Joint Mobility

You Can Get Relief From Jaw Pain with PT

Over the years, I’ve seen quite a few patients with temporomandibular disorder, or TMD. TMD is a dysfunction of the temporomandibular joint and/or the surrounding muscles. Often TMD, is incorrectly addressed as TMJ. TMJ is the temporomandibular joint, or the joint that connects the jaw to the skull.

Throughout my career as Physical Therapist, I have had conversations with various dentists and orthodontists regarding the treatment of temporomandibular disorder (or TMD). The thing that I hear over and over from dentists and orthodontists is that they often don’t know exactly what to do with these patients, other than providing them a splint and referring them to a TMD specialist. Physical Therapy for TMD can be quite effective as a conservative option for treatment, and if needed, often can be used in conjunction with splinting and/or referral to a specialist.

Patients with TMD can present differently from person to person. I have seen patients with very severe symptoms including intense pain on one or both sides of the jaw, the inability to chew or even open their mouth to get food into their mouth, clicking or popping of the TMJ, or a locking or inability to move the jaw. I have seen great outcomes in working with TMD patients resulting in a significant reduction in pain and dysfunction, and often complete resolution of symptoms. When working with a TMD patient, I do a comprehensive evaluation followed by a 4 step treatment approach.

Evaluation:

During the evaluation, the assessment is focused on posture (including head, neck, and shoulders), ROM of the cervical spine (neck), thoracic spine (mid back) and TMJ, strength of muscles in the previously mentioned areas, and joint mobility and soft tissue flexibility of the previously mentioned areas.

Following the evaluation, the treatment consists of the following:

Step 1: Control inflammation and irritation with the use modalities

Modalities, such as ultrasound and electric stimulation can be used to reduce swelling and muscle spasms to decrease pain levels. Also dry needling can be quite beneficial in improving range of motion and decreasing pain.

Step 2: Patient education on the specifics of the injury and proper self management

Patient education is crucial and begins on the first day of physical therapy. If the patient doesn’t understand what they have, what is causing it and how to alleviate it, then they won’t get better in the long run and they definitely won’t understand how to self manage. It is our job as PT’s to provide that knowledge to the patient. A customized home exercise program will be provided that addresses all impairments that were found as well.

Step 3: Manual therapy including joint mobilizations and stretching of tight/inflexible muscles
As PT’s, we have the knowledge and skillset to assess and treat most joints and muscles of the body. Our goal is to restore normal joint mechanics and tissue flexibility. Also, a home exercise program that re-emphasizes that manual work, will be provided.

Step 4: Therapeutic exercises to address weak muscles

Muscle groups pertinent to the TMD include the muscles of the head, neck, mid back, shoulders and jaw. All impaired tissues will be addressed and a home exercise program that addresses the weak areas will be provided as well.

The results of TMD treatment with physical therapy can be significant. As a PT, I greatly value the benefits of using physical therapy to alleviate patients’ symptoms with conservative means of treatment.

Bad Headache? Your Posture Might Be To Blame

What is a cervicogenic headache?

A cervicogenic headache is head and/or neck pain that is referred from the bony structures or soft tissues of the neck including the muscles or joints. Referred pain is pain that is felt at a site other than where the cause is located. These kinds of headaches can present on their own, or in conjunction with other types of headaches, such as migraines.

While these headaches can be seen after a traumatic event such as a motor vehicle accident or assault, these headaches are often seen without a precursor of trauma or specific injury. In fact, many people with cervicogenic headaches have sedentary jobs that often include sitting at a desk or computer for most of the day.

Cervicogenic headaches often appear in conjunction with other types of headaches. Some experts say there are as many as 150 different types of headaches. Also, a person can experience more than one type of headaches and many are hard to tell apart. The different headaches can affect each other as well (ie: cervicogenic headaches can be worsened by migraines and vice versa).

Symptoms Physical Therapists can Help

-Pain localized to the base, side or front of the skull
-Pain localized above or behind the eye, jaw/ear area
-Pain into the head or neck that is intermittent and lasts hours to days
-Pain that worsens with head/neck movement, or sustained or awkward positions - range of motion is often limited
-Can have any of these symptoms with nausea and visual disturbances as well

How to prevent or minimize cervicogenic headaches

Often, people who suffer from cervicogenic headaches, sit at desks for the majority of the day. This contributes to a forward head and rounded shoulders posture. As a result, this can lead to shortening and weakening of the muscles around the neck and shoulder blades. Below are ways to prevent/minimize headaches.

Posture:

Sit up tall
Pull back shoulder blades Stand up every 30 minutes

Massage:

Massage from neck to mid back

Exercises:

Chin tucks- hold 5 sec, repeat 5x (insert chin tuck pic)
Neck stretches- pull ear to shoulder & chin to shoulder, do 2x, 30 sec holds (insert neck stretch pic)
Rows: pull shoulder blades back, do 2 sets of 10 (insert row pic)

When evaluating a patient with cervicogenic headaches, a Physical Therapist performs an assessment of the following:
-Posture of head, neck, shoulder blades, and mid back
-Range of motion of neck, mid back, and shoulder

-Flexibility of soft tissues surrounding the neck, shoulders, shoulder blades, and spine -Strength of muscles around neck, shoulders, and shoulder blades
-Joint mobility of the neck, mid back, ribs, and shoulders

After assessing the patient, the Physical Therapist will treat the patient. When treating my patients, I utilize 5 methods:

  1. Modalities such as ultrasound or electric stimulation to promote blood flow and healing and decrease inflammation

  2. Exercises to strengthen/stretch muscles in the neck, rotator cuff, also postural exercises.

  3. Education- instructions on body mechanics when sitting (in car or at desk), standing, bending/lifting, sleeping (proper use of pillow)

  4. Manual Therapy- joint mobilization and muscle stretching to improve joint and muscle flexibility

  5. Home exercises to reinforce program

Physical Therapy can be a very effective means in the reduction and often complete resolution of cervicogenic headaches. If you are unsure as to whether you’re a candidate for physical therapy, ReThrive can help determine the best course of action. If you’re interested, contact ReThrive, and schedule an evaluation.