ErgoPractice News – April 2014 – Article 2
In the early 1990s Dr. Lance Rucker (DDS, FACD, Professor and Director of Clinical Ergonomics in the Department of Oral Health Science at The University of British Columbia in Canada) raised a question: Are Surgical Telescopes (called Loupes) Posture Maker or Posture Breaker?1 The importance of the declination angle in selecting loupes was recognized and the benefits of properly designed loupes were reported.2, 3 However, today many clinicians are still using traditional through-the-lens (TTL) loupes or traditional front-lens-mounted (FLM) loupes with relatively small declination angles (20-25 degrees) which force users to tilt their heads excessively. Working with this anti-ergonomic posture has been shown to lead to chronic pain in the neck, shoulders and upper back.4, 5
Why are Clinicians using Traditional Loupes?
Ergonomic postures are not a natural posture such as a tennis stroke or baseball swing or golf swing. Our natural instinct is to tilt our heads and twist our bodies to get a closer view to our work. Using loupes effectively and ergonomically, by sitting upright and rotating our eyes down through a strong declination angle, takes practice. So it is easier for us to use traditional loupes (FLM or TTL) with small declination angles, at first.
Pain in one’s neck, shoulders and upper back plus injuries due to the use of non-ergonomic loupes with small declination angles may not develop for a few years. Since young clinicians, such as dental students and surgical residents, do not feel this pain immediately, they may start their careers using traditional, non-ergonomic TTL loupes. Also contributing is the lack of clear guidelines for selecting ergonomic loupes for the safe practice of dentistry and surgery.
Ms. Bethany Valachi (PT, MS, CEAS, President of Posturedontics, Portland Oregon) as a physical therapist, an ergonomist and a consultant has analyzed the head and body postures of numerous practicing dental professionals. From this research, she has found an ideal postural working range for dentistry.6
According to her recommended model, the maximum sustainable head tilt should be less than 20 degrees. Ms. Valachi found that loupes profoundly influence the musculoskeletal health of clinicians. She found a majority of loupes on the market are not ergonomic and place the user in an unsafe forward head-tilt posture (greater than 20 degrees). In her international consultations, Ms. Valachi consistently found that clinicians with chronic neck, shoulder and upper back pain have used non-ergonomic loupes with small declination angles. But by switching to properly designed and adjusted loupes, such as SurgiTel’s ergonomic loupes, they were able to eliminate their chronic neck, shoulder and upper back pain.
We received numerous reports from clinicians who were able to eliminate their chronic neck, shoulder and upper back pain with SurgiTel ergonomic loupes. Several examples are listed below.
“Like most surgeons, I was trained using traditional TTL loupes and developed chronic pain in my neck, shoulders, and upper back during stressful and long surgical operations. Over time I developed herniated cervical disks. Since switching to SurgiTel’s ergonomic loupes, I am able to stand perfectly upright with shoulders relaxed. The SurgiTel loupes have simply saved my career.”
-Raymond Singer, MD, FACS, FACC, FCCP
“I was using an orthopedic neck brace during vascular procedures. Then, switching to an ergonomically designed loupe by SurgiTel, I was able to eliminate chronic neck and upper back pain.”
-Hongsuk Sue, MD
“I attended your presentation at the AAE in San Antonio. At that time, I had chronic pain in my neck, shoulders, and upper back. I had been using traditional TTL loupes for many years. After listening to your presentation, I purchased a set of SurgiTel 6.5x flip-up loupes. Once I stopped using the traditional loupes and got the SurgiTel’s correctly adjusted and the working distance figured out, I have been pain free ever since.”
-Don Anderson, DDS
Note: Dr. Anderson attended one of Ms. Valachi’s presentations: ‘Practicing Dentistry Pain Free.’
“Prior to using SurgiTel loupes, I had experienced serious neck pain. Today I can work without the pain I had before using other traditional loupes. I am more proficient in my practice because of SurgiTel.”
-Patrick L. Roetzer, DDS, FICD
“After gaining the discipline required to properly use SurgiTel loupes, my back pain disappeared. My neck is no longer stiff, and the shooting pain that I occasionally experienced down my left arm went away.”
-Warren J. Kaplan, DDS
“I thought that all brand loupes are the same. So I chose the least expensive. I soon learned that was a mistake. My bargain basement loupes ended up in the junk drawer. Later I purchased a custom, ergonomic loupe from SurgiTel. With the SurgiTel loupe I went from chiropractic work three times a week to maybe two times a month. I almost can’t believe it. I can’t undo the injuries I’ve already suffered, but when working correctly I experience a huge difference.”
-Joyce Turcotte, RDH, M.Ed, FAADH
“We were not taught about magnification loupes in hygiene schools back in the early 80’s. Graduating from FSU in 1985, I worked six days a week with poor postures and in 2009 I required extensive spinal surgery which ended my clinical career. If I had known about the benefits of SurgiTel’s ergonomically designed loupe from the start of my career, I am convinced I would still be practicing dental hygiene. I compared various brand loupes and found that SurgiTel loupes are the most comfortable for my neck.”
-Edie Gibson, RDH, BSDH, MSc, MAAH
“I awoke to severe neck pain and a lack of mobility. As the day progressed, I experienced pain worse than child birth! I joked about my ‘bad neck’ being just a part of working dentistry. I was diagnosed with a severely ruptured disc between C 6 and 7. My journey to recovery included not only surgery but several weeks of physical therapy, follow up appointments and more. I made several changes to my life including the use of SurgiTel FLM loupes with adjustable declination angle. My journey led me to present a course on ‘Preserving Your Back Health’ for dental hygienists.”
-Linda Meeuwenberg, RDH, MA, FADIA
What Can SurgiTel Ergonomic Loupes Do for Your Health?
The number one design goal of all SurgiTel’s vision products (both loupes and headlights) is to help clinicians avoid work-related pain and injuries. Designing and manufacturing true ergonomic loupes is more challenging than traditional loupes. Learning to use ergonomic loupes feels less natural because true ergonomic postures are not in our natural instincts, such as a tennis stroke, baseball swing or golf swing. But once you dedicate yourself to ergonomic postures you will practice more efficiently and safely and have a longer and more fulfilling career.
Neutral posture (with neutral neck posture) and operating postures with various loupes are compared. From the photos below we can easily recognize that with traditional loupes we have to tilt head more than with SurgiTel ergonomic loupes.
From these posture photos, we are able to sample head tilt angles. The head tilt is 9 degrees with the SurgiTel FLM loupe (b), 20 degrees with the SurgiTel TTL loupe (c), 33 degrees with traditional TTL #1 (d), 36 degrees with traditional TTL #2 (e), 36 degrees with traditional FLM #1 (f), and 32 degrees with traditional FLM #2 (g).
It should be noted that SurgiTel invented a new manufacturing method (patent pending) to assemble TTL loupes with larger custom declinations than FLM loupes. (The achievable declination angle of SurgiTel TTL loupes will vary according to frame type and facial features.)
- Rucker LM, Surgical telescopes: posture maker or posture breaker? In, Murphy D, ed, Ergonomics, and the dental care worker. Am Public Health Assoc, Washington DC, 1998, 191-216
- Rucker LM, Beattie C, McGregor C, Sunell S, Ito Y, Declination angle and its role in selecting surgical telescopes, J. Am Dent Assoc 130: 1096-1100, 1999
- Chang BJ, Ergonomic benefits of surgical telescopes: selection guidelines, J Cal Dental Assoc, Vol.30.No2., 2002: 161-169
- Chaffin DB, Localized muscle fatigue: definition and measurement, J Occupation Med 15(4): 346-354, 1973
- Rucker LM, Sunell S, Ergonomic risk factors associated with clinical dentistry, J Cal Dental Assoc, Vol.30.No2., 2002: 139-148
- Valachi B, Practice dentistry pain-free, Posturedontics Press, Portland, OR, 2008