Understanding the Silent Pain of Positioning

 


Weekend with close friends is one of the best moments we all look forward to. One such weekend, I was sitting with a dear friend Don. He’s not just overweight—he weighs around 180 kgs (≈ 396 lbs). We were talking about hospital and clinic marketing—he’s a brilliant web developer—and the conversation wandered into dental treatment. Casual, light-hearted… until he said something that really made me pause.

“Doc, I guess I need to get a filling done.”

Now, Don is not my patient. I never treat close friends—I usually refer them to trusted colleagues to avoid emotional overlap. But I asked him, “What’s holding you back?”

He smiled and said, “It’s not the drill, Doc. It’s the fatigue after the procedure.”

Then came the real question:

“Is it normal to experience pain and fatigue in other parts of the body during or after dental treatment?”

It caught me off guard.

He explained: “I have limited mouth opening. If I sit in the chair for more than 20 minutes, my back starts aching, and my neck cramps up.”

And suddenly, I remembered something I hadn’t processed fully.

A year ago, I had undergone Bankart surgery on my right shoulder. (Bankart surgery is a procedure to repair a torn labrum due to shoulder dislocation.) Post-operatively, when I woke up, it wasn’t my shoulder that hurt most—it was my left thigh. For nearly a month, walking was difficult. I later realized it was Lateral Femoral Cutaneous Nerve (LFCN) compression, medically known as Meralgia Paresthetica. It was caused by positioning during surgery. The intense thigh pain and burning lasted for weeks. Even now, I occasionally feel a tingling sensation.

I weigh around 130 kgs (≈ 287 lbs) myself. So I understood Don—deeply.

This conversation—and my own experience—prompted me to dig deeper.


 The Ergonomics for the Patient

Modern dental chairs and OT tables are marvels of engineering, designed with clinicians in mind. Adjustable height, headrest tilt, lumbar support... but rarely do we question:

Are these chairs truly comfortable for patients—especially during long procedures?

And more importantly:

How does a patient’s body weight, height, and anatomy impact their tolerance?

The Science of Pressure and Pain

1. Operating Table Pressure Injuries

  • Gefen A. et al. "Clinical and biomechanical aspects of pressure injury prevention using prophylactic dressings in surgical patients." Journal of Wound Care, 2020; 29(Sup6b):S1–S52. .

            Demonstrated how standard OT table surfaces contributed to localized tissue damage and increased the risk of pressure ulcers, especially on sacrum and heels. The use of foam and air-filled pads significantly reduced injuries.

2. Dental Chair Ergonomics and Static Muscle Load

  • Gupta A.et al. “Ergonomics in Dentistry: A Comprehensive Review.” Indian Journal of Dental Research, 2021; 32(4): 412–420.

            The review highlighted how prolonged stillness in dental chairs affects both patients and practitioners. Especially in overweight individuals, static postures can lead to muscle ischemia, back pain, and increased heart rate.

3. LFCN Compression – A Case of Meralgia Paresthetica

  • Apfelbaum JL, et al. "Postoperative Peripheral Nerve Injuries." Anesthesiology, 2020; 132(2): 387–403. 

            The article detailed how surgeries in the beach-chair position increase the risk of lateral femoral cutaneous nerve compression, especially in obese patients, due to the proximity of the nerve to the ASIS under pressure.

4. Large Body Frames and Table Engineering



  • Seow YH, et al. "Operating table dimensions and support surface design for bariatric patients: A review of safety considerations." Surgical Innovation, 2022; 29(1): 85–91.

        This paper emphasized the mismatch between standard OT table widths and the body proportions of bariatric patients. It recommended minimum pad thickness of 10 cm and adaptive cushioning zones for safe distribution.

Solutions: Evidence-Based Positioning Strategies

We must move from a one-size-fits-all approach to a personalized, physiology-driven strategy. Here’s a table that highlights considerations for different body types and procedural lengths:

Patient TypeRecommended SetupArticle 
General (Normal BMI)5 cm foam padding on OT table, neutral head and leg positioningGefen et al., J Wound Care, 2020
Overweight (>100 kg)Use 4–5" viscoelastic foam pad, add gel cushions under heels and sacrumApfelbaum JL et al., Anesthesiology, 2020
Tall Patients (>6 ft)Ensure chair/table length is ≥ 200 cm, add lumbar and cervical paddingGupta et al., IJDR, 2021
Long procedures (>90 min)Reposition limbs every 90 mins, avoid pressure on ASIS or inguinal areaSurgical Positioning Guidelines, AORN Manual 2022
LFCN Risk (High BMI)Avoid tight hip straps, place foam wedges around pelvic region, slightly abduct legsMayo Clinic Nerve Injury Review, 2021
Bariatric (BMI >40)Use OT tables with 450–500 kg weight capacity, 10 cm thick viscoelastic padding, extendable widthSeow et al., Surgical Innovation, 2022

The Bigger Picture: Positioning Is a Patient Right

        Positioning is often discussed in the context of surgical safety and anesthesia risks—but it must become a routine conversation in general clinical care. Patients who feel fatigue, tingling, or numbness after long procedures may never trace it back to positioning. But as clinicians, we must.

        We need interdisciplinary research, policy revisions, and equipment designs that consider real-world human variation—height, weight, body contour, nerve path proximity. We need to listen not only with stethoscopes but with curiosity.

We care about clean margins and precision sutures. Let’s also care about the numb legs, burning thighs, and aching necks that patients never complain about.

What I took out of it?

Don’s comment opened my eyes. My own injury confirmed it. And now, I can’t unsee what I once overlooked:

Comfort isn’t luxury—it’s dignity.

When a patient walks in for a root canal or lies unconscious on a surgical table, they trust us with more than treatment—they trust us with their body’s silence.

Let's try and reduce the appointment time as much as possible.

If we need lengthy appointments for patients keep it with frequent breaks so that the patient can move and relax if they are conscious.

If we cannot give a break, then, at least give adequate support to pressure areas and have our assistants monitor the patients discomforts so that we can move their positions and release pressures. 

Better concepts and design of dental chairs and OT tables, which can ensure adequate relaxation of muscles depending on patient's anatomy.

The hospitals and clinics need to rethink about the lines of customer satisfaction into how the hospital and clinic settings while procedures can give maximum comfort to patients there by getting better reviews rather than satisfaction to show off.

Inform the patient not only about the possible complications associated with the treatment before taking the consent, but also about the possible discomfort that could arise due to lengthy procedures before taking consent. 

Last but not the least, "WHEN DISTRESS CREEPS INTO US, DO NOT FORCE YOURSELF TO JUST DO THE PROCEDURE. STEP BACK, TAKE A BREATH, WAIT FOR 2 TO 5 MINS WHILE RELAXING OUR STRAINED BODY AND MIND AND THEN CONTINUE THE PROCEDURE. A STRESSED OPERATOR HAS STIFF MUSCLES THAT CAN AUTOMATICALLY TRANSFER TO THE ALREADY STRESSED PATIENT."

Let’s make sure that silence doesn’t carry pain.

– Dr. Saji Pillai

Comments

  1. Hamza Hassan MohamedAugust 6, 2025 at 6:47 AM

    Thank you for this powerful and eye-opening write-up, Dr. Saji. It’s made me rethink so much about what happens around the procedure, not just within it. I’ve definitely learned from this, and I’ll be more mindful going forward; of comfort, positioning, and the silent stress patients carry. We all have room to do better.

    ReplyDelete

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