One exercise dentists should never do

Dear Bethany: I read an article in a dental journal, ‘The One Exercise that All Dentists Need to Do’ that states the ‘superman’ exercise is the best exercise for dentists. However I have been going to a physical therapist for my back pain and he says that the ‘superman’ exercise is unsafe. Which is correct?

Dear Doctor: You have a wise physical therapist! This exercise has been shown to place unsafe compressive loads to a hyperextended spine, and should be avoided. 

The theory of the superman exercise is that it targets one of the primary spinal stabilizers, the lumbar multifidus, by lifting both arms and both legs simultaneously. Dysfunction and atrophy of the multifidus muscles has been closely related to chronic low back pain.^1,2,3  

There are many strengthening exercises that target the lumbar multifidus muscles-the most popular are the bird dog, bridging and superman exercises. However, according to the world’s foremost expert on spinal biomechanics and low back pain, Dr. Stuart McGill, the superman exercise “results in over 6000 N of compression to a hyperextended spine, transfers load to the facets and crushes the interspinous ligament… It should not be done in any form”.⁴

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Further, the superman exercise is a dynamic exercise that takes the lumbar spine through a range of motion under high compression. Back machines at the gym that replicate this movement have been shown to cause disc herniation.⁴

The superman exercise was one of Joseph Pilates’ original exercises. The Australian Physiotherapy and Pilates Institute (APPI) evaluated the original Pilates exercises, based on the latest research, and recognized that many of the early Pilates exercises are ballistic and unsafe and have modified or removed many of these. The original ‘superman’ exercise was one of the exercises that was modified.

The resultant APPI program, the ‘Modified Pilates Rehabilitation Program’ is now taught in 22 countries. (In Australia and the United Kingdom, most Pilates instructors are APPI certified must adhere to the ‘Modified Pilates Rehab Program’-the original superman exercise is not allowed!)  Unfortunately, in the United States, there is little regulation of Pilates certification and many unsafe exercises are still commonly used. 

Fig. 1: Research shows that the 'superman' exercise places unsafe compressive loads on the lumbar spine and should be avoided.

Fig. 1: Research shows that the 'superman' exercise places unsafe compressive loads on the lumbar spine and should be avoided.

The article you are referring to was written by a resident dentist who provided no references for the efficacy of or appropriateness for the superman exercise. As medical professionals, we must thoroughly vet our sources. If I, as a physical therapist, wrote an article on posterior composite restorations, how much credibility would you place in that article? (None, I would hope!)

Aerobic, stretching or strengthening: Which is the best exercise for dentists?

There are three variations of the ‘superman’ exercise that are much safer, and approved by the APPI. These modified exercises include:

1) lifting arms only off the floor

2) lifting legs only off the floor

3) lifting opposite arm and opposite leg simultaneously off the floor

Fig. 2: The bird dog exercise is a safer and more effective exercise to prevent low back pain in dentists

However, the safest way to strengthen the multifidus muscles is with the ‘bird dog’ exercise. When performed with abdominal bracing and neutral spine, this is a very safe and effective way to strengthen the multifidus (and other back extensor muscles) and prevent low back pain. ^{4, 5}

Watch a video of the bird dog exercise here.

For a free whitepaper ’14 Exercises Dental Professionals Should Avoid”, please email info@posturedontics.com.