Ergo Practice News logo January 2019

Team-Based Ergonomics Training Program Self-Ergonomics Gap Analysis

ErgoPractice News – January 2019
By Jin Chang PhD

Symptoms of Work-Related Musculoskeletal Disorders

Numerous professionals such as dentists, hygienists, and surgeons are suffering from work-related musculoskeletal disorders. Although the reasons for work-related musculoskeletal disorders are varied, the main contributing factor is poor working posture. However, working ergonomically will help prevent work-related pain and injuries in the neck and lower back. Figure 1 shows how, recently, the use of magnification loupes has helped eliminate lower back pain, but improperly designed loupes have become the main cause of chronic neck pain and injuries.

Symptoms of work-related musculoskeletal disorders may progress in three stages from mild to severe:
  • Early-stage: moderate discomfort during the work shift but disappears at night.
  • Intermediate stage: moderate aching and tiredness occurs during the work shift and persists at night.
  • Late-stage: aching, fatigue, weakness persisting at rest, and inability to sleep. An acute pain incident only after enough damage has already occurred.1, 2

Pain is often a good indicator that you are not practicing ergonomically and your body is being strained. Some clinicians may go years without feeling the effects of poor posture and ergonomics, then suddenly they experience acute neck pain and other parts of the body because the last part of the ligament is finally broken.

Team-Based Ergonomics Training Program

Currently, there are no effective ergonomics training programs for healthcare professionals, so we would like to propose the “Team-Based Ergonomics Training Program” concept, similar to Duke’s “Peer-Based Ergonomics Training Program” model. With Duke’s program, senior surgeons teach residents. With a “Team-Based Ergonomics Training Program” all members will help each other, but for optimal implementation, a senior clinician should lead the training program.

This proposed “Team-Based Ergonomics Training Program” will start by evaluating the working posture of team members by taking posture pictures and sharing their work-related discomfort or pain. Team members will also share how correctly fitted loupes alleviated or eliminated their pain. If necessary, the team may invite an ergonomic consultant to evaluate the working posture and equipment used in the clinic.

In this month’s ErgoPractice News, we will review a process of “Ergonomics Gap Analysis” which allows team members to determine their working postures and to recognize potential health risks.

What Is Ergonomics Gap Analysis?

Gap analysis is the process of determining where you are, where you want to be, and how to get there. The ergonomics gap analysis determines what type of working posture each team member should have, what their current working posture is, and making a plan to get there.

Where You Should Be

Figure 2 is an ergonomically ideal posture diagram adapted from a book on dental ergonomics written by Dr. Bethany Valachi, a physical therapist. This ideal posture may look unobtainable, but with continued practice and the use of proper tools, it is possible. Of course, the clinician will work outside of these recommended ranges on occasion but the objective is to not continually work outside of these ranges. Team members can watch each other’s working postures and let each other know if they see awkward postures.

Figure 2 shows that loupes have a significant impact on the forward neck/head tilt. If loupes are properly made, the clinician can look down through their loupes while keeping their head up, allowing the clinician to easily maintain a head tilt of fewer than 25-degrees, SurgiTel loupes have been built from the ground up for this very purpose. As seen in Figure 3, forward neck tilt greater than 25-degrees amplifies fatigue and when sustained will lead to musculoskeletal disorders.3 Furthermore, when using traditionally designed loupes, they may actually force the user into an extreme head tilt.4

Additionally, the seating position also has a significant impact on the back and legs as seen in Figure 2. Only a tilting seat pan with straddle design (such as RGP designs which SurgiTel offers as an ergonomic package) allows the clinician to appropriately share the weight of their body between the left foot, right foot, and torso. This maximizes stability and reduces stress on the body. A flat seat pan puts all the stress on the torso, often pinching the sciatic nerve and reducing blood flow to the legs and throughout the body.

Where You Are

To complete the ergonomic gap analysis you need to compare this ideal to where you are now. The easiest way to tell where you are now is to have one of your team members take two side view photos: one photo of your neutral posture and another of your working posture. If you need help determining your body posture angles, you may send your two photos to We will send you the photos back with the head tilt angles measured.

In many cases, clinicians will find their equipment actually prevents them from achieving a comfortable and safe posture. Despite claims of extreme declination angles and excellent ergonomics, they still fail to provide the promised ergonomic benefits once in use.4 This sort of misrepresentation is exactly why this sort of gap analysis is so important.

Long-Term Health Effects From Poor Ergonomics

Why is this sort of gap analysis so important? The majority of clinicians are currently suffering from pain needlessly. They suffer through it, thinking pain is “Just part of the job.”

This mindset often leads to early retirement and serious musculoskeletal disorders as the damage only amplifies over time. Short-term solutions such as visits to the chiropractor, physical therapy or even surgery are only treating the symptoms, not the root problem. The problem will only continue until the source of the problem is addressed.

What To Do?

Get those photos taken today. Don’t stage it, be honest with your actual working posture. Sometimes it may help to have someone take a few candids of you working to catch you as you truly work when you’re not hyperaware of your posture.

Analyze your current ergonomics, make a commitment to improve, give yourself a realistic goal, create a plan, and a realistic timeline to achieve that goal. SurgiTel was built upon the fact that clinicians don’t need to work in pain. That includes you.

For further information on the importance of ergonomics, consider reading “Practice Dentistry Pain-Free” and or taking the CE course: Dentistry Shouldn’t Be a Pain in the Neck by Dr. Bethany Valachi, PT, DPT, MS, CEAS (see below). For any questions, contact me at Or you may schedule a visit with one of our representatives who can be found at Find a Rep.


Interested in reading more? Explore “Practice Dentistry Pain-Free” to help determine how your job and equipment are impacting your health and learn how to implement the best long-term research-based solutions and strategies.

Get certified in ergonomics! Dr. Bethany Valachi presents CE Video Course: “Dentistry Shouldn’t Be a Pain in the Neck”. Check it out for a deeper understanding of ergonomic strategies.




  1. Valachi, Bethany. Practice dentistry pain-free. Portland, Oregon: Posturedontics Press, 2008.
  2. Linda Meeuwenberg, RDH, M.A., F.A.D.I.A. “How SurgiTel Custom FLM Loupes can Prevent Career-ending Injury, SurgiTel. November 2013. Accessed January 21, 2019.
  3. Rucker, LM. Surgical telescopes: posture maker or posture breaker? In, Murphy D, ed, Ergonomics and the dental care workers. Am Public Health Assoc, Washington DC 1998: 191-216.
  4. Chang, BJ. Choosing Loupes for Dental School: 3 Most Common Myths in the Loupe Industry Demystified, ErgoPractice News, July 2018.