Treating TMJ Issues--(http://wp.me/p1Si61-9R)
The National Institute of Dental and Craniofacial Research estimates that there are approximately 10 million people who suffer from some sort of TMJ dysfunction in this country. With the difficulty in diagnosis and treatment, many people will just live and suffer with this condition. The NIDCR indicates that the two most widely accepted triggers for TMJD is direct trauma to the jaw and stress. There are also debates (and strong doubt) on whether braces or clicking of the jaw can lead to TMJD, however research is not available. (1)
So what is a person supposed to do who is suffering with TMJD? Good question. The common answer seems to be less is more. The NIDCR indicates in another article that the best things you can try at home are:
- Try simple self-care practices such as eating soft foods, using ice packs and avoiding extreme jaw movements, like wide yawning and gum chewing. Short-term use of over-the-counter or prescription pain medicines may also provide relief.
- Avoid treatments that cause permanent changes in the bite or jaw. Such treatments include crown and bridge work to balance the bite, orthodontics to change the bite, grinding down teeth to bring the bite into balance (occlusal adjustment), and repositioning splints, which permanently change the bite.
- Avoid, where possible, surgical treatment for TMJ. There have been no long-term studies to test the safety and effectiveness of these procedures. Before considering any surgery on the jaw joint, it's important to get opinions from other doctors and to fully understand the risks. (2)
An Alternative Treatment:
Like any other articular bone in the body, the first thing that I test for is biomechanical integrity. If a joint is not moving properly, it may be from an actual joint issue, a muscle imbalance, a compensatory pattern that was never properly treated or corrected, or a combination of all three.
The most important part of the treatment in my opinion is the observation and diagnosis aspect. I have seen dozens of cases of TMJD, and although they are similar, no two cases are exactly the same. More often than not, the history and initial assessment will give 80% or more of the diagnosis. From this, a treatment plan can be formulated but will often have to be revised once rehabilitation is started because of the many changing clinical factors.
So What Exactly is the Treatment?
Manipulation: Treatment for TMJ usually starts out with a light manipulation. I do not use the internal method that many have tried. The method used is a light skin contact on the angle of the jaw. Most patients say that they have very little to no discomfort. With soft manipulation, it is possible to allow the disc to reposition itself properly without a lot of firm pressure.
Myofascial release: One of the staples of treatment involves myofascial work on the muscles of the jaw. This is the most difficult part of the process as many chronic TMJ pain patients will have a lot of scar tissue and inflammation surrounding these small muscles. With gentle soft tissue mobilization, patients will experience more movement with less compensatory motion (Z-pattern). This is ultimately the first part of the rehabilitation.
Rehabilitation: This is the most important part of care once the patient's jaw starts moving again without catching or locking. The exercises start light and very easy. They progressively get more challenging but require no special equipment or braces. Ultimately, it is every patient's responsibility to make sure that they continue their home care. The patterns or habits that one has ultimately affects their ability to recover.
Referrals: I work with several dentists in my area. I feel that it is a very important part of my patient's care that we work with their dentist. We utilize the dentist's professional skill and advice on items like braces or mouth guards, bruxism, and of course injury/risk to the teeth.
Like any other joint in the body, the TMJ is a joint that requires care and rehabilitation if there is an injury. Improper care or ignoring the problem can lead to more serious issues and can effect every aspect of your life if it becomes chronic. In a future blog, I will discussing three cases that all had successful outcomes, but also a few unexpected twists.
TMJ Etiology (for the full article see: http://wp.me/p1Si61-9A)
TMJ stands for temporomandibular joint. Many people who have jaw pain exclaim that they have TMJ, which is of course a misnomer because everyone has TMJ, more specifically two of them 
However, TMJ disorder can cause severe jaw, face, ear, and mouth pain. It is also often related to certain types of headaches as well.
The Basic Anatomy
The TMJ is a highly unusual joint in that it has two actions. It both opens like a simple hinge as well as glides backwards to forwards. As you can see from the pictures below, there is a disc and cartilage that pads the jaw joint from the skull. This disc will rotate as the jaw slides to protect it throughout the motion. There are also several muscles that play a major role. The pterygoids, masseter, and temporalis.
Problems of the TMJ
The normal structures when working properly allow us to sing, laugh, eat, chew, and converse without any problems. However, the disc, muscles, and joint itself can all cause issues. For example, the disc can cause problems if it slides too far forward or too far backwards. If it slides too far forwards, it is difficult to open your mouth and often results in a Z-pattern and an audible pop or click.
The muscles of chewing can also cause issues. For example, if the pterygoid muscles are tight, you may have clicking or popping in the jaw. They are also a possible culprit for the source of deep jaw pain, as well as the reason your mouth shifts to the left or right when you open and/or close it. The masseter and temporalis, if in spasm, can cause headaches, bruxism, and tooth damage.
Symptoms of TMJ Dysfunction
- Jaw pain and soreness
- Jaw locking
- Jaw crepitus or popping
- Abnormal bite/painful chewing
- Pain referring into the base of the neck, ear, and back of the eye
- Inability to open your mouth fully
Treatment of Tennis Elbow (For the full article, please go to http://wp.me/p1Si61-8X)
In my last post, we discussed tennis elbow or lateral epicondylitis. This condition is quite common and is often not caused by tennis. Repetitive injuries requiring finger dexterity, lifting, or excessive wrist motion can often lead to (non-tennis) lateral epicondylitis. When the injury is caused by tennis, it is usually from one or more factors that when corrected will often alleviate the condition.
So What Do I Do If I Have Tennis Elbow?
Treatment for lateral epicondylitis is usually pretty simple if you catch it early enough.
If the injury is new or acute, I suggest the following things:
- Stop the insulting activity. Many people will try using braces or medications in order to continue their activities. Unfortunately, until the tendon is allowed to heal, every new insult prolongs your recovery time.
- Rest. If you are having tendonitis, don't carry or lift things with the arm. Avoid gripping or gripping and twisting motions.
- Use ice. Remember that the skin and tissue around the elbow is usually thin, so make sure you use protective layers between you and the ice. Also, make sure you do not use it too long (in general 5-10 minutes per 30-60 minutes).
- Consult a physician. If you have had an acute trauma (car accident, sports fall, or other direct blow to the elbow) consult a medical professional immediately! Also, if the problem lingers past 4 days or gets worse, don't wait, get a medical exam to rule out other threatening and more serious problems.
- If it is a minor injury and you have less pain with conservative care, start making changes to your activities or equipment. If you are suffering with a tennis injury, check in with your tennis professional. They can examine your grip, string type and tension, as well as your stroke. One or all of these may be contributing to your problem.
For the remainder of the article, please click http://wp.me/p1Si61-8X
Tennis Elbow-Etiology and History --( For the full article, please click here http://wp.me/p1Si61-8X)
Tennis is a fantastic sport. It requires coordination, agility, and endurance. It also allows you to get exercise in an individual or team environment. It is appropriate for people of all ages. However, there are a few pitfalls to the sport. One such injury is what we will be discussing today and that is tennis elbow or otherwise called lateral epicondylitis. Our discussion will be divided into two major topics, background information of the injury in this post and the treatment of the disorder in a future post.
So What is Tennis Elbow? Lateral epicondylitis is the inflammation (-itis) of the outside (lateral aspect) of the elbow. Symptoms usually occur on or close to the elbow, but may radiate as far down as the wrist.
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*(source at end of post)
Starting with the basic anatomy around the elbow, we will discuss the bony landmarks first. The lateral epicondyle (of the humerus) is located on the outside of the arm. The two bones of the forearm are the radius and ulna, with the ulna on the outside of the forearm (pinky finger side) and radius inside (on the thumb side). If you look at your own arm now, first move your fingers and watch the muscles move in your forearm. These are the muscles we will be addressing.
For the rest of the article, please go to http://wp.me/p1Si61-8X
Plantar Fascitis
So what exactly is plantar fascitis? If you look at the diagram below, notice the white material stretched between the heel (calcaneus) and the toes (just past the metatarsals). This white material, also known as fascia is the connective tissue within the foot. Incidentally, you also have this material in your hand. So, to put it all together, the "plantar" refers to the foot, the "fascia" is the connective tissue between the bones, and the "-itis" is the inflammation of it. Easy enough, right?
Source: http://www.google.com/imgres?imgurl=http://chicagodancesupply.com/wp-content/uploads/2011/08/PlantarFasciitis2.jpg&imgrefurl=http://chicagodancesupply.com/2011/08/dancer-dilemma-i-have-plantar-fasciitis/&h=290&w=300&sz=13&tbnid=2CdbKTTbr-sZPM:&tbnh=81&tbnw=84&prev=/search%3Fq%3Dpic%2Bof%2Bplantar%2Bfascia%26tbm%3Disch%26tbo%3Du&zoom=1&q=pic+of+plantar+fascia&docid=y8nNjpgbl2sINM&sa=X&ei=VxFvT7zuOMPMtgen-cWlBg&ved=0CHQQ9QEwEA&dur=4713
So why do we get plantar fascitis?
Plantar fascitis is the result of any irritation to the plantar fascia. This may be from a genetic disorder like flat feet or it may be from walking in shoes that are old and worn out. Your weight can also negatively affect the plantar fascia. Many will find that by dropping a few extra pounds, they will also feel improvement in their feet.
So how do I get rid of plantar fascitis?
There are so many options on the market today. There are many different brands of shoes, inserts, orthotics, and customizations to your shoes that are available, most people are paralyzed with their choices. Today, I will focus on the healing aspect of the condition, rather than the consumer product support (i.e. I'm not going to tell you a certain brand of shoe or insert to buy :))
New research is emerging daily suggesting that if a person will strengthen their feet, it is possible to improve a flat-footed condition. I have done some personal case studies in my office that are shocking. In one study, I found a patient who had been prescribed orthotics (customized) 11 years ago. My findings were that his foot got flatter! We have started working with him by doing myofascial release and adjusting the foot, as well as doing some physical strengthening and proprioception exercises with him. He has also taken his orthotic out and is using a shoe that has less arch support. He was very sore for the first two weeks, but over the course of the last month, he has not only had less pain, but his foot is less flat when scanned using our custom orthotic device! (and no, I didn't make him new orthotics)
In my practice, I am trying to improve people's feet with gate analysis and exercises, as well as strengthening protocols. Please understand, I do not recommend anyone just trying to go to a less supportive shoe unless you have consulted with a professional. Why? You could experience increased plantar fascia pain, the inability to walk without severe pain, Achilles' tendonitis, shin splints, knee pain, and hip pain just to name a few.
If you have tried everything else, I invite you to consider doing a foot strengthening protocol. Our bodies were not designed to run with two inches of padding on the sole of our foot. If you have a large barrier, your muscles will weaken and the chance at atrophy is much higher than if you exercise your muscles fully. However, please be smart and do it in a controlled manner and under the care of a professional.
Treatment of Plantar Fascitis
So earlier this week we discussed the what and the why of plantar fascitis so now we need to discuss its treatment. Lucky for us, the treatment is essentially stretching the foot and possibly doing some myofascial work if necessary. I must warn you, if you are not medically trained this may be very difficult to understand . . . NOT!
One of the reasons I like home/self-treatment for plantar fascitis is because it is so easy. Referring to the picture below, you can see the "hot spot" that is plantar fascitis. The middle diagram provides the best view because you are able to see the five distal (toe) attachments with the one anchor (heel). The reason this is significant is because the five toe attachments can distribute the pressure from the body's weight equally on them whereas all five points pull on the one heel attachment site.
*Picture provided by: http://www.plantar-fasciitis.org/images/plantar_fasciitis.jpg&imgrefurl=http://www.plantar-fasciitis.org/&h=240&w=626&sz=32&tbnid=zCARnmoBOfuPRM:&tbnh=43&tbnw=111&prev=/search%3Fq%3Dpictures%2Bplantar%2Bfascia%26tbm%3Disch%26tbo%3Du&zoom=1&q=pictures+plantar+fascia&docid=MZUrpOOWZHuc3M&sa=X&ei=tvp0T9enBoms8QSl0LWbDQ&ved=0CE8Q9QEwAg&dur=691
Treatment of the Plantar Fascia
1. Stretching the plantar fascia. I recommend that before you get up, you should slide yourself to the foot of the bed and allow the covers to gently pull your toes to your nose. Hold this position for 10-20 seconds. If you foot begins to cramp or hurt, stop immediately. Stretching can also be accomplished with a band or towel with which you wrap the toes and pull back towards your body.
2. Home massage is an easy and gentle way to help the plantar fascia. Warning: aggressive massage may cause severe pain and difficulty with walking. Massage can be done with your hands or a soft tennis ball. I recommend that if you use a tennis ball, do so in a non-weightbearing position (seated) first. Standing on a tennis ball initially will be quite painful and you risk causing spasm and severe pain. Work the non-weightbearing massage for two to three weeks before trying to do the massage in a standing position. If you have tried it in a standing position, I would recommend consulting a physician or a massage therapist experienced in plantar fascia treatment.
3. Strengthening the plantar fascia is also important. This will be the last phase and may take weeks to months to work up to in order to be successful. (Your plantar fascia-heel should not be hurting at this point.) I recommend sitting on a chair in a room with tile or hardwood floors. Start with a thin wash cloth and try to scrunch it up with your toes about five times. As you become stronger, you can use a thicker/heavier cloth or towel and increase your repetitions and sets.
4. Other notes: Rolling on a foam roller for your calf muscles and hamstrings will also help loosen the lower extremity. Also, if you do have an acute flare up, try using an ice bucket/bath for it. Your foot will be placed in the ice water for 10-15 seconds, then removed for at least 2 minutes. Warning: if you leave it in the ice bath too long, cramping and pain can result! Then, make sure your foot has warmed up and even try putting a little pressure on your foot before walking.
I hope you have enjoyed this post. I would recommend that if you have had previous foot surgery or may have an unusual condition to consult with a physician. The dangers of home treatment is that you may harm yourself. If you have tried the above measures and are still having trouble or are doing worse, contact your doctor immediately.
Have You Had Your Shot Today?
One Shot, then you're set for morning. Another shot after lunch to stay awake . . . then the real question, when does it end?
http://news.yahoo.com/photos/inhalable-caffeine-reviewed-by-fda-1329760082-slideshow/aero-shot-caffeine-device-displayed-boston-tuesday-feb-photo-105456256.html
Aeroshot, now available in New York and Massachusetts, offers a quick puff of caffeine, up to 100 mg/shot! Engineered by Harvard engineering professor David Edwards, the caffeine is packed into something the size of a lipstick container and is sold in units of three for about $3. Amazingly enough, the FDA is now getting around to reviewing the product for its safety and efficacy.
So why do we need more caffeine? It must be due to our always amped up lives rather than the lack of sleep (sarcasm). For some, the Aeroshot will provide a quick boost on a long drive or to finish a term paper. However, more dangerously, others will use the Aeroshot as a daily "vitamin" of sorts to compensate for a 3-4 hour night's sleep on a regular basis. Before I discuss the negative effects of caffeine, please understand I do realize that there are some good benefits to short term caffeine supplementation on athletic performance as well as the increased acuity of your physiological state.
That being said, our country has moved to the theory of if a little is good so a whole lot must be better. Ergo the dangers of packaging caffeine in lipstick sized containers in an inhaler type apparatus. Overcaffeinated.org discusses the following effects:
"Caffeine stimulates the central nervous system and can produce restlessness, headaches, and irritability. caffeine also elevates your heart rate and blood pressure. Over the long-term as your body gets used to caffeine, it requires higher amounts to get the same effects."
http://www.overcaffeinated.org/effects-of-caffeine-on-the-body.php
They also go onto discuss the long-term effect of the body building a tolerance to caffeine requiring more of the drug to stimulate your system. Further, the effects of continual stimulation on the sympathetic (fight or flight) nervous system can lead to adrenal fatigue (the "hitting-the-wall" effect) and lowering your metabolism. http://wp.me/p1Si61-6C Finally, and probably the most disturbing is the half-life of caffeine. Caffeine has a half life of about 6 hours. This means, 100 mg of caffeine at lunch time (one shot of the AeroShot product) will still be in your system at 6 pm (50 mg) and 12 am (25 mg)! This of course will interfere with normal sleep which is precisely the reason we are having to use the caffeine in the first place!
Although I do enjoy coffee in the morning and an occasional soda with lunch, the idea of making a product that offers approximately double the amount of caffeine in one soda does worry me. Our country seems to SUPERSIZE everything, so we need to use products like these with caution. To find out how much caffeine is in your favorite beverage, check out: http://www.cspinet.org/new/cafchart.htm.
10 Habits to Change Your Workout
10 changes to help you be successful.
- Make sure you exercise is not part of your “To Do” list, but rather part of you. It should be like eating, sleeping, or showering-part of your routine that you just can’t live without.
- Don’t skip workouts-or even cut your workouts short. Workouts should be like doctors appointments or watching your favorite sports teams (you don’t leave before the end of the game do you?)
- You have to sleep. All athletes who excel must have sleep to perform at their peak.
- Eating should be pre-planned and as serious as your workouts. If your routine is the drive thru, think again! You should write your meals out for the week so you don’t get tempted to eat poorly between workouts. Try http://saymmm.com/mealplan.php# to get yourself aquainted with meal planning.
- Keep pushing! We all hit roadblocks. Whether it’s at work or with our workouts, prepare yourself to mentally to achieve success and push through the tough times.
- Use your short comings for motivation. Many of us will shy away from our weaknesses and only repeat what we are good at-change that mentality and always try to improve yourself.
- Envision the final goal. Whether it’s weight loss, a strength goal, or making yourself healthier, it all starts with vision.
- Write your goals down and keep a journal. As with any other goal, keeping a journal and knowing how close you are to achieving your goals is imperative.
- Take your favorite music. Music is a great motivator and has been scientifically proven to stimulate your limbic system. It will also help get you pumped and ready to workout. Feyza Sancar says, “For any individual who either avidly listens to or performs music, it is understood that many melodies have amazing effects on both our emotions and our perception.” (http://serendip.brynmawr.edu/bb/neuro/neuro99/web1/Sancar.html)
- Celebrate your accomplishments. When you hit a goal, reward yourself!!
To read the rest of the story, go to http://wp.me/p1Si61-5M.
NIH Study says Chiropractic and Home Exercise is Most Effective
Neck pain is a common symptom affecting approximately 80% of people at some point in their life time. It may be from an auto accident (whiplash), a sports injury, sleeping wrong, poor posture while sitting at work, or popping your own neck (self-manipulation). So what do most American's do for their neck pain? Most take some sort of medication whether it's an over-the-counter medication (non-steroidal anti-inflammatory) or a stronger prescription medication. The reason for this is most often convenience. It's a lot easier to take a pill than it is to actually see a qualified professional for help and then undergo a series of home exercises that will help to reduce the risk of future occurrences. Everydayhealth.com discusses the use of alternative therapy providers and more specifically about the use of chiropractors in a recent article. To read the conclusion of this article, please click the link: http://wp.me/p1Si61-2l
February 11, 2012
To Yawn or Not to Yawn
Yawning, just saying it makes me . . . well yawn! Today's blog has to do with the positive scientific research of a good yawn. We will discuss a little anatomy (which might make you yawn :) ) and then we will discuss why it is so important to yawn. There may be a way that you can help slow down age-related diseases or improve attention-deficit behaviors just by slowing down enough to yawn regularly!
First, we should dispel the myth that yawning is what people do when they are bored, or is it? Is it something we only do when we are sleepy? Or, is it only what people do when they see someone else do it (the social yawn)? All three are actually correct, we do it in order to stimulate brain activity. This may be to "wake up" when we are bored (hopefully not with this article :) ) or when we are tired to help us prepare for sleep, or when we are "influenced" by our surrounding peers. Your-health-news.net says, "Yawning is also very contagious, when your friends yawn you start doing it too. The reason for this is that it helps people synchronize their behavior with others." (http://www.your-health-news.net/natural-remedies/yawning-is-a-real-neurological-treat/)
To read on, follow this link to my wordpress blog: http://wp.me/p1Si61-53
February 9, 2012
Rib Pain-Sharp, Stabbing Pain in Your MidBack
Have you ever had sharp back pain just off to the left or right side of your spine? Many people will describe it as if someone stabbed them with a fork and point to the area over the ribs? Well, I got to experience that wonderful pain this weekend. Although it has been some time since my last episode, this reminder served as my inspiration for this blog. We will discuss the anatomy of the ribs, the possible causes of the pain, and the solutions if you suffer from this pain.
The anatomy of the posterior thorax surprises many of my patients. The reason is there is a lot of confusion around the relationship between the spine and the ribs. Below is a picture taken from wikipedia (http://en.wikipedia.org/wiki/Human_back) As you can see, the ribs articulate into the thoracic vertebrae with the shoulder blades (scapulae) lying over top of them.
To read more, follow this link to my wordpress blogpage: http://wp.me/p1Si61-4A
February 2, 2012
Golf Stretches for Your Lower Body
Too many golfers today leave work, jump in their car as they are calling their friends to confirm their tee time, changing shirts at the stop light, and trying to make a 15 minute drive happen in 11 minutes. Does this sound like you? If so, it also probably means that you are not stretching (even after tying your shoes on the first tee)! So what's the big deal? With every practice swing, stroke, and putt, you are asking your body to perform a unique exercise that it was not prepared to do. In turn, your body will not be able to do that activity without significant risk of injury to the muscles and joints. Further, like any repetitive activity, when you change the pattern of performing a task, you will create muscle memory-like a bad habit-which will be difficult to change in the future.
In yesterday's blog we focused primarily on the muscles of the upper trunk. Today, we will focus on the lower body including the lateral hip stabilizers (gluts and piriformis), the hip flexors (iliopsoas), as well as the lower leg (gastroc/soleus).
The lateral hip stabilizers are crucial in the game of golf to aid the back muscles during your swing. These muscles help to generate the maximum effort created by the forward momentum of your body. In order to stretch these muscles, it is imperative that you plan ahead. If not, you could irritate the sciatic nerve (the largest nerve in the leg) that can lead to tingling, numbness, or pain (not to mention a bad golf game)! The piriformis muscle looks like this:
As you can see, the piriformis muscle lies directly overtop the sciatic nerve (and the gluts overtop the piriformis). Therefore, if the muscles have not been stretched, you will have some amount of compression on the sciatic nerve which can lead directly to aggravating symptoms in your hip/gluteal region or down your leg. Further, it can also set you up for future episodes of either back or leg pain.
To stretch the piriformis, cross the leg you will be stretching over the other leg with the knee bent while lying on your back. You will apply pressure with your hand on the knee towards the opposite shoulder. Please be careful NOT to pull on the knee while simultaneously leaning forward or lifting up with your torso. This may lead to a disc injury-your back should be kept straight. See diagram below. There are additional variations of this stretch. If you do not seem to feel a stretch deep in the gluteal region, consult your doctor for additional stretches.
To read more, go to: http://wp.me/p1Si61-4k
