TMJ Dysfunction Part 1

TMJ / Jaw

Did you wake up this morning with acute facial pain and inability to open your mouth? When you think to yesterday, you remember taking a big bite from an apple and experienced a sharp pain in your jaw joint. Today, you can’t really open or fully close your mouth. That unexplained clicking in your jaw that you’ve had for two years has suddenly gone away. Now, there’s just facial tenderness in front of your ear and you’re worried that you can’t eat! If you experience this, you likely have a “locked jaw”, or Acute Disc Displacement. This is one of the common disorders of the Temporomandibular Joint, more known as the TMJ.

The TMJ is the ball and socket joint that connects the Mandible (jaw bone) and the Temporal bone (one of the bones of your skull). It’s the small joint located in front of your ear. There is a cartilage cushion in between the ball and socket, referred to as the Disc. The disc is supported by special Ligaments, which keep the disc in place. Movement problems of the disc can be responsible for creating many symptoms in the TMJ, such as clicking, crepitations, locking, muscle spasm, and pain.

TMJ Disorder/Dysfunction, or TMJD/TMD, is seen more commonly in women than men. There is a 3:1 incidence in females to males, and can include one or both jaw joints. In most instances, the dysfunction is a result of an imbalance or change in the normal function of the bones, ligaments, muscles, disc, or nerve components of the TMJ complex.

Disc Displacement is a mechanical problem that occurs when the disc ends up in the wrong position within the ball and socket. In this case, it is likely that the disc has become displaced due to the wide opening, creating increased stress and strain on the ligaments, resulting in pain around the joint and spasm in the facial muscles. There is also a longstanding history of unexplained clicking in the joint, which may be a pre-disposing factor to this problem. In essence, the disc needs to be properly re-educated to find its’ normal resting position again, and the mechanics restored to the muscles and joint. Specialized physical therapy care would assist in restoration of disc position, to restore movement and function, as well as normalize the pain.

Dysfunction in these tiny joints can have many causes. These can include trauma such as blow to the head, whiplash, falls, sports injuries, arthritis, dental occlusion, dentures, history of joint noises, stress (clenching, grinding), poor habits (posture, physical, oral), and many others. Signs and symptoms may include facial pain, headache, neck pain, ear pain, sudden changes in bite, tooth pain, ringing in the ears, shoulder pain, and facial tingling or numbness.

A physical therapist can help you understand and manage your TMJ dysfunction. Often it is obvious that the TMJ is the cause of symptoms you experience. However, for many people, the symptoms they experience can be widespread, and may not make it so obvious. As mechanics for the human body, physical therapists can properly assess, diagnose, and treat the TMJ and most of the possible influences. We provide a specialized hands-on approach to treatment, education, and exercise program. Treatment may also include other muscle re-education techniques such as Intramuscular Stimulation (IMS). In many instances, we often work with your oral practitioner (dentist, orthodontist, oral surgeon) to ensure the best outcome possible for your TMJ. Treatment can be very effective in a short period of time. A self-applied approach with a little guidance from specialized physical therapy practitioners will help with long-term benefits.

Acute Disc Displacement is only one of several diagnoses of TMJ dysfunction. Keep connected to read about other problems that these tiny joints can give you. Don’t stop eating apples though…

Vince Cunanan is a registered physiotherapist and associate at Sun City Physiotherapy’s Downtown Kelowna and Glenmore clinics. He can be contacted at info@suncityphysiotherapy.com

Bone Health and Exercise

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Bone Health and Exercise

Optimal bone health is a serious consideration in people approaching mid-life. It is common knowledge that bones become more brittle as we age. What may be less recognized are the factors we can control through exercise and nutrition in the first half of adult life that have a direct effect on prevention of osteoporosis.

Osteoporosis is a disease characterized with a loss in bone mass and deterioration in the sturdiness of bone structure. This is associated with the increased risk of fractures, particularly in the hip, wrist and spine. It is prevalent in the older population. If you are a woman, you have a 50% lifetime risk of a fracture from osteoporosis.
Bone loss is an insidious process. In the early stages it is called “osteopenia” It can occur when an arm or leg is casted after a frracture. A loss in bone mineral density (BMD) can accelerated after taking steroid medications or with certain autoimmune disorders or diabetes.

Reduced levels of estrogen after menopause accelerate bone loss. However, it is well- established that if a woman in her 40’s and 50’s exercises regularly and has good nutritional habits, she can diminish her post-menopausal bone density loss substantially. Osteoporosis is optional!

How does exercise affect bone health?
Bone is a living tissue. Bone cells, called osteophytes, have the ability to act like strain gauges and adapt to the amount of stress placed on them. Regular weight bearing exercise or strength training is essential to maintaining healthy bone. Resistance training improves muscle mass and strength and can increase spine and hip bone density. It is essential that the exercises chosen are safe and appropriate for the individual. Physiotherapists assess posture, understand risk factors and can advise which exercises are best for those with osteoporosis.

As a preventative measure and for those with mild osteopenia, high and medium impact exercise such as soccer, tennis, activities such as skipping and step-ups can stimulate healthy bone cells to produce a stronger bony matrix and increase BMD.

For individuals with moderate osteoporosis, weight bearing exercise and moderate impact exercises are appropriate, high impact exercise is not. Strength training exercises should target the specific areas affected. Balance exercises and fall prevention awareness are important, as falls can result in fractures, which are painful and can take much longer to heal than with normal bone. Working with a physiotherapist with specific knowledge about osteoporosis to set up an exercise program is highly recommended. Check with your physician before beginning a strenuous exercise program.

Attention to postural alignment during strength training is important. Certain exercises place too much strain on the midback area and can increase the rounding, or kyphosis in this area. For example, repeated curl-ups for abdominal strengthening, or swinging kettle balls with arms extended should be avoided.

Why does nutrition play such an important role in prevention of bone mineral density loss?
Bones are important warehouses for calcium and other important minerals needed for cellular function. If our diet is low in calcium, the body borrows it from our bones. If it’s not restored, a net deficit in minerals can result in reduced BMD.
In order to maintain optimal bone health, sufficient amounts of Calcium, Magnesium, Vitamin D are recommended.

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Tennis Elbow

Elbow, Wrist and Hand

Tennis Elbow – you don’t need to play tennis to get it!

Tennis elbow is so called as one of the reasons you can get it is from faulty technique in a tennis shot. This is only one of the ways that you can get tennis elbow though, it can come on from many other activities that involve a lot of wrist and forearm use.

The medical name for this condition, lateral epicondylitis, gives us more information about where the problem occurs. The lateral epicondyle is a small bony prominence on the outside of the elbow and is the point of attachment for the tendons of the wrist extensor muscles. These muscles run up the top of the forearm and play a role in movements such as bending the wrist back, making a fist, and twisting the forearm.

Lateral epicondylitis occurs if these muscles are used more than they are used to, resulting in pain and damage to the tendon where it attaches onto the bone at the lateral epicondyle. If you have tennis elbow, you will likely report an increase in pain when gripping tightly or shaking hands, using a screwdriver or twisting a jar, or any activity that requires wrist and hand use. The outside of the elbow can be very sensitive to touch, and you may find it will get very stiff, especially first thing in the morning.

In order to treat tennis elbow, it is important to identify the reason why it became injured in the first place and correct that. Apart from stopping the aggravating activity, there are often other contributing factors that need to be changed in each individual case. These can be related to our own anatomy in the elbow and arm, movement patterns which are overloading and therefore damaging the tendon, or factors relating to the equipment being used.

A physiotherapist can identify the changes that need to be made in each individual case and implement these. As well as this there is specific treatment that can be done to the tendon to ensure optimal healing such as friction massage and laser, and a stretching and strengthening program should be implemented too to ensure the muscles and tendons are in good shape to be able to cope comfortably with being used in the future.

So even if you don’t play tennis, you can still be affected by tennis elbow. Taking the right action will take your pain away.

Don’t take a holiday from good low back posture.

Back

Don’t take a holiday from good low back posture.

Trains, planes and car rides to visit friends and family; sitting down for a big turkey meal; sledding or hitting up the ski hill on snowy days; lounging around on Christmas morning admiring the tree and wrapped presents – this all sounds like a perfect holiday. While it is a wonderful combination for good times and many smiles, it unfortunately for some can also be a perfect recipe for a sore back. Something that all of those activities listed above have in common is a forward bent – or ‘flexed’ – position of the low back.

With normal standing posture, the low back has a slight curve, which is known as ‘lordosis’. When we bend forward or sit, we lose the lordosis and our lumbar spine – the low back – goes into flexion. Spending too much time flexed, or performing heavy tasks in this position, can put a strain onto the lumbar discs. The ‘intervertebral disc’ is a structure that sits between adjacent vertebrae in the spine. It is composed of a tough, fibrous periphery with a gel-like nucleus in the centre. Repetitive or sustained flexion, as well as heavy lifts or bends, can injure the disc by causing tears in the fibrous rings. When this occurs, the gelatinous nucleus can bulge into the tear. In more severe cases, the gel can even push outside of the disc. It is most common for injury to occur in the back of the disc rather than the front.

To visualize what happens, imagine a jelly donut, where the dough is the fibrous outside of the disc, and the filling is the nucleus. Line up the hole that was used to fill the donut as being at the back/side of the imaginary spine. If you push on the front of the donut, the jelly will squeeze out toward the back, and can even push out of the donut (which would be the case in severe injury, or ‘prolapse’). Forward bending is similar to this – there is an increased pressure on the front, and a suction force at the back, causing the gelatinous nucleus to move posteriorly if the fibrous rings are not holding it in place. Even with just an outward bulging of the disc (so, the jelly in the donut has moved but hasn’t escaped through the hole) can cause inflammation, and irritation of surrounding tissues, including nerves.

There are several strategies that can be used to help in the prevention of lumbar disc injuries. A few are:

Use a firmly rolled towel, or a ‘lumbar roll’, in the curve of your low back if sitting. It is helpful to keep one in your vehicle
Avoid the slumped position when sitting. A lumbar roll helps with this, as does your leg posture. Having your hips and knees in a deep bend, such as in a low chair, increases the forward bend in your back
Take standing and walking breaks when traveling, or during long meals
Stay flexible – tight hamstrings (backs of the thighs) in particular can have an effect on low back posture
Keep a strong core to help support your back during activities. This doesn’t necessarily mean doing crunches or sit-ups, but exercises that target the deep core muscles
During the post-holiday clean-up, avoid stooping to bend down to pick things up. Instead, bend your knees and hips to get into a good squat position. It’s a good way to exercise your legs, too!

Even with taking precautions, injuries can occur either with a single incident or over time. When this is the case and you notice you are having back pain, it is important to seek care from a health provider. Lumbar disc injuries, along with other causes of low back pain, can often be treated conservatively (meaning, non-operatively). It is important to note that not all back pain is due to disc injury. A physiotherapist can help to determine what structure may be causing your pain, and give you appropriate exercises, stretches, hands-on treatment, and strategies for management, specific to your injury.

Carpal Tunnel Syndrome

Elbow, Wrist and Hand

Carpal tunnel syndrome is a common wrist and hand injury. It occurs when one of the major nerves called the median nerve is compressed within the carpal tunnel of the wrist. This may occur for a number of reasons but some of the more common reasons include: pregnancy, gout, trauma (repetitive or direct trauma), or infection. Carpal tunnel can happen at anytime, however it is more common between the ages of 40-60 and women tend to be affected more often then men.

This condition is characterized by burning wrist pain and numbness or tingling within the hand. This often occurs at night and the patient usually wakes up due to the symptoms. In some cases the pain can radiate to the forearm, elbow, and shoulder.

Some of the other symptoms reported by patients include poor sensation in the hand, weakness of the hand, cramping in the hand, reduced temperature in the hand, and sometimes shaking or flicking the hand relieves the symptoms. There may also be muscle wasting around the thumb. Movements of the hand are often pain free, however some resisted movements around the thumb can be painful.

Diagnosing carpal tunnel syndrome is often done based on the patient’s medical history. Your physiotherapist or physician will take you through a series of tests and if carpal tunnel syndrome is suspected a nerve conduction test may be ordered to confirm the diagnosis. Diabetes should be excluded, as it can be a risk factor for carpal tunnel syndrome.

Mild cases can be treated conservatively. This may include splinting, activity modification, diuretics, and NSAID medications. Techniques such as contrast baths, which are alternating baths of cold and warm water, may be used in some cases to control inflammation and swelling. A physiotherapist may give you specific exercises that can be helpful with a patient’s recovery. For more persistent or severe cases, corticosteroid injections or surgery may be required.

Wrist and hand injuries are often difficult to diagnose so if you are experiencing symptoms of this nature it is recommended that you see your health care professional to have it taken care of.