Dentists & Chiropractors Help TMJ Patients

By: Charles Blum, D.C.

While all doctors ultimately want what is best for their patients, sometimes the concept of collaboration isn’t always considered. Historically, chiropractors and dentists would both help treat jaw or TMJ related pain or disorders on an individual basis helping patients as best they can. However, new research has been showing some fascinating relationships between how the body functions from a postural standpoint and how the jaw can respond.

To understand how a relationship between body posture and jaw function could occur, we need to look to some ingrained features of the human nervous system. We have two ways of keeping our heads on straight, one is associated with our eyes and other with the semicircular canals within our ears. They are called the visual and vestibular righting mechanisms. Together, they keep our eyes and ears level to the horizon regardless of any postural imbalance related to our legs, pelvis or spine.

Another important factor that helps us understand the posture and jaw interrelationship is that the body functions as a unit. The jaw or mandible sits in muscles that come off the head and neck. As the head and neck change position due to posture, the jaw muscles are likewise affected. What is fascinating is that a change in posture can affect jaw function, the way the teeth touch, the way the jaw joint is positioned and our ability to breathe.

A 2007 Tufts University study with 45 asymptomatic subjects found that if a dental splint appliance is placed in the mouth preventing the teeth from being in the proper position that this affects the patient’s ability to maintain proper body balance. Then, with the same patients they also found that if they placed a heel lift under one foot, the subject’s teeth would first contact when biting down on the side of the heel lift. This study illustrates how a change in the way teeth contact and the jaw position can affect posture and how body posture can affect teeth contact and jaw position.

What this has developed is a desire in the chiropractor’s part, when working with a patient with a jaw/TMJ problem, to make sure the patient’s posture is in balance in order to facilitate the dentist’s work to balance jaw function. Looking at it from a different angle, after appropriate dental work is performed on a patient, sometimes this change in teeth and jaw position changes a patient’s posture and a chiropractor can help the patient’s body accommodate to these new changes.

Since these concepts are relatively new, it can be challenging to find a dentist or chiropractor willing to co-treat a patient with jaw pain disorders. Not every patient needs this integrative care, but a patient who has concurrent neck or back pain, or is aware of a relationship between jaw and body pain should attempt to see if they are a candidate for this “team” care.

Here is a simple guide to determine how a person may assess their need for TMJ care:

How do you know when you have a TMJ condition that may warrant dental care?

• Does your partner say you are grinding your teeth at night or constantly snore?
• Do you have tooth temperature sensitivity, pain on chewing, or are you wearing your teeth down?
• Did you notice a relationship between orthodontic or dental work and your jaw pain?

These all may warrant a dental evaluation by a dentist trained in TMJ.

How do you know when you have a TMJ condition that may warrant chiropractic care?

• Do you have jaw joint pain, tension, and popping on opening or closing?
• Did your jaw pain start after having some lower back or neck pain?
• Did your neck or low back pain start after having jaw pain?

These all may warrant a chiropractic evaluation by one trained in TMJ care.

How do you know when you have a TMJ condition that may warrant both dental and chiropractic?

• When chiropractic care helps but the condition keeps returning, this commonly necessitates a referral to a dentist.
• When dental care helps but the condition keeps returning, this commonly necessitates a referral to a chiropractor.
• Ideally, before any dental work is finalized and becomes permanent, chiropractic care to balance posture is advised.

The future of healthcare will involve developing a relationship between the different doctors who treat similar conditions with the goal of offering our patients the best possible care. This would involve the least amount of intervention with the best outcomes. It is also important patients become knowledgeable about their condition. They need to be involved in searching for the most updated options for their care.

Dr. Charles Blum is a chiropractor located in Santa Monica, CA. He’s treated TMJ disorders for 30 years. He’s a senior clinical instructor in the Cranial Facial/TMJ Clinic at the White Memorial Center in Los Angeles.

To Foam Roll or Not to Foam Roll

Foam rolling: is it hype, a fad, beneficial or just plain painful? Let’s explore what foam rolling is first, then we will discuss the when and why.

Foam rolling is a myofascial release technique that uses pressure to reduce and release scar-tissue build up and adhesions in your fascia. This frees up your muscles to move and essentially work better during exercise or any other activity for that matter.

But what is this fascia you always hear about? And why is it so important to movement? Fascia is the web-like fibrous connective tissue that surrounds our muscles, organs, bones and every other internal structure in our bodies. It is a very densely woven matrix that is actually one uninterrupted system that connects every single internal structure. So when fascia develops scar-tissue or adhesions for any reason, it will create restrictions in movement of the attached structures and can also lead to pain in that area.

Now back to the when and why we should all be foam rolling. If you are wanting to quickly decrease your stiffness and aid in your warm-up, you should foam roll before your workout. Foam rolling after your workout is great for decreasing muscle soreness and aiding in muscle recovery from strenuous exercise. If you are wanting to increase your overall mobility and flexibility, foam rolling any time of day regardless of relationship to your workout would be beneficial.

If you have any questions on specific techniques or how to foam roll certain muscles, please contact our office and we would be happy to guide you through the process.

How do you know if you have a whiplash injury?

 

The term whiplash is actually a generic term that we use for injuries to the neck caused when the neck is suddenly and/or violently jolted in one direction and then another, creating a whip-like movement.

Most commonly, after well over a 11 years in practice and diagnosing hundreds (if not thousands) of whiplash cases, I can tell you whiplash is most commonly seen in people involved in motor vehicle accidents, but that’s not all.  It can also occur from falls, sports injuries, work injuries, and other incidents.

I remember seeing an 8 year old little girl who was pushed from behind by her older brother and gave her whiplash – not exactly the “gift” you’d like to receive! By the way, he felt horrible and learned an early lesson about being more responsible during play.

What’s actually injured in a whiplash?

Whiplash injuries mostly result in sprain-strain of the neck. The ligaments that help support, protect, and restrict excessive movement of the vertebrae (your spinal bones) are torn, which is called a sprain. The joints in the back of the spine, called the facet joints, are covered by ligaments called facet capsules, which seem to be particularly susceptible to whiplash injury.

Additionally, the muscles and tendons are strained or more easily understood as stretched beyond their normal limits. The discs between the vertebrae (which are essentially ligaments) can be torn, potentially causing a disc herniation. The nerve roots between the vertebrae may also be stretched and become inflamed. Even though it is very rare, vertebrae can be fractured and/or dislocated in a whiplash injury.  I’ve unfortunately seen a patient this happened to twice!

What are the common signs and symptoms of a whiplash injury?

Typically, the most common symptoms of whiplash injuries are pain and stiffness in the neck. These symptoms are generally found in the areas that are “whiplashed.” During a whiplash, first the head is lifted up from the upper-cervical spine. This creates a sprain/strain in the region just below the skull, where symptoms usually occur. Symptoms may also commonly be seen in the front and back of the neck. It’s not uncommon to experience pain in the front sides of your neck and perhaps even feel a “knot in your throat.”  Swallowing can even be painful.  Turning the head often makes the pain and discomfort worse.

Headaches, usually at the base of the skull, is also a common symptom, seen in more than two thirds of patients. These headaches may be one-sided or experienced on both.  Oh and as if that’s not bad enough, the pain and stiffness may extend down into the shoulders and arms, upper back, and even the upper chest.

In addition to the musculoskeletal symptoms, some patients also experience dizziness, difficulty swallowing, nausea, and even blurred vision after a whiplash injury. While these symptoms are disconcerting, in most cases, they disappear within a relatively short time. If they persist, it is very important to inform your chiropractor that they are not resolving – that’s definitely something I’d want to know. Vertigo (the sensation of the room spinning) and ringing in the ears is also a possible symptom.  What about pain in the jaw?  Yup!  That’s another possible symptom I’ve seen. Additionally, patients will even complain of irritability, fatigue, and difficulty concentrating. These symptoms also resolve quickly in most cases. In rare cases, symptoms can persist for weeks, months, or even years.

Another important and interesting aspect of whiplash is that the signs and symptoms often do not develop until 2 to 48 hours after the injury!  I should also mention that it’s not uncommon to feel OK after your accident only to discover 3-months later that you now get regular (or periodic) headaches, that you’ve never had before.

How do you recover from a whiplash injury?

One of the most important aspects of whiplash management is for the patient to stay active, unless there is some serious injury that requires immobilization. Patients should not be afraid to move and be active, within reason. In addition, I will often prescribe an exercise or stretching program. It’s in your best interest to follow your exercise/stretching program that I may give you, to ensure the best outcomes long-term.  Trust me, you don’t want to deal with lingering symptoms for years – although, I probably don’t have to remind you!
Ice and/or heat are often used to help control pain and reduce the muscle spasm that results from whiplash injuries.

Chiropractic adjustments are absolutely essential in order to reorganize your lost structural integrity and ideal spinal motion.

Without this, your spine will likely “settle” into a less-than-ideal alignment that can be permanent, so don’t delay!

Can whiplash be prevented?

Generally speaking, whiplash cannot be “prevented,” but there are some things that you can do while in a motor vehicle that may reduce the chances of a more severe injury.

• Always wear your shoulder and lap seat-belt
• Sit far enough but not too far from your steering wheel so the airbag works properly
• Ensure that the headrest in your vehicle is adjusted to the appropriate height – a common overlooked easy prevention measure!
• You could drive with a neck brace on all the time, that would help, but you’d look a little silly
• Be aware and avoid accidents – that’s still your best defense.

If you believe you may have suffered a whiplash injury, give the office a call and schedule a consultation with Dr. Cooper.  360-693-3030

Oh, and here’s a couple additional resources for more information, for your convenience:

http://www.spineuniverse.com/conditions/whiplash/chiropractic-care-symptoms-whiplash

http://www.acatoday.org/content_css.cfm?CID=3131

http://www.treatmentforwhiplash.com/

Race more, recover quicker with Kinesio Taping

Race season is rapidly approaching.  Whether it’s your first 5K or 5th marathon, right now is the time to think about what races to register for this year.  How far apart will you space those races?  How quickly will it take for you to recover from one race to the next? A lot of factors play in to the recovery process, with Kinesio Tape (also known as K-Tape) being one of them. This is not your traditional athletic tape that restricts movement and blood flow. Kinesio Tape is very pliable and allows much more range of motion.

You may see athletes wearing this highly visible, colored tape during races for specific musculoskeletal support and for post race recovery. This tape facilitates lymphatic drainage by microscopically lifting the skin, increasing interstitial space allowing better blood flow, a reduction of inflammation and better muscle mobility.  Kinesio Taping can also aide in reducing muscle tightness. It helps relax soft tissues while stimulating nerve fibers to control pain.

K-tape is most commonly used during the acute stage of injury and can be used along with other modes of therapy. To bring about change in affected tissues and facilitate the body’s natural healing process, k-tape is used in different ways to achieve desired results. Applied in a partially stretched state, the direction of pull acts as a communication system on muscle receptors. The tape is applied from the muscle origin towards its insertion point to work in the direction of the muscle fibers. Contact with the skin provides stimulus for neuromuscular re-education by creating awareness of the muscle group. The athlete feels the tape on his/her skin during activity, causing the underlying muscles to respond and reminding the body what it’s supposed to do. If the muscle begins to overstretch, the tape provides a cue for the muscle to back off and avoid further injury.  Most of my patients notice relief almost immediately!

Kinesio Tape is designed to stay on for approximately 3-4 days. The adhesive is heat- sensitive, so the tape is rubbed to make sure it is properly adhered to your skin. After a couple hours of normal activity, the Kinesio Tape should be properly bonded to the treated area. As a result of this strong bond, you can exercise and shower with the tape on without any issues. However, it is not recommended to swim with the Kinesio Tape on due to the chemicals in pool water that can potentially deteriorate the adhesive and loosen the tape.

Patellar tracking problems? Iliotibial band syndrome? These are just a few of the common issues I see in runners.  While Kinesio Tape is not a quick fix, it can certainly help support and rehabilitate the area.  Other common conditions that Kinesio-Tape can help include: carpal tunnel syndrome, neck and back pain, achilles tendonitis, strain/sprains, whiplash, lymphedema, plantar fasciitis, rotator cuff injuries, tennis elbow, golfer’s elbow, and postural abnormalities.

Again, this is just one component of accelerating recovery. Having raced 5Ks up to 50ks, I’ve had my fair share of nagging injuries. Using a variety of different therapies, including Kinesio Taping, has allowed me to recover from my injuries faster and helped me get back on the trails more quickly.

Get on my schedule at Cooper Chiropractic for an assessment to see if Kinesio Taping can help you reach your race goals this year.

I look forward to meeting you!

-Dr. Kremer

When To Workout With Pain

Yesterday, a good friend of mine and personal trainer, Tim Arndt, called me to voice his frustration because a doctor had told his client to stop working out due to low back pain. Tim is the owner of Tim Arndt Fitness and he blogs and podcasts on topics focused on simplifying fat loss and strength training. Tim worked very hard to design a weight loss workout for this client that did not irritate her low back pain. So, I can certainly see why he was frustrated. This brings up a very important question that I get a lot at BC Chiropractic Clinic: “When is it okay to workout after an injury?”

Pain can be very debilitating and it is the body’s way of letting us know that there is something wrong. However, physical activity is pivotal in  recovering from many conditions and injuries that cause pain. The different qualities and severities of pain are almost as varied as the conditions that cause them. In general, if pain is severe enough that a patient cannot get around comfortably and safely then he or she cannot workout.

That being said, it is in the patient’s best interest to return to some sort of workout routine as quickly as possible. What I tell patients in this situation is, “If it recreates your pain, don’t do it.” I use “recreate” because there is usually some sort of soreness that goes along with working out, but this is normal. It is important for us to understand that just because we are injured does not mean we are incapable of physical activity. If one area of the body is injured we can still work the healthy areas in ways that don’t aggravate the injured one. Physical activity increases blood flow and releases endorphins, which helps with healing, pain control, and our sense of well being. Furthermore, there is a physiological process called neurogenic overflow that takes place in the body when working out. Meaning, injured areas get stronger from simply working the areas around them. For example, doing curls with one arm will actually strengthen, to some extent, the opposite bicep.

Finding a workout that does not recreate pain can be easier said than done. However, this is usually because patients simply do not have the biomechanical knowledge or the familiarity with enough exercises to devise a workout that won’t make their conditions worse. Dr. Karis and I always try to help our patients by giving them exercises that will help them get stronger without irritating them. However, working with a qualified personal trainer that has open communication with your doctor will not only help you recover faster but it will also keep you on track with your health and fitness goals. If you have questions about how to find a good personal trainer talk to your doctor, Your doctor may be able to recommend some he or she trusts for patients. I recommend Joey Hogan at No Limit Personal Training. Tim is excellent, but he is in Spokane.

Remember, these are only guidelines for workout readiness. Always consult your doctor before starting any fitness routine.