The temporomandibular joint connects the mandible (lower jaw) to the temporal bone of the skull located in front of the ear. This joint is present on both sides of the face and these two joints allow the jaw to move. Any dysfunction to these joints can lead to pain in the head, neck, facial muscles and ears. The inability to fully open the mouth may also occur as well as a clicking sound when the jaw moves and the jaw may also lock in position when open, which would indicate that the joint is dislocated. The TMJ consists of muscles, bones, nerves and blood vessels. Some of the muscles associated with the TMJ are also referred to as the muscles of mastication, meaning the muscles that allow movement for chewing. These muscles enable the jaw to open and close and the TMJ also works to provide movement that includes rotation and a hinge action, allowing the mouth to open and close and to open wider, such as is necessary during a yawn. Dysfunction that occurs to this joint is referred to as TMJ syndrome. This syndrome can be caused by injury to the joint, wear and tear as we age or improper habits such as grinding or clenching of the teeth.

Myofascial Release Techniques

It is important to seek treatment for TMJ syndrome when symptoms first present. Early symptoms are the same as later symptoms, just less intense. Early treatment will help to avoid any episodes of the jaw locking or severe pain throughout the face, ears and neck. A physical examination will be performed and the jaw will be examined, the physician noting any pain or tenderness and the range of motion of the joint. Imaging may be utilized but is not always necessary. Conservative care is normally adequate for treatment as the symptoms of TMJ syndrome do not usually last for long periods of time. Applying warm packs to the joint will help to alleviate pain and icing the area will help if there is any inflammation present. Chiropractic care generally focuses on trigger points within the muscles associated with the TMJ. Trigger points within the medial pterygoid muscle can cause pain in the face, the TMJ, ears, nose and neck. Myofascial release techniques such as stripping of the muscle and compression to the trigger points can be done to relieve tension and reduce pain. These techniques are rather painful but work well to alleviate symptoms of TMJ syndrome. Chiropractic care may also include joint mobilization with the use of the activator method. This method utilizes a small activator tool that is capable of delivering a low-impact, high frequency adjustment to small areas of the body, such as the TMJ. If grinding or clenching of the teeth is an issue, night guards can help to prevent these habits during sleep.

References Cited in this Article

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Sleep refreshes unlike anything else.  Sleep is almost always refreshing but more importantly it is absolutely necessary for our survival.  On average, most Americans will spend a third of their lives asleep.  Most of us are unaware of how important this is until were unable to perform this simple task.  For millions of people, poor sleep leads to higher stress, difficulty concentrating, and ultimately health problems.  So just how many of us are losing sleep?  Over one-third of Americans are losing sleep at least one night per week, 65% report that they regularly lose sleep due to stress, and a staggering only 3% say they never lose sleep. 

Too busy to sleep

The question remains, are Americans becoming too busy to sleep?  In 1910, Americans averaged about 9 hours of sleep per night compared to 6.5 in 2011.  Sleep is imperative for our nervous system to function properly.  During sleep our brains are extremely active.  This activity is described as neuron function.  Individuals that suffer from sleep loss deplete their neurons with energy and allow their brain to be polluted with byproducts of normal cellular activity. 

Five stages

There are five stages of sleep.  During the first stage, muscle activity slows down and there is occasional muscle twitching being performed.  The second stage is the largest of all five stages and causes breathing to become shallower and the heart rate to decrease slightly.  The third stage is the deep sleep stage and delta waves become evident.  The fourth stage is even deeper yet generating more delta waves and rhythmic breathing.  Dreaming occurs in the fifth stage and rapid eye movement is present. 

Sleep pattern

So how much sleep do we actually need?  The Harvard Women’s Health Watch states there are six reasons to get enough sleep and include: mood, memory, cardiovascular health, sickness, disease, and safety.  It is crucial to maintain a specific sleeping cycle.  This may be especially challenging to individuals who work in emergency services such as firemen, policemen, military personnel, and medical personnel.  Their sleep schedules are constantly being interrupted by swing shifts and emergency situations.  Our sleep cycle is regulated by circadian patterns located in our brain.  A regular waking time in the morning strengthens the circadian function and can help initiate sleep onset at night.  Establishing a set time for sleep and a pattern is key whether this be reading or watching television before bedtime.  It’s important to create a sleeping environment that is tranquil and calm to prepare your mind and body for Power of Sleep. 

Sleeping tips

Some important sleeping tips include: not eating 2-3 hours before bedtime, and regular exercise to stimulate the body to release chemicals in the brain, sleep on a comfortable mattress since you sleep a third of your life, receive regular Chiropractic care to clear energy blockage throughout the body. 

Pain is your body’s way of telling you that something is wrong.  Millions of people experience pain at some point in their day.  The most common condition linked to neck pain and tension is a cervical subluxation.  Chiropractic treatment for the neck improves the mobility of the spine and restores loss of motion.  Physical therapy and massage therapy for the neck will increase flexibility and strengthen weak muscles in the neck and shoulders.  Nerve Impingement Syndrome and Pain can be evident within the lower back.  Unfortunately, 80% of the population will experience some sort of back pain within their lifetime.  Most cases of back pain are mechanical in origin.  Spinal subluxation and muscle weakness are key elements that are linked to chronic lower back pain.  Chiropractic and physical therapy can alleviate many symptoms associated with such low back conditions such as the following: Sciatica, disc herniation, Scoliosis, spinal degeneration, stenosis, pelvic imbalance, and core strengthening.  The primary causes of Nerve Impingement Syndrome and Pain include the following: auto accidents, pregnancy, repetitive stress, poor posture, lack of exercise, and sports injuries. 

Auto accidents

When you’re involved in a motor vehicle accident, the extent of the physical injury to your spine can not be linked to the amount of damage to your vehicle.  Whether you are involved in a minor “fender bender” or a rear-end collision, you should have your spine evaluated for subluxation and abnormal curvature of the spinal column. 

Pregnancy

In contrast, pregnancy can be a wonderful blessing in a women’s life; however, this process involves a physical change in a women’s body which may result in long term effects to her spine and pelvis.  The effects of pregnancy can result in the following: exaggerated spinal curves, an irritated sciatic nerve, overstretched and weakened abdominal muscles, and loosened pelvic joints.  Chiropractors, physical therapists, and massage therapists are trained in providing safe and comfortable care to women before and after their pregnancy. 

Repetitive stress

Nerve Impingement Syndrome can be caused from repetitive stress.  Whether you’re at work or play, doing the same activity over and over again can produce repetitive stress injuries.  Some symptoms of repetitive stress injuries include: stiffness, pain, weakness, and loss of motion.  Muscles, tendons, and joints that are not properly treated will result in chronic problems. 

Conclusion

Chiropractors, physical therapists, and massage therapists are all skillfully trained in the art and science behind the musculo-skeletal system and can aid in much-needed relief to Nerve Impingement Syndrome.

Do you suffer from chronic fatigue and diffuse pain throughout your body?  You may be suffering from a very common condition known as Fibromyalgia.  Fibromyalgia is a musculo-skeletal condition that is diagnosed by having 11 out of 18 tender points throughout the body.  The etiology of this disorder is unknown and usually affects middle aged women most commonly.  These individuals have chronic debilitating pain that is characterized by achy muscles, joints, and ligaments.  They are usually stressed individuals and this has been linked to depression, fatigue, difficulty sleeping, headaches, stiffness, numbness, and overall anxiety.  These individuals need to exercise regularly and control their diet.  Another factor that helps considerably is receiving massage therapy, chiropractic care, and using moist heat packs to reduce muscle tension. 

Pain

Fibromyalgia may develop on its own or along with other autoimmune conditions such as Rheumatoid Arthritis (RA) or Lupus.  With Fibromyalgia, the patient will complain of long-standing tender points throughout their body.  Tender points vary from trigger points in that tender points are sore to the touch but do not radiate pain upon palpation like trigger points do.  Since Fibromyalgia can mimic the pain of Fibromyalgia, diagnose is extremely important.  RA is an autoimmune disease in which the body is attacking its own synovium, the lining that coats the inside of joints.  RA can also cause joint deformity and destruction, visible on x-ray.  However, Fibromyalgia is much more vague in the signs rather than the symptoms.  A physician’s diagnosis of Fibromyalgia is obtained via case history and the presence of eleven out of eighteen tender points on the body.  Fibromyalgia sufferers will describe the pain as being a gnawing, radiating, shooting, deep ache that ranges from mild to severe in nature.  Some patients complain of pain that improves during the daytime but increases into the evening; however, most patients describe day-long unrelenting pain that continues into the evening.  Pain seems to be exacerbated by stress, cold weather, exercise, and anxiety. 

Treatment                                                                                                      

Since this disorder is so vague, treatment options may be difficult to implement.  However, the patient should ultimately lower their stress levels, eat a balanced nourished diet, exercise regularly, and apply most heat compresses to sore muscles.  In 2007, the pharmaceutical drug Lyrica was the first approved drug by the FDA used for the treatment of Fibromyalgia.  Since then, two more drugs have been approved by the FDA.  In addition, Chiropractic care, massage therapy, and acupuncture are all excellent alternatives for the treatment of Fibromyalgia.  They work simultaneously to balance the musculo-skeletal and nervous system.  Chiropractors work with the most important system in the human body the nervous system.  The nervous system controls and coordinates every single organ system and body part in the body.  When interference is present in the spinal column, it may put pressure on the spinal nerve roots that corresponds to a specific organ or body part.  When this happens, that particular organ or body part cannot function at 100%, leaving the body to develop disease processes and reduced range of motion in that joint. 

Vertigo is a dizziness feeling when a person is standing completely still.  Vertigo is caused from a dysfunction with the 8^th cranial nerve called the Vestibular-cochlear nerve.  The dysfunction ultimately lies within the vestibular, or balance portion of the nerve and not the hearing portion. 

Symptoms of Vertigo

Vertigo presents the following signs and symptoms: nausea, vomiting, difficulty standing and walking, patient will feel like their swaying when standing still, and feeling of passing out.

Causes of Vertigo

Some known causes of Vertigo include but not limited to the following: Benign paraoxysmal positional vertigo, vestibular migraine, Meniere’s disease, vestibular neuritis, and excessive alcohol consumption.  Vertigo is divided into two classifications: either central or peripheral.

What is Central Vertigo?

Central Vertigo arises from the brainstem and can cause neurological symptoms.  These symptoms can range from slurred speech, double vision, and pathologic nystagmus which is eye fluttering. 

What is Peripheral Vertigo?

Peripheral Vertigo is caused by dysfunction within the inner ear or vestibular system.  Some causes include Meniere’s disease, BPPV, labyrinthitis, and inflammation. 

Nystagmus

Most vertigo sufferers will experience reoccurring symptoms.  This can be detrimental to one’s quality of life.  Nystagmus may be unilateral, bilateral, asymmetric, vertical, horizontal, congenital, or acquired.  Horizontal nystagmus occurs in patients suffering from a unilateral cerebral hemisphere disease, especially with posterior lesions.  Their eyes will drift horizontally towards the side of the lesion. 

Treatment

Treatment depends on the cause of the vertigo symptoms.  Vertigo can be treated with pharmaceuticals taken by mouth, a patch on the skin, or an IV administration.  A bacterial infection causing symptoms will require an antibiotic, Meniere’s disease sufferers may also be required to be on a low salt diet in addition to meds, a hole in the inner ear will require surgery, and BPPV patients will have a maneuver performed on them called the Dix-Hallpike Maneuver.  This is where the doctor places the patient in a certain position in order to move the small stones to their correct position since they become displaced with this condition.  This particular movement is repeated until there is no longer visible eye movement or dizziness symptoms.

Chiropractic Care

Chiropractic Care may be utilized to decrease the symptoms of Vertigo.  Since the C1 vertebra is in such close proximity to the brainstem, when this bone is mis-aligned or subluxated it may cause dizziness or nausea.  C1 has many muscles that attach to it and when they become taut they can pull this bone out of its normal alignment causing a subluxation.  When this happens, some individuals will complain of headaches, nausea, dizziness, eye pain, ear aches, and general fatigue.

Ulcers are sores that resemble a crater that can form within the lining of the stomach (gastric ulcers), right below the level of the stomach and the beginning of the small intestine called the duodenum (duodenal ulcers), or they can form in the esophagus (esophageal ulcers) which are much less frequent.  These can range in size from ¼ inch to 2 inches in size, but more frequently range from ¼ inch to ¾ inch.  Ulcers within the stomach and duodenum are typically referred to as peptic ulcers as a general rule.  Since the stomach is a muscle that essentially mixes juices to breakdown food particles, sometimes those liquids like hydrochloric acid and pepsin have a tendency to leak out if there is damage to the stomach lining; hence causes peptic ulcers. 

Causes

In general, too much acid and pepsin may damage the lining of the stomach.  However, more commonly there is another causation factor that makes the stomach lining more susceptible to general gastric acid.  For example, a person undergoing physical, chemical, or emotional stress is much more likely to develop ulcers than someone who doesn’t exhibit those particular stressors.

Treatment

If left untreated, ulcers may turn into bleeding ulcers or perforated ulcers.  Bleeding ulcers form when the ulcer has literally eaten through the blood vessel and the blood has entered the digestive tract.  Perforated ulcers form when the ulcer has eaten a hole through the stomach or duodenum and bacteria and partially digested food has entered into that hole causing further inflammation.  Things an individual can do to treat or prevent ulcers from reoccurring include the following: find out food allergies, eat healthy, and try to avoid daily stressors, use over-the-counter benzocaine, and finally seek a doctor’s help.  Individuals suffering from reoccurring mouth ulcers will find that their typically allergic to something in their everyday diet.  By eliminating this cause the ulcers should decrease and/or diminish significantly.  To determine what foods cause allergic reactions, get a food allergy blood test from your doctor.  This will show not only food allergies but sensitivities and the severity of the allergy to those particular foods.  There are many alternative ways to cope with stress and include: reading self-help books, talking to a psychiatrist or counselor, yoga and meditation, proper diet and exercise, chiropractic, acupuncture, massage therapy, social outreach groups, positive reinforcement, and any activity that provides uplifting and positive thoughts.

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What is TMJ?  TMJ stands for Temporal-Mandibular Joint Disorder.  TMJD can be caused from trauma, disease, general wear and tear due to the aging process, and habits like chewing gum or motions with the mouth.  Trauma may be divided into two types such as micro-trauma and macro-trauma.  Micro-trauma is like teeth-grinding or clenching.  Macro-trauma would be described as a blow to the face in which the jaw is contacted.  This can break the jaw or even damage this disc (joint).  This area connects the lower jaw to the skull and allows for the jaw to open and close.  Two conditions which can affect the TMJ and cause significant pain and discomfort include both Osteoarthritis and Rheumatoid Arthritis. 

Symptoms

TMJ Disorder is a general term clustering many different types of symptoms a patient may experience including but not limited to: locking of the jaw, clicking of the jaw, earaches, ringing in the ears, hearing loss, permanent speech abnormalities, toothache or loss, facial pain, and headaches.  Things you may notice are the following: pain on one side of the face, difficulty opening the mouth, your bite may feel off, you may feel dizziness, nausea, or even experience vomiting. 

Treatment

There are many treatment options available to TMJ sufferers and they include the following: Arthocentesis which is considered a non-invasive procedure by some which lasts about fifteen minutes in which the doctor drains the fluid that accumulated in the joint, Arthoplasty (surgery) may include repositioning of the disk itself, discectomy or removal of the disc, and joint replacement.  Some conservative treatments include the following: massage therapy, acupuncture, and Chiropractic care.  Massage therapists will work the facial muscles, and Chiropractors will re-position the joint itself either manually or with a specialized instrument.  Another effective treatment includes wearing a mouth-guard at night while sleeping.  This allows the mouth-guard to take the shock of the bruxism, or grinding.  These may be custom-fitted at dentist offices or basic mouth-guards may be sold at retail chains for a much-reduced fee and sell for around twenty dollars.  However, these mouth-guards require boiling in hot water prior to fitting them yourself.  Both are extremely effective in the treatment and management of TMJ Disorder. 

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Rheumatoid Arthritis is an inflammatory condition that leads to swelling of the joints and surrounding structures causing pain and sometimes deformity.  Early symptoms include: fatigue, morning stiffness that lasts more than an hour, a loss of appetite, muscle aches, and weakness.  Joint pain will later follow and is typically on both sides of the body in the fingers, wrists, elbows, shoulders, hips, knees, ankles, toes, and the neck.  When the lining of the joint becomes inflamed this causes the synovial fluid to cause swelling in the affected joints.  Some additional symptoms related to Rheumatoid Arthritis (RA) are: reduced range of motion, a low-grade fever, pleurisy, numbness, tingling, skin redness, swollen glands, and anemia.  Noticeable joint destruction is noted within 1-2 years of the onset of the disease. 

X-ray changes seen with Rheumatoid Arthritis (RA)

Although diagnosis is made by a detailed case history, physical examination, and laboratory studies; x-rays are equally important in the diagnosis of RA.  The changes that the physician will notate on an x-ray include the following: narrowing of the joint space, periarticular osteopenia, juxtaarticular bony erosions, subluxation and gross deformity, and periarticular soft tissue swelling.  The erosions seen with RA include Haygarth’s and Bouchard’s nodes.  These affect the MCP and proximal interphalangeal joints respectively.

Treatment

Unfortunately, Rheumatoid Arthritis is a chronic condition with no known cure.  The best treatment programs available for RA patients include medical, social, and emotional support of the affected patient.  Treatment is aimed at reducing pain and inflammation, reducing or eliminating the progression of deformities before they set in, and increasing range of motion and the patient’s quality of life through diet and exercise.  Treatment may include pharmaceutical medications, reduction of stressors to the joints, physical and occupational therapy, Chiropractic care, Acupuncture, massage therapy, and sometimes surgical intervention for severe deformities. 

Chiropractic Care

Chiropractic care is essential for anyone suffering from an arthritic condition.  The Chiropractor’s job is to reduce pain and inflammation, increase range of motion in all joints, and reduce subluxations or mis-alignments within the spine and/or extremities to prevent diseases from occurring within the human body.  They work on the most important body system in the human body-the nervous system.  The nervous system controls and coordinates every organ and body part.  Chiropractors utilize static and kinetic palpation to effectively determine the level of subluxation and therefore perform manual adjustments accordingly. 

Osteoarthritis (OA) is also known as degenerative arthritis or degenerative joint disease (DJD).  Symptoms may include pain, tenderness, clicking, locking, and inflammation.  OA most commonly affects the hips, knees, hands, feet, and spine.  When OA affects the hands, Heberden’s and Bouchard’s nodes may be present on the proximal and distal interphalangeal joints.  It has been researched that overuse and activity may be linked to the development of Osteoarthritis or dramatically increase one’s risk for the condition.  Overuse can damage the joints and break down the cartilage within them.  Ultimately, this will cause local pain and inflammation.  There are two types of Osteoarthritis: primary and secondary.

Primary and Secondary

This is a chronic degenerative disorder related to the body aging.  As we age, we lose the water capacity within our joints, causing the joints to therefore breakdown.  In the spine, OA will cause bony outgrowths known as osteophytes. On the contrary, Secondary OA is caused by one of the following conditions: Diabetes, congenital disorders of a joint, inflammatory diseases, septic arthritis, Marfan syndrome, obesity, Alkaptonuria, and Hemochromatosis. 

Diagnosis 

Diagnosis of OA is straightforward for the most part.  A physician will take a detailed case history and through physical exam; however, the real diagnosis is made once the physician looks at an x-ray report.  Upon x-ray of an Osteoarthritis patient, the physician will observe the following changes: decreased joint space narrowing, subchondral sclerosis, subchondral cyst formation, and osteophytes. 

Treatment 

There are many advancing treatments for the treatment of Osteoarthritis patients.  They include but are not limited to: lifestyle modification such as diet and exercise, analgesics, physical therapy, chiropractic care, surgery, glucosamine supplements, acupuncture, and other supplementation such as vitamin A, C, E, ginger, turmeric, omega-3 fatty acids, and chondroitin sulfate. 

Chiropractic care 

Chiropractors can significantly reduce the effects of OA.  They can increase range of motion and reduce pain and local inflammation by administering manual manipulations and incorporate physiotherapy modalities.  These modalities may include the following: ultrasound, electrical muscle stimulation, cold laser treatments, inter-segmental traction, whirlpool, spinal decompression, paraffin baths, and diathermy.  Since OA is a wear and tear type of condition, significant improvement is not very common.  The above treatments may help relieve the patient’s symptoms; however, most patients won’t get significant re-growth of the cartilage which has broken down.  Most will only see minor improvements according to the current literature out there. 

Do you experience any type of numbness in your extremities?  Unfortunately, there are many causes for Numbness.  Some of the causes include: sitting for extended periods of time, nerve injury, pressure on local and peripheral nerves, shingles, herpes zoster, lack of blood supply, Diabetes, Multiple Sclerosis, Carpal Tunnel Syndrome, Seizures, Stroke, Migraines, lack of B12 in the diet, and Raynaud’s phenomenon. 

Herniated Disk

The vertebral column is made up of bones called vertebra.  In between these bones are fibrocartilage jelly-like disks which absorb the shock of the spine.  When were young, these disks are well-lubricated with water; however, as we age wear and tear can cause the breakdown of these delicate disks causing possible disc herniations.  Disc herniations may be contained or non-contained.  In addition to these criteria, they may also be a sequestration, involution, or extrusion.  Herniated discs may cause a number of signs and symptoms not limited to: muscle weakness, pain, inflammation, reduced reflexes and sensations, numbness, and tingling.  Diagnosis of a herniated disk is performed with a through case history and physical exam, this may also include special diagnostic imaging such as an x-ray or MRI.  An MRI is the most sensitive test for a disk herniation.  This will show the exact location and severity of the disk bulge, in addition to determining whether the bulge is pressing on the spinal cord.  When a disk herniation is present in the cervical spine, the patient may experience numbness and tingling down one or both arms; however, if the disc herniation is present in the lumbar spine, the patient will experience numbness and tingling down the posterior leg into the calf and possibly down to the foot.  This will mimic the symptoms of a relatively common condition known as Sciatica. 

Chiropractic care

Chiropractic care is essentially for patients suffering from any type of numbness or tingling.  This is almost always nerve-related and may be treated through manual manipulations to the spine and/or extremities.  Chiropractors are trained in the art of the nervous system, the most important organ system in the entire human body which controls and coordinates every organ and body part.  They will use static and kinetic palpation to effectively determine the level of subluxation within the spine and/or extremities.  They will then deliver a HVLA (high velocity low amplitude) thrust in the plane line of the facets to correct the mis-alignment.  They may also incorporate the use of physiotherapy modalities to speed up the recovery process and reduce the numbness and tingling symptoms.