body) Hoses should be positioned away from the body Over-the-Patient or Over-the-Head equipment is most ergonomic Use mobile carts for less commonly used equipment

Optimize space for work from 7 o’clock to 1 o’clock position for right handed Hygienists (11° to 5° if Left Handed)

Instruments should be accessible while seated (within 20 inches of the front of body)

Hoses should be positioned away from the body

Over-the-Patient or Over-the-Head equipment is most ergonomic

Use mobile carts for less commonly used equipment

Ergonomics for Dental Hygienists Scheduling Scheduling of procedures should be considered. Difficult procedures scheduled back-to-back does not allow your body sufficient relaxation time Potential strategies Increase treatment time for more difficult patients Alternate heavy and light calculus patients within a schedule Vary procedures within the same appointment Shorten patient’s recall interval

Scheduling of procedures should be considered.

Difficult procedures scheduled back-to-back does not allow your body sufficient relaxation time

Potential strategies

Increase treatment time for more difficult patients

Alternate heavy and light calculus patients within a schedule

Vary procedures within the same appointment

Shorten patient’s recall interval

Ergonomics for Dental Hygienists Reduce Physical Effort Avoid bent or unnatural postures Minimize sustained effort Brief but frequent rest pauses can minimize fatigue and enhance productivity Incorporate different activities to shift musculoskeletal demands from one part of the body to another

Avoid bent or unnatural postures

Minimize sustained effort

Brief but frequent rest pauses can minimize fatigue and enhance productivity

Incorporate different activities to shift musculoskeletal demands from one part of the body to another

Ergonomics for Dental Hygienists Equipment If your air/water syringe has a tightly coiled cord, consider replacing it with a lightweight hose Swiveling devices can be placed on a handpiece to reduce torque Newer handpieces are much lighter than the older models

If your air/water syringe has a tightly coiled cord, consider replacing it with a lightweight hose

Swiveling devices can be placed on a handpiece to reduce torque

Newer handpieces are much lighter than the older models

Ergonomics for Dental Hygienists Hand Instruments Look for: Hollow or resin handles Round, textured grooves, and compressible handles Carbon-steel construction Color-coding may make instrument identification easier

Look for:

Hollow or resin handles

Round, textured grooves, and compressible handles

Carbon-steel construction

Color-coding may make instrument identification easier

Ergonomics for the Dental Hygienists Magnification Systems Should improve neck postures and Provide clearer vision Consider additional lighting Weight should also be considered

Should improve neck postures and Provide clearer vision

Consider additional lighting

Weight should also be considered

Ergonomics for Dental Hygienists Gloves Gloves are one of the most overlooked ergonomic items Hand-specific gloves allow the thumb to be in a more natural position Gloves should not be too tight across the palm or too constricting at the wrist The finger length should be adequate to allow for comfortable finger movement

Gloves are one of the most overlooked ergonomic items

Hand-specific gloves allow the thumb to be in a more natural position

Gloves should not be too tight across the palm or too constricting at the wrist

The finger length should be adequate to allow for comfortable finger movement

Preventing Ergonomic Injuries Move Change Position There is no one “correct” posture best for an entire working day The Human Body Needs Change and Mobility

Move

Change Position

There is no one “correct” posture best for an entire working day

The Human Body Needs Change and Mobility

Preventing Ergonomic Injuries Taking frequent, shorter breaks is preferable to taking longer, fewer breaks Change positions before painful symptoms arise Remember to go back to neutral postures

Taking frequent, shorter breaks is preferable to taking longer, fewer breaks

Change positions before painful symptoms arise

Remember to go back to neutral postures

Preventing Ergonomic Injuries Stretching Guidelines Never stretch to the point of pain or discomfort Do not bounce or use quick, jerky movements Stretch should be performed every half hour

Never stretch to the point of pain or discomfort

Do not bounce or use quick, jerky movements

Stretch should be performed every half hour

Suboccipital Muscles Deep muscles at the base of the skull responsible for protraction, rotation, and tilting of the head Suboccipitals become shortened with forward head postures Common cause for headaches

Deep muscles at the base of the skull responsible for protraction, rotation, and tilting of the head

Suboccipitals become shortened with forward head postures

Common cause for headaches

Levator Scapulae Primary function is to elevate the scapula Also bends the neck to the side Tightens up when carrying a bag with a strap or talking on the phone

Primary function is to elevate the scapula

Also bends the neck to the side

Tightens up when carrying a bag with a strap or talking on the phone

Scalenes Functions to stabilize the neck during lateral movements Aids in inspiration Becomes tight with awkward leaning positions while seated

Functions to stabilize the neck during lateral movements

Aids in inspiration

Becomes tight with awkward leaning positions while seated

Trapezius Upper elevates the shoulders Middle retracts the shoulder blades Lower rotates the shoulder blade downwards Becomes tight with elevated arm postures

Upper elevates the shoulders

Middle retracts the shoulder blades

Lower rotates the shoulder blade downwards

Becomes tight with elevated arm postures

Pectoralis Minor Functions to draw the shoulder blade forward and downward Tight in people with a rounded shoulder posture Shortened pec minor is a possible cause for Thoracic Outlet Syndrome

Functions to draw the shoulder blade forward and downward

Tight in people with a rounded shoulder posture

Shortened pec minor is a possible cause for Thoracic Outlet Syndrome

Wrist Flexors/Extensors Prime function is to flex and extend the wrist “ Tennis Elbow ” is pain on the lateral side of elbow “ Golfer’s Elbow ” is pain on the medial side of the elbow

Prime function is to flex and extend the wrist

“ Tennis Elbow ” is pain on the lateral side of elbow

“ Golfer’s Elbow ” is pain on the medial side of the elbow

Hamstrings Main function is to bend the knee Secondary role in extending the hip Weak low back and glute muscles increases tightness in the hamstrings Prolonged seated postures also causes tight hamstrings

Main function is to bend the knee

Secondary role in extending the hip

Weak low back and glute muscles increases tightness in the hamstrings

Prolonged seated postures also causes tight hamstrings

Iliopsoas Primary function is to flex the hip (bring thigh up towards the abdomen) People with chronic lower back pain often have very tight hip flexors Commonly shortened with prolonged seated postures

Primary function is to flex the hip (bring thigh up towards the abdomen)

People with chronic lower back pain often have very tight hip flexors

Commonly shortened with prolonged seated postures

Piriformis Main function is to externally rotate the hip/thigh Shortened in people who sit for long periods of time “ Piriformis Syndrome” causes compression of the Sciatica nerve

Main function is to externally rotate the hip/thigh

Shortened in people who sit for long periods of time

“ Piriformis Syndrome” causes compression of the Sciatica nerve

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