What is a TMD and what are the symptoms?

What is a TMD?

The temporomandibular joint (TMJ) is the name of the joint located on either side of your head, just in front of your ears. These joints connect your mandible (jawbone) to your temporal bone (skull). The TMJ, which can rotate and move forward, backward and side to side, is considered by the Canadian Dental Association to be one of the most complex joints in the body.

The TMJ allows us to chew, speak, swallow and yawn. When you have a problem with one of the structures in the TMJ complex (muscle, bone, ligament or disc) you have a temporomandibular disorder (TMD).

What are Common Causes?

Studies suggest most TMJ problems are due to dysfunction of the masticatory muscles related with parafunction and/or emotional stress.

However, many factors can influence the TMJ function and lead to a TMD, such as:

Dental and orthodontic work
Inadequate occlusion
Cranial default
Psychological stress
Trauma
Postural stress
Systemic disease e.g. arthritis
Congenital defect

Considering this list, we can say that 80% of the time the TMD is caused by one or many of the above factors.

What are the symptoms when you suffer from a TMD?

The symptoms we hear the most amongst patients are the clicking or grinding of the jaw. Other common symptoms include pain in the ear, cheek, teeth and temples. Symptoms can also include stiffness of the neck, pressure behind the eyes or difficulty swallowing. In some cases people won’t consult until they experience pain, but all symptoms should be mentioned to your health professional.

If we take ear pain as an example, studies have shown that when an ear infection is ruled out, one third of patients had a TMJ disorder, one third of patients were suffering from a cervical spine disorder (CSD), and the final third of patients experienced pain from both areas. The same can be said for forehead pain. When the sinuses are ruled out as being the cause, the pain will come from the neck musculatures.

When someone is experiencing pain with their teeth, it is better to see the dentist first to ensure there is nothing wrong with a tooth or a nerve. A panoramic radiograph will be made in some cases, or medication will be prescribed by your doctor, but remember that teeth pain is also a symptom of TMD.

TMD diagnoses we find in Physiotherapy are hypomobility and hypermobility of the TMJ, anterior disc displacement with and without reduction, musculature syndrome, osteoarthritis, and post injection syndrome.

There is also an important relationship between TMJ function and posture. Studies point to the influence of an anterior head position as an important factor on the masticatory function. There is evidence to prove that changes in body posture influence the muscle tension on the TMJ. Furthermore, studies are discussing the relationship between the dental occlusion and the posture. Nowadays, the influence of the teeth in the orofacial balance and masticatory muscle is recognized.

Conclusion

To conclude, this is why an assessment and treatment of the TMJ includes neck function and posture as well as cranial mobility. It is a joint like any other in the body with a complexity added by the disc in the TMJ. Statistics say that 70% of people will have a TMD, but will not consult a professional until they experience pain.

TMD is manageable in Physiotherapy with manual therapy, electrotherapy, and specific exercises for this joint.

Acupuncture, IMS & You

IMS

Acupuncture, IMS & You

We all get aches and pains. Many of us have tight muscles. So what’s an effective treatment your physiotherapist can provide?

Acupuncture and Intra-Muscular Stimulation (IMS) are two effective treatment options. They are used to treat a variety of conditions such as the neck and back pain you experience; but they can also be used to treat tendonitis, chronically tight muscles, headaches and many more. Although many people have heard these terms, most people do not know exactly what they are, or how they work. Both forms of treatment can be very effective, and may be the trick to getting rid of your ailment.

Anatomical Acupuncture is a form of treatment where very fine needles are inserted into certain points throughout the body. These points are based on anatomical structures and will stimulate muscles, tendons, nerves, and blood vessels. The effects of acupuncture include reduced inflammation, reduced pain, and increased regeneration. This happens through the needle triggering an immune response which fights inflammation, releases endorphins which helps with pain, and a regenerative response to increase tissue growth. All of these reactions will help with pain and healing. Physiotherapists are not “Acupuncturists”, and the form of Acupuncture we use is tied to a western medicine diagnosis rather than Chinese medicine.

IMS was created to help with chronic pain. It is similar to Acupuncture, except the needles are inserted into taut “trigger points” in the muscle. This helps reset contracted muscles that have shortened from distress. The effects of releasing these tight muscles reduces pain as well as relieves pressure put on nerves by contracted muscles. Nerves that are under pressure can cause radiating and referred pain. IMS works through the muscle “grasping” onto the needle when it is inserted, which causes a cramping sensation and a muscle twitch. This triggers three reactions: a “relaxation reflex”, a small tissue injury that draws blood flow to the area stimulating the natural healing process, and an electrical impulse that resets the nerve to function normally again.

These two treatment techniques have many similarities, and many differences. Similarities include how it triggers a natural healing response, reduces muscle tension, and desensitizes nerves. Differences include how the treatment is administered, the overall sensation, and the science behind how they work.

During a treatment you can expect a full assessment and physiotherapy treatment. For acupuncture, the needles will be placed in certain points and left for 10-20 minutes. With IMS, the needles will be inserted and stimulated by the therapist, then immediately removed. You can expect some fatigue after treatment, and possible muscle soreness. Drinking water will be important to help battle these side effects. Overall they are alternative treatment methods that have been shown, in some cases, to give phenomenal results. Please discuss with a physiotherapist certified in Acupuncture or IMS to see if it is the right treatment for you.

Sun City Physiotherapy Locations

Running Injuries

Hips and Knees

Running Injuries

With the fall clock running down, many of us weekend warriors are being chased down by the injury bugs. Following a long, hot season of pounding the trails, it’s not uncommon for some aches to show to up. For both the avid year-round runners and the warm-weather aficionados, the mileage starts to add up. With the mileage comes various ailments to our hips, knees and ankles. This can be contributed to poor training habits, technical errors or the body just hates us. Regardless of the reason, the point of the fact is there is a broad spectrum as to why the body breaks down. Looking at it anatomically — and biomechanically — from a physiotherapist’s standpoint, two of the most common areas where a runner’s body can break down are the hips and the feet. This article will focus on the hips. The hip can be a cause of a variety of common injuries encountered by runners. These include patella-femoral syndrome, aka runner’s knee, IT band pain, or the dreaded plantar fasciitis. Weakness or imbalance in the muscles of the hip, or tightness of the hips, can change how the joints below your hips move. For the runners that have been told their knee and/or feet pain is due to flat feet, or over-pronation, it could very well be due to one of the above-mentioned reasons related to the hip. The hip is an important part of running as it is designed to take the bulk of the impact when we land, it is also responsible for generating the energy that moves us forward. Because humans are inherently designed to compensate for faulty systems in our bodies, we have become very good at using different body parts and movements to achieve the same goals. In running, when the hips aren’t doing their job, the muscles and joints below can take up the slack. Overtime, these systems can be overworked and this is when we can start getting achey joints, and chronic muscle and tendon injuries. With a physiotherapist, the initial assessment includes: comparison of both walking and running patterns (viewed from in front, behind, and from the side); strength assessment; lower extremity alignment; and education regarding the findings. A plan can then be put together that best fits with the runner’s goals, including activities aside from running. There is not a single solution, but let us work with you to find your stride.

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Sun City Physiotherapy Locations

Cervicogenic Dizziness

Vestibular Rehabilitation (Dizziness and Vertigo)

Cervicogenic Dizziness

Dizziness is not necessarily vertigo!

Have you ever experienced dizziness and the Doctor tells you it is vertigo? Yet you are not responding to the vertigo treatment? There is a chance that the symptoms are not from a classic BPPV (benign positional paroxysmal vertigo) because there are many other reasons why you could feel dizzy.

There are other vestibular sources that can provide dizziness and to understand where it is from, you need to know more about the vestibular system.

Anatomy

In your body there are 3 systems to keep you in balance:

Eyes/vision
Vestibular system
Proprioceptive system

These 3 systems work together, so if one of them is lacking you might suffer from dizziness as a symptom. For example, if you have glasses and a stiff neck because of anxiety, your vestibular system has to work harder to compensate for the two others. If the 3 systems are not coordinated it might result in vestibular problem.

Cervicogenic dizziness is a diagnosis of exclusion. This means that when the medical and vestibular problems are ruled out you can consider this diagnosis.

The main characteristics of this problem are feeling imbalance and having neck dysfunction or pain.

Symptoms

Many people are surprised to know that their symptoms could come from their neck. Cervicogenic dizziness can provide symptoms such as faintness, disorientation, imbalance and perception of spinning (inside vertigo). Along with those symptoms you will have a lack of cervical spine range of motion (ROM) and probably pain. The dizziness can last from minutes to hours, compared to BPPV (seconds).

Causes

Studies put forward explanations to those symptoms and the first possible cause they agree on for cervicogenic dizziness would be a physical injury and/or psychological issues. For example, a physical injury could be falling, a whiplash or a head concussion. The psychological issues could be depression/anxiety, employment difficulties, fear of space etc. It is good to mention that you can find in some people cervicogenic dizziness combined with any other vestibular problem. For instance, people with BPPV could still feel dizzy even after getting rid of their vertigo.

To conclude, cervicogenic dizziness is all about the input (information) brought to the vestibular nuclei. With 6x more receptors in the neck versus the rest of the body, the information from the cervical spine to the head (here vestibular system and vision) is really important to feel balanced.

Now, how can we treat cervicogenic dizziness?

Some studies say that manual therapy has good result with this kind of problem. Usually when the neck ROM is restored and pain has gone, the dizziness symptoms will go away too. That combined with vestibular exercises can provide the patient with long term improvement. It is important to have a good assessment of the problem in physiotherapy to make sure the right diagnosis is identified. Some physical therapists are qualified in differentiating between the many vestibular problems. A neck assessment should be done in addition of the temporomandibular joint and cranial area if necessary.

Sources:

Yaseen, K. and al., The Journal of Physical Therapy Science, Vol. 30, No. 1, 2018
Reiley, A. and al., Archives of Physiotherapy (2017) 7:12
Wrisley, D. and al., Journal of Orthopaedic and Sports Physical Therapy, Vol. 30, No. 12, December 2000

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Headache & Migraine: Physiotherapy Management

Neck

Headache & Migraine: Physiotherapy Management

Is that pain in your head really a pain in the neck? Do you suffer from persistent headaches when sitting at your desk at work? Or does your headache come on when there is added stress in your life? Maybe when you get a migraine you’re in bed for the next 2 days?

These are all common descriptions physiotherapists hear when they treat someone who suffers from headaches or migraines. They are an incredibly common problem – up to 47% of the global population suffer with headache, and an estimated 10-15% suffer with 1-year prevalence of migraine according to the World Health Organization. They also create significant socio-economic burden due to the volume of time taken off work.

Some of the most common forms of headache include cervicogenic headache, tension-type headache, and of course, migraine. Cervicogenic headaches are ones that originate from the cervical spine (neck), whilst tension-type headaches are related to muscle tension in the forehead, face and neck. Migraines are a neuro-vascular cause of headache and relates to altered activity of the brainstem and nerve tissue. They usually have unique characteristics of sensitivity to light and sound, nausea or vomiting.

Your physiotherapist will be able to diagnose your specific type of headache according to key characteristics such as;

quality and area of pain
severity of pain
chronicity (length of time you’ve suffered headaches) and length of each episode
regularity of episodes
the presence or absence of light/sound sensitivity.

Evidence strongly supports physiotherapy intervention for all three forms of headache. In the past there has been some controversy and debate when it comes to intervention for migraine, but recent research suggests the joints, muscles and nerve tissue in the neck may have a significant role to play when it comes to migraines – indicating physiotherapy management as an option.

Medical management of migraine includes non-steroidal anti-inflammatories, corticosteroids or the migraine-specific group of medication known as the triptans. Some patients report excellent results, however, quite a few report no improvement with medication, and some even report worsening symptoms!

Another intervention that has been experimented with in recent years is botox injections into the muscles of the forehead and neck in chronic migraine sufferers, paralyzing the muscles – however research shows only “small to modest” benefit and this must be repeated every 12 weeks.

In most cases, physiotherapy alone offers an effective solution for tension headaches.

Correct diagnosis– On your first visit, we can establish a correct diagnosis to direct the most effective care to your headache. Establishing the correct diagnosis early is imperative as several injuries have similar symptoms yet have different treatment protocols. Early treatment will be focused on reducing pain and regaining normal neck range of motion.
Improving neck joint mobility– Using manual therapy techniques to improve upper neck joint mobility and muscle flexibility will aid your symptoms
Improving your posture– Your headaches and migraines can be improved by improving your posture. Poor posture can lead to strain on your back and neck muscles possibly leading to headaches and migraine.
Pillow assessment– A cervical pillow assessment can help ensure that you have the proper pillow to obtain an optimal neck position during sleeping.
Workstation /work desk set up– Sitting incorrectly at your desk, having the computer screen at an incorrect height could be some of the leading causes of headaches and migraines
Strengthening program– The physiotherapist will then prescribe an exercise program to improve the strength and coordination of your deep neck stabilizers and upper back muscles, which are important for preventing re-injury.

If you are someone who suffers from headache or migraine then come and see a physiotherapist for a thorough and careful assessment followed by outlining an appropriate treatment regime to manage and resolve the condition.

Acupuncture, IMS & You

Sun City Physiotherapy Locations

Phone: 250-861-8056

Phone: 250-762-6313

Phone: 250-766-2544

Phone: 778-699-2006

Running Injuries

Sun City Physiotherapy Locations

Phone: 250-861-8056

Phone: 250-762-6313

Phone: 250-766-2544

Phone: 778-699-2006

Cervicogenic Dizziness

Dizziness is not necessarily vertigo!

Sun City Physiotherapy Locations

Phone: 250-861-8056

Phone: 250-762-6313

Phone: 250-766-2544

Phone: 778-699-2006

Headache & Migraine: Physiotherapy Management

Sun City Physiotherapy Locations

Phone: 250-861-8056

Phone: 250-762-6313

Phone: 250-766-2544

Phone: 778-699-2006

Sun City Physiotherapy Locations

Phone: 250-861-8056

Phone: 250-762-6313

Phone: 250-766-2544

Phone: 778-699-2006