Temporomandibular Joint (TMJ) Pain & What to Do About It

Temporomandibular joint (TMJ) or jaw pain is a very common condition – actually the second most common musculoskeletal condition after low back pain. It affects around 12% of the population or 38 million people.1 It typically affects more women than men, often between the ages of 35-45 years of age, but may occur at any age. Interestingly, 70% of patients with TMJ pain also have neck pain2 and there is a lot of overlap between both conditions and treatment.

The temporomandibular joint is where the mandible (or jaw bone) meets the temporal bone (part of the skull, forms the temple). You can find the joint on yourself by gently pressing just in front of the ear below the bony ridge of the cheekbone. There are a lot of muscles that attach in this region that help you open and close your mouth. They can become tight or irritated. There is also a small disc of cartilage that lies between the two bones of the temporomandibular joint and moves with the joint. In some people, the disc can cause clicking as the person opens and closes the mouth. This may or may not be painful.

Common Symptoms:

  • Pain or stiffness in the jaw, often first thing in the morning
  • Pain through the temples or frequent headaches
  • Pain with chewing gum, hard or tough foods
  • Pain opening mouth or moving jaw forward or to the side
  • Pain with talking, kissing or yawning
  • Frequent clenching or holding the back teeth together
  • Ear fullness or ear pain

If you are experiencing TMJ pain, there are several things that you can start working on to reduce your pain.

  1. Be aware of clenching your teeth during the day. Your back teeth should only be touching when you are chewing, as holding your back teeth together all day overworks the muscles and may cause pain.
  2. A good, relaxed position for the jaw is with a slight space between your top and bottom front teeth with your tongue gently resting (not pressing) on the roof of your mouth. This allows the muscles to relax.
  3. Posture has a huge effect on your jaw pain. A slumped position with a forward head changes the position of your jaw and increases how much the neck and jaw muscles have to work. Check your posture frequently during the day, especially while sitting.
  4. People often clench their teeth when they are stressed. Frequently take a look at how you’re holding your teeth and consciously work on relaxing the muscles of the face and jaw.
  5. Avoid sleeping on your stomach or resting your head on your hand during the day or while on your phone. The increased pressure directly over the jaw can cause pain.
  6. Focus on soft foods and avoid things that are excessively hard or chewy (including gum) to allow your muscles to relax.

Treatment:

Your dentist or physical therapist can help you with improving your jaw pain and function. Other treatment strategies may include:

  • Soft tissue mobilization, massage, dry needling and other manual therapy techniques to the neck and jaw musculature and joints to improve mobility and decrease feelings of tightness and pain.
  • Exercises to improve mobility and strength for improved posture and body mechanics.
  • Gentle electric stimulation, heat and relaxation exercises.
  • Oral appliance or a night splint to decrease clenching or grinding at night.

Pain through the jaw can be exhausting and affect someone’s personal, social and work lives. Most people will improve with treatment, so if you are experiencing frequent pain through your jaw, don’t hesitate to call your physical therapist. Spinal Dynamics & Body Dynamics of Wisconsin has several physical therapists that are specially trained in treating this condition. We can help you with strategies to reduce your pain and improve your function. We can also assist you in finding a dentist experienced in treating temporomandibular dysfunction if needed. Let us know if we can help.

Sources:

  1. Dworkin SF, Huggins KH, Leresche L, et al. Epidemiology of Signs and Symptoms in Temporomandibular Disorders: Clinical Signs in Cases and Controls. The Journal of the American Dental Association. 1990;120(3):273-281. doi:10.14219/jada.archive.1990.0043.
  2. Ciancaglini RG, Testa M, Radaelli G. Association Of Neck Pain With Symptoms Of Temporomandibular Dysfunction In The General Adult Population. Scandinavian Journal of Rehabilitation Medicine. 1999;31(1):17-22. doi:10.1080/003655099444687.

New Therapeutic Laser!

Our goal at Spinal Dynamics & Body Dynamics of Wisconsin is to continuously evolve to offer you the very best care possible.

Staying true to this mission, we are currently testing LiteCure’s LightForce EXP Class IV Laser. Because a therapeutic laser is a large investment for a private practice, we want to give it a trial run to see if it is a good long-term fit for our practice. 

Learn more about laser therapy and our free trial of treatments or give our office a call at (414) 302-0770 to schedule.

Plantar Fasciitis – What is It & What Can You Do About It?

By: Lauren Hogan, PT, DPT, OCS, ATC

Plantar fasciitis is one of the most common foot-related conditions that we see in the clinic. Around 10% of people will experience plantar fasciitis at some point in their lives. It can be incredibly painful to put weight on the foot and walk, making it a very challenging injury for patients to deal with.Plantar fasciitis is irritation of the plantar fascia as it attaches to the calcaneal tuberosity, or heel bone. (https://en.wikipedia.org/wiki/Plantar_fasciitis)

What is Plantar Fasciitis?

The plantar fascia (or aponeurosis, as labeled in the picture above) is a thick band of connective tissue that attaches from the heel bone up through the toes. As we walk, the plantar fascia works to help support the arch, along with muscles in the foot and ankle. When we sleep or sit, our feet are often in a pointed toe, relaxed position, so the plantar fascia may be resting in a shortened for a prolonged period of time. When we get up in the morning or stand after sitting for a while, the plantar fascia is suddenly stretched as we put weight on the foot. For people that have irritation of the plantar fascia, the attachment at the heel can be painful for several steps until the tissue starts to loosen up.

Anyone can get plantar fasciitis, but there are several factors that can put someone at risk for developing pain through their heel. Tightness through the calf and limited ankle range of motion are common causes. Runners and workers that spend a lot of time on their feet on hard surfaces are more likely to be diagnosed with the condition. Patients with a higher body mass index also may be at increased risk. Poor footwear can also be a triggering factor.

There are several things you can start doing if you are experiencing heel pain.

  1. Wear supportive shoes consistently throughout the day. Adequate arch support and cushioning are necessary to help avoid irritating the plantar fascia.
  2. Stretching the calf muscles is extremely important. The more mobile the calf muscles and ankle are, the less strain there is through the plantar fascia with walking.
  3. Rolling through the bottom of your foot with a golf ball can help massage the arch and surrounding muscles.
  4. Icing or rolling the foot over a frozen water bottle can help relieve pain.
  5. Sitting with your feet flat on the ground helps to maintain a little bit of a stretch through the calf and foot, making it less painful when you first get up and start walking.

If your symptoms are not improving within a few days with self-treatment, a physical therapist can help. Treatment may consist of hands-on massage to loosen up tissues in the calf and foot, joint mobilization to improve foot and ankle mobility, as well as work on strengthening the foot and ankle muscles, balance, and working on gait. Some patients may benefit from an orthotic insert to further support the foot, or a night splint to help gently stretch the calf at night to minimize pain first thing in the morning. You can ask your PT how to use these tools to help with your recovery.

Early treatment is important, as chronic plantar fasciitis can be challenging to treat and take longer to resolve. If you are in pain for more than a few days and it is not responding to the ideas above, talk to your physical therapist to get on the road to feeling better.

Cindy & Chris Go to Vegas

By: Cindy Marti, PT

52 years old and I’ve never been to Vegas! I didn’t win big (actually, I didn’t win at all!) but I had a great time with 1,600 other people attending the American Physical Therapy Association Private Practice Section meeting, with my very own employee extraordinaire…Chris Hahn!

Cindy & Chris in Las Vegas

Cindy Marti, PT & Chris Hahn, office & business manager, in Las Vegas for the APTA Private Practice Meeting.

Here are a few of our takeaways…personal and professional!

Personal:

  • The fountains at the Bellagio are cool, going off to Elton John’s “Lucy in the Sky with Diamonds”
  • It is hard to walk in Vegas with an injured foot that requires a boot and a cane (yes, me)
  • Hotel rooms should always have coffee pots
  • Don’t trust the airport shuttle to pick you up at 6 a.m. at your hotel. Take an Uber.

Ok…now for some PT takeaways:

Back Pain:

I attended a presentation on low back pain treatment and costs. Musculoskeletal pain is the 3rd largest healthcare cost in the US, and 70% of that is related to low back pain. Research clearly shows that the “point of entry” for patients with back pain should be a physical therapist. Not a primary care doctor. Not a chiropractor…but a physical therapist. If patients go DIRECTLY to a physical therapist when they hurt their back, they typically spend less on their total care, recover faster, and have better outcomes. On average, patients that get physical therapy within the first 14 days of experiencing low back pain save around $2,700 over patients that wait. Luckily, Wisconsin is a “direct access” state for physical therapy, meaning patients can see us right away for any musculoskeletal problem — no referral necessary. So, do yourself and your wallet a favor and choose PT first when you have pain. We can typically schedule patients in on the same day or next day to get you started toward feeling better. Give us a call.

Osteoporosis:

1 in 2 women and 1 in 4 men over 50 will have an osteoporosis-related fracture in their remaining lifetime. WOW! I had no idea the rate was that high. The good news is that research shows physical therapy can help reduce bone loss, falls and fractures. If you are concerned about your bone density or risk of fractures or falls, let us evaluate you and design a prevention program to keep you healthy. We will coordinate any necessary bone density assessments with your physician and get you started.

Opioids:

The APTA states “According to the Centers for Disease Control and Prevention (CDC), sales of prescription opioids have quadrupled in the United States, even though there has not been an overall change in the amount of pain that Americans report.” I am proud that our profession is participating in consumer education about the overuse of opioids. Check out #ChoosePT for Pain Management to learn more about the opioid epidemic and what you can do about it. Although opioids can be an important short-term part of a patient’s overall care plan, overuse or long-term use can have unintended and dangerous consequences. Be informed and work with your medical team to create an overall treatment plan that minimizes the use of medications when possible.

Gratitude:

I left the conference grateful. Grateful…

  • To be in an extremely rewarding profession
  • To be in private practice
  • For my very talented and devoted staff
  • To be inspired by my fellow private practice owners
  • To my clients and community that support our practice. That means you. Thank you.

Thanks for reading about our trip to Vegas. Mention this blog post and get either a 30-minute free injury consultation for new patients OR a 30-minute free dry needling session for existing patients.* 

Cindy

*Appointment offering based upon therapist availability. Offer expires Dec 1, 2016.

Spinal Dynamics of Wisconsin - Milwaukee

The Selective Functional Movement Assessment (SFMA)

Sometimes the pain you are experiencing isn’t always coming from the place you feel it. For example, knee pain may not be coming from the knee itself, but could be coming from problems either above (the hip) or below (the foot). If the knee is not the primary cause of the pain, directing treatment there may be ineffective. The Selective Functional Movement Assessment (SFMA) can help.

The Selective Functional Movement Assessment (SFMA) is a comprehensive assessment technique used by clinicians to help determine the underlying causes of someone’s pain to appropriately direct treatment to the dysfunctional area. It involves testing seven fundamental movements and allows the clinician to figure out what is actually affecting their movement and influencing their pain. Many professional sports teams, Division I college teams, and other high-level athletes utilize the SFMA to help improve pain, function, and performance. It is also an effective way to look at all patients, not just athletes, from a whole-body perspective.

Spinal Dynamics & Body Dynamics of Wisconsin is privileged to have several physical therapists trained in the SFMA process. One of our therapists, Matt Kinkade, DPT, recently had the opportunity to attend the SFMA Level 2 course in Chicago and was kind enough to share his experience here on our blog.

By: Matt Kinkade, DPT

Matt Kinkade, DPT recently took the SFMA Level 2 course in Chicago.

One of the things that I love about working at Spinal Dynamics is having the opportunity to discuss difficult diagnoses with our staff of experienced clinicians. Over the past year, I have observed Meg Gogin, MPT integrate some of the concepts from SFMA Level 2 into her practice and therapy interventions. Before going to this course, I looked at these “exercises” as tasks only and did not understand the rationale or background behind them. Now I have a better understanding of the motor control and motor learning background behind these interventions.

While SFMA Level 1 focused on assessment or finding and identifying dysfunctional movement, SFMA Level 2 focused on correcting the dysfunctional movement with an emphasis on motor control and motor learning. For example, when one patient might need dry needling and joint mobilization for decreased thoracic rotation, another patient might need rolling and chopping patterns. The first patient may have stiffness in the area and needs assistance to loosen the area up, while the second patient has the joint mobility but is not able to use it correctly due to inadequate muscle control. The decision is made based on a thorough evaluation of functional movement and of the surrounding tissues.

Some of my patients may hear me use terms such as “reset,” “reinforce,” and “reload” with therapy interventions. These terms come from the SFMA and their analogy of a computer model. If your computer becomes “dysfunctional” often the first step is to RESET the system. After a reset, we want to reinforce the improved behavior and RELOAD the system with the proper software. We want to reload our brains with the proper motor patterns for pain-free and functional movement. The second SFMA course focused mainly on the RELOADING portion but also touched on some reset and reinforcement techniques.  I now have a better repertoire of motor control exercises with the proper rationale and background to appropriately implement with appropriate patients.

SFMA Level 2 was well worth my time and money and helped me grow as a clinician. It was beneficial for me to catch up and rub shoulders with some of my fellow colleagues and apply proper assessment and interventions to promote functional movement.

SFMA Logo

Want to know more?

If you have been struggling with repeat or stubborn injuries that aren’t responding well, the SFMA may reveal some underlying problems that could be influencing your symptoms. Learn more about the Selective Functional Movement Assessment at their website or give our clinic a call at (414) 302-0770 to set up an appointment with one of our SFMA-trained clinicians.

Spinal Dynamics of Wisconsin - Milwaukee

Why is My Doctor Sending Me to PT for My Headaches?

Headaches are not all in your head. In fact, tightness through the joints or muscles of your neck, upper back, or shoulders can often be the underlying cause of pain through this area. Patients are often surprised when their physicians send them to physical therapy for their headaches or migraines and wonder how PT can help.

Headaches can be miserable. PT can help.

There are multiple types of headaches, including tension and cluster headaches, migraines, and those related to the temporomandibular joint (TMJ or from the jaw) or facial muscles. Tension-type headaches are the most common type in adults, but can also occur in children. They may occur after a neck injury, whiplash, heavy activities, prolonged sitting, poor posture or workstation set-up, or with stress.

On average, your head weighs somewhere between 8-12 pounds. Imagine holding an 8-pound bowling ball in your hands. If you keep it close to you, you can hold the ball for awhile without too much strain through the muscles of your arms.

Your head weighs about the same as an 8-12# bowling ball - holding it up all day with poor posture can cause headaches.

Now imagine holding the same bowling ball in front of you with your arms straight, away from your body. Despite the fact that the weight is the same, your muscles have to work much harder to hold the bowling ball up against gravity. You most likely won’t be able to hold it up very long. The same thing happens with your neck muscles. Prolonged positions with the head forward places increased strain through the muscles as they try to keep the head up as you work on your computer or read this blog post on your phone. Eventually those muscles get tired of working so hard, joints can get stiff and the increased strain can lead to headaches.

Treatment

So how do we fix this? As physical therapists, we do a comprehensive evaluation to determine what is exactly causing your headaches. Often, patients have compensated for a long time due to their symptoms. They may have stiffness through their neck, upper back, jaw, or shoulder blades. Hands-on techniques, including mobilizations or manipulations, can improve mobility and improve pain. Patients may also have tightness or “knots” through the muscles in the area. Tight areas through the shoulders or neck can often refer pain to the head. Soft-tissue mobilization techniques, myofascial release and trigger point treatments can all be effective in reducing some of the pain associated with tightness through the muscles.

Tight muscles or "knots" in the neck, face, or shoulder blade region can often refer pain to the head and cause headache symptoms.

Tight muscles or “knots” in the neck, face, or shoulder blade region can often refer pain to the head and cause headache symptoms.

Hands-on techniques are important for improving mobility and reducing pain, but work on strength and posture is typically crucial to keep headaches in check long-term. The deep neck muscles and those between your shoulder blades are the “core” muscles of your neck and upper body. Improving the strength, control and coordination of these muscles help you to maintain better posture during the day and take pressure off of the joints and muscles in your neck that can cause headaches. A physical therapist can help you determine what exercises may be beneficial for you, as well as make recommendations on setting up your workstation in a way that may help with improving posture and reducing pain.

Need Help?

Frequent headaches can be miserable and significantly affect someone’s quality of life. The good news is that most can be treated without medication. Improving mobility, strength and posture can often decrease the frequency and intensity of headaches and improve daily function. If you have been struggling with headaches, physical therapy may be a great option for you. Most patients do not need a referral to see a physical therapist. Give us a call at (414) 302-0770 if you have further questions or would like to set up a consultation to see how physical therapy can help your pain.