Temporo-mandibular Joint Problems (TMJ)

The temporomandibular joint (TMJ) is the hinge joint that connects the lower jaw (mandible) to the temporal bone of the skull.

Temporomandibular disorders (TMD) occur as a result of problems with the neck, jaw, jaw joint, and surrounding facial muscles that control chewing and moving the jaw.

This joint is immediately in front of the ear on each side of your head. The joints are flexible, allowing the jaw to move smoothly up and down and side to side, enabling you to talk, chew, and yawn. Muscles attached to and surrounding the jaw joint controls its position and movement. When you talk and chew the jaw moves and also causes the upper neck vertebrae to move as well!

The cause of this disorder is not clear, but chiropractors and dentists believe that symptoms arise from problems with the muscles of the jaw or with the parts of the joint itself.
Injury to the jaw, temporomandibular joint, or joint and muscles of the head and neck such as from a heavy blow or whiplash can cause this disorder.

Other possible causes include: grinding or clenching the teeth, which puts a lot of pressure on the TMJ, dislocation of the soft cushion or disc between the ball and socket,  presence of osteoarthritis or rheumatoid arthritis in the TMJ and stress, which can cause a person to tighten facial and jaw muscles or clench the teeth.
People with Temporomandibular joint problems can experience severe pain and discomfort that can be temporary or last for many years. More women than men experience this disorder and it is seemingly seen most commonly in people between the ages of 20 and 40.


Common Symptoms from Jaw problems:
Headaches, neck aches, dizziness, ringing in the ears, earaches and hearing issues

Pain or tenderness in the face, jaw joint area, neck and shoulders, and in or around the ear when you chew, speak or open your mouth wide

Limited ability to open the mouth very wide

Jaws that get “stuck” or “lock” in the open- or closed-mouth position

Clicking, popping, or grating sounds in the jaw joint when opening or closing the mouth (which may or may not be accompanied by pain)

A tired feeling in the face, swelling on the side of the face

Difficulty chewing or a sudden uncomfortable bite as if the upper and lower teeth are not fitting together properly.

Jaw problems are complex and often require multiple treatment type to aid in resolving them!  Treatments such as: a night guard, acupuncture point stimulation, Chiropractic Manipulative Therapy, Active Release, Graston (Instrument Assisted Soft Tissue Mobilization), LLLT (cold laser), exercises and stress reduction.


Chiropractic treatment for the Jaw (TMJ)
Initial treatment for a temporomandibular joint disorder (TMD) can include applying heat or cold to the jaw area, eating mostly soft foods, taking anti-inflammatory drugs, or wearing a bite guard in the mouth at night. If these methods are unsuccessful, many patients resort to dental treatments to modify the bite or even surgery of the jaw. For those with TMJ symptoms, chiropractic is available as an alternative to those more invasive treatments.
Chiropractic care for the temporomandibular joint (TMJ) can ease pain by correcting the misalignment between the spine and nervous system. Chiropractic can be effective at reducing the pain associated with TMJ, either when used alone or as a complement to other treatments.

An adjustment to the joint(s) can also be done by hand or instrument (Activator), or using a technique that causes a tiny stretch inside the joint to release any fibrous attachments made by the body due to previous trauma. We most often give the patient home exercises to help strengthen the joint and loosen the tight muscles.
In some cases, misalignment of the jaw that results from improper posture or a back problem can cause temporomandibular joint (TMJ) disorder. An approach to treating TMJ caused by misalignment in the neck and upper back is to perform chiropractic adjustments on the spinal joint in these areas.


Do you have full movement in your jaw?
The jaw is a hinge joint connecting the mandible (jaw) to the skull and is surrounded by 68 pairs of muscles immediately in front of the ear on each side of the head. They allow you to chew, yawn, speak, and swallow and are in constant use. This joint is one of the most frequently used in the body. You can locate it by placing a finger in your ear and push forward while opening and closing your mouth. The articular disk separates the condyle head of the mandible and the skull. When this disk is misplaced it will cause Temporal Mandibular Joint Dysfunction (TMJ). Studies show about 35% of the North American population has TMJ disorders.

A common symptom could be having a limited range of motion within the joint. If you have TMJ, every time you open and close your mouth you put wear on the tissues of the joint. This can cause severe problems if not treated properly. . You can test the range of mobility in your jaw by holding your palm vertically with your thumb facing the ceiling. Flex your index finger so it is out of the way. Open your mouth as wide as you can without strain or pain and place the three remaining fingers (middle, ring, and pinky) between your upper and lower teeth.  If you cannot fit all three fingers and you experience pain, it is possible you have TMJ. Don’t be worried if only 2 or maybe 4 fingers fit. If there is no pain and it doesn’t affect how or what you eat then, the diagnosis is probably negative.

TMJ disorders have various causes. Misaligned or missing teeth can force the bone out of its proper position. Trauma from a fall or car crash can do the same thing. Whiplash is a very common cause of TMJ. Many times stress results in a grinding of the teeth or clenching of the jaw. This can over strain the muscles and cause discomfort, tension or pain. It can affect your face, neck, and head causing various symptoms and discomfort. TMJ may appear as various symptoms (headaches and earaches) that wouldn’t normally be considered in conjunction with it. Consult us for an examination if you experience these symptoms.  (770) 922-1212.

The Wonderful Nervous System and Its Control and Coordination of the Body

Last time, I touched on the methodology of our treatment protocol and how we treat the area of pain, but also addressed what is often the underlying cause of one’s malfunction. Obviously, if there is a cause-effect that renders a back, knee or shoulder less than optimal in its performance, that area needs to be the focus of attention. However, if there is a repeated injury, that over time, possibly due to surrounding weaknesses, becomes a chronically recurrent issue, there may be structures that are north or south of the symptomatic area that are preventing a resolution of the problem; thus, they must be addressed or there will be added frustration. So, a muscle, tendon or ligament may be the tissue that needs attention, or a vertebra or other bony structure may need to be adjusted for proper mechanics to prevail. But, often, because of a repetitive strain cycle or major trauma, nerves can become entrapped, thereby not allowing the normal signaling from the brain to reach the tissue that it ends in.

So, if a muscle, say the triceps, cannot fully extend the elbow to straight because the radial nerve that supplies it is being negatively influenced (pressured upon), the biceps, in the front of the arm will pull the forearm and flex the elbow and become over tightened, because it is overworking. Now, looking at the diagrams below, each organ, including the glands, has to be coordinated, like each member of a symphony, to constrict, relax, secrete, dilate or quicken to enable the overall concert of a healthy body to keep “in tune” and give life to the notes on everyone’s pages.  If you look closely, there is even an inherent or built in mechanism to inhibit digestive functions when the body is responding to an emergency situation…like running for one’s life; hence, the term “fright-flight”. Isn’t it great that our Maker gave us the ability to run for cover without our body hesitating, to first digest our quinoa and turkey salad? But what would happen if we were in that situation and had an entrapped sciatic nerve in the buttock, or, of a branch from the celiac plexus of nerves going to the stomach? You could be greatly injured because your bum leg prevented you from moving quickly from a speeding car’s path or you might develop a case of excess stomach acid because your stomach was not neurologically informed that digestion needed to take a back seat to survival!

Therefore, you can see that just treating a muscle (or gland) on its own may not be sufficient to address the direct cause of one’s ailment; that nerves play a paramount role in our bodily functions, neuromuscularly and somato-viscerally (nerve-gut).  Now, make no mistake, that if I see someone that has 200/100 blood pressure, I am not going to immediately find the cause, whether it be hereditary, endocrine, metabolic or psyco-emotional…I am going to demand emergency treatment by their primary care doctor or the local emergency room!  After any necessary crisis care is rendered, the cause can be addressed to work to prevent future episodes.

So, if you have been experiencing ailments that just do not seem to be improving, or are making you and your current doctor scratch their head in a quandary, please call our office to evaluate your situation.

Figure 1.

Figure 2.

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Source

Figure 1.  Illustrated Physiology, McNaught and Callander, Third Edition. ©1975  Pg. 268

Figure 2.  Illustrated Physiology, McNaught and Callander, Third Edition.  ©1975  Pg. 269

Why Do You Treat Areas That Are Not Where My Pain Is?

This question is one of those that gets asked quite frequently. The default answer has been along the line of “looking at a leak in your ceiling, in that it could be coming from the sink directly above, or from a leak in the roof 30 feet away”. Hopefully, this will better define our approach which was taught to me by a professor of mine, Alejandro Claraco, M.D. at McMaster University in Hamilton, Ontario.

We take a “Global” approach in the treatment of musculoskeletal complaints. At times, according to the exam findings, we will adjust, release or stimulate one or more of the following areas of influence to your pain or dysfunction:

•          Local area: where peripheral nerve trunks are “plugged in” to associated muscles, joints, etc. This area is treated to effect, regulate or normalize that particular region where the pain, weakness or hypertonicity is manifesting. For example, I saw a patient who stumbled and sprained an ankle. It was obviously beneficial to address that immediate area first, and so I did via Active Release, mobilization, as well as electrical stimulation, all with the intended goal to reduce swelling and increase range of motion and ability to bear weight on the injured limb. In this particular case, there were other issues north of the ankle that were longstanding, and mechanically hindering the normal gait with walking and running, so they needed to be addressed as well; but for some, that may have been the sole issue that after a few treatments, the case would be closed.
•          Spinal Segmental area: this area manifests or provokes symptoms via indirect stimulation of the spinal nerves through the surrounding muscles of the spine (close to the spinal midline). Most often, this area is addressed by spinal adjustment, manually, or by instrument. It is important to realize here again that symptoms are not always initiated by the immediate area. A patient complaining with arm pain may have their neck involved; sometimes, however, the upper back may be the primary issue.
•          Systemic Regulatory areas: are predominantly along the upper and lower extremities, as well as on the head and ears. These points are sometimes addressed to affect the muscles and other organs of the body (ill-functioning nerves are often overlooked as a contributing causative factor in, say, cardiovascular, endocrine or digestive malfunction).  While I am not in the habit of advertising for patients to come in for complaints involving non-musculoskeletal problems, I know too well that there are times when there is an electrical malfunction that allows these problems to develop. I first witnessed this early on in my practice when patients brought up the issues they were experiencing prior to the care they received for their spine and wondered why they could now breathe better without congestion, have better bowel movements and not have to get up to urinate so often. Nerves are extensions of the brain that control and coordinate every organ in the body, including skin, muscle and glands. Let me emphasize that there can be a number of causes to a malfunction, but simple modulation, or normalization by chiropractic as well through other soft tissue techniques may save one a lot of expense and time. If there is any doubt as to whether more diagnostic or revealing tests need to be made, I will either have them ordered directly, or work through your primary care provider to get them done in a timely manner, in some instances, even prior to beginning any treatment. In cases involving Medicare, the primary care doctor is always needed in ordering any specialized tests (government controlled).

The strategy or methodology employed on each patient will differ according to particular presentation and examination findings. Some of these procedures may be recommended to expedite a patient’s care, but, may not be covered by their insurance. Patients ultimately will have to make the informed decision of which procedures they would like to pursue. While I will emphasize what needs to be done to accomplish the quickest resolution of one’s issue(s), the individual may desire to proceed without, say, Active Release or rehabilitative exercises, understanding that it may take longer. If I sense, however, that the procedures are necessary and not opted for, I may suggest that we do not begin care, as your best interests, as well as my reputation for success, are paramount goals that I do not wish to compromise. I look forward to continue in gaining your trust for your health needs in the coming year!

Lower Cross Syndrome

Last time I addressed the posture pattern Upper Cross Syndrome (UCS). This article will focus on what happens with the lumbo-pelvic region, the lower back and hip area. Let me preface this discussion by saying while these syndromes are talked about independently, there are instances when there can, in fact, be a combination of the two, namely, Layer Syndrome (LS). This occurs with long standing muscle imbalances. But, I will for simplicity sake, stick with LCS so as to not cause confusion.

We have, in each of us, two types of postural muscles, those that are prone to tightness, or HYPER-tonicity and those that are prone to weakness, or inhibition. The following lists are not to bore you with the technical, but hopefully give you a better picture of the tissues involved. The symptom presentations are part of what may be experienced, and not complete. There can be significant overlapping of involved tissues because of fascial connections and pain may just be what you initially notice; there may be issues that one has compensated for that are easily ignored i.e. lower back range of motion decrease with a golf swing leading to eventual shoulder pain. The clinical manifestations or consequences of these muscle imbalances can lead to; painful and or restricted motions, dysfunctional, weak or absent motions, painful, abnormal or absent sensations, as well as swelling in the involved tissues.

UCS AND LCS MUSCLES PRONE TO TIGHTNESS/HYPERTONICITY:

• suboccipitalis (attaches to back of skull)…neck pain and headaches
• sternocleidomastoid (attaches from skull behind ear to the collar bone)…neck pain and stiffness
• scalenes (attach deep to side of neck)…neck and arm pain as well as tingling and numbness
• upper trapezius (attaches to side and back of neck to skull)…neck pain and headache
• levator scapulae (attaches from tip of shoulder blade to neck)…neck and shoulder blade pain
• pectoralis major and minor (chest muscles)…neck, shoulder and mid back pain
• temporalis (sides of skull around ears)…temporo-mandibular joint syndrome
• masseter (cheek muscles)… temporo-mandibular joint syndrome
• biceps (muscle in front of arms)…shoulder and arm pain
• erector spinae (deep muscles in back along spine)…back pain
• quadratus lumborum (between hip and lower rib)…back pain
• hip adductors (inner thigh muscles)…hip and back pain
• iliopsoas (attaches deep abdominally to sides of spine to top of thigh bone)…back pain
• rectus femoris (top center quadriceps muscle in front of thigh)…back pain
• tensor fascia latae (top side of thigh muscle that ties into ilio-tibial band)…hip and knee pain
• hamstrings (muscles in back of thighs)…hip, knee and back pain
• piriformis (muscle deep in buttock)…can spasm, along with surrounding muscles on sciatic nerve
• gastrocnemius and soleus (calf muscles)…knee pain and plantar fascitis

UCS AND LCS MUSCLES PRONE TO WEAKNESS/INHIBITION:

• serratus anterior (along side of ribs to shoulder blade)…shoulder and rib pain
• middle and lower trapezius (mid back from spine to shoulder blade)…mid back and neck pain
• gluteus muscles (hip and buttock area)…lower back and pelvis pain
• abdominals (belly area)…back pain
• rhomboids (between shoulder blade and spine)…mid back pain
• triceps (large muscle behind upper arm..shoulder pain
• deltoids (muscle that drapes over shoulder)…shoulder pain
• tibialis anterior (muscle along outside shin)…shin splints and ankle sprains
• peroneus muscles (muscles along outside lower leg)…ankle sprains and outer knee pain

The lists above name common symptoms associated with the named muscle and are not necessarily complete.
The most common pattern of muscle imbalance that the discoverer of these syndromes, (Vladimir Janda) in this discussion regarding LCS is the combination of tight hip flexors (rectus femoris and iliopsoas) and lower back (erectors), paired with weak abdominals and gluteal muscles. This scenario leads to an excessive lower back arch, a flabby tummy and a flat buttock area. What we do as far as treatment is to determine which muscles are tight and break down the adhesions. Also, the muscles that are weak or inhibited need to be strengthened. Inflammation may be treated by instrument assisted soft tissue mobilization or cold laser. Any spinal issues that may be contributory to pain, burning, tingling, etc. are addressed via manual or instrument adjusting. Ultimately, the goal is to help the individual achieve a better lifestyle, whether to be able to perform activities of daily living, or work, or re-engage in a sport activity.

I hope this has not proved to be too technical an article and that hopefully has, in fact, been helpful in understanding your physical ailment or weakness or sub-par performance at work or in your sport. Please call us at (770) 922-1212 if you have issues in this area.

Please visit our website: chiroserra.com

Upper Cross Syndrome

This month, I’d like to address a pain development that is seemingly epidemic in today’s society, that is, “upper cross syndrome”, or “UCS”.  While one may not yet be in pain, the insidious onset of muscle tightness or weakness, gradually leading to imbalances and poor posture, can be very much like heart disease or cancer; when the symptoms present, it grabs your attention by getting in the way of carrying out the normal activities of daily living.

So, what is UCS? You can observe it in people whose necks flex forward and their shoulders are rounded with the head straining back so they don’t fall on their faces; poor posture leads to UCS! Someone who works at a computer terminal, or who does a lot of driving, or who cuts hair or even attends patients as a surgeon or dentist, as each of these professions lend themselves to the flexor muscles in the front becoming overworked, especially in comparison to the extensors of the back muscles. This imbalance of muscle tension puts you at a higher risk for injury. Slouching posture must be constantly checked during one’s workday! As this poor posturing progresses, it may become increasingly more difficult to get a deep breath as shallow breathing becomes the norm and expanding the chest cavity becomes difficult, or even very uncomfortable.

In a previous article, I talked about Repetitive Strain Injuries and how if muscles stay in a contracted state for a prolonged time, the circulation to the muscles involved can be decreased and adhesions develop within, around and between other muscles, and even nerves. This is usually when I begin seeing individuals with UCS. They cannot recall any trauma or incident that brought their neck, back or upper extremity pain on, they just awakened one day with it, or just innocently sneezed or made a quick head movement.

A short list of the usually involved tight muscles includes the upper trapezius, SCM, levator scapulae and pectoralis major and minor. Muscles that become weak and inhibited (not firing or contracting optimally include in part, the deep neck flexors, middle and lower trapezius, serratus anterior and rhomboids. My job now is to find the tight and weak muscles, as well as those that are inhibited, locate the adhesions and then flush out the swelling and restore the normal function of the involved joints and muscles. Exercises and, yes, nagging you about your posture become necessary to then begin activities with a gradual pain threshold increase (everyone will have a tissue tolerance or redline, how high it is will be determined by genetics, amount of wear and tear as well as the degree to which flexibility and strengthening exercises are followed).

So, observe how you are sitting, standing and performing work/sports activities, possibly using a mirror, window reflection or by having someone look at you and capturing you on their phone camera; then call us at (770) 922-1212 if you think you have UCS! Next time I will address, what else?....Lower Cross Syndrome!

Please visit our website: chiroserra.com

Kinesio Taping

 Another procedure that we employ is Kinesio Taping.  Although this technique has been around for about 25 years for sports performance, pain management and swelling (edema) control, it wasn’t until the 2008 Olympics in Beijing that the media coverage expanded and interest or even curiosity increased.

Kinesio Tape is applied over injured areas or where tissue needs to be supported, relieved of edema or re-educated for a given exercise.  The tape gives support and stability to joints and muscles without restricting circulation or range of motion.  While traditional “strapping: of sports tape has long been utilized strictly for stabilization, the side effects of fluid obstruction often lead to swelling.  To ensure that muscles have near/full range of motion, the tape was developed to have 130-140 % elasticity.  In fact, Dr. Kenzo Kase manufactured the tape with the same elasticity as healthy human muscle. We often use the tape on youngsters involved with over-use syndrome, with soccer in particular, but with adults in repetitive or over-use straining from yard work, running, golf, and tennis.  This is a procedure that can be learned and done at home, although, it has been observed by me that a couple of sessions of having it applied by someone with experience, enables better quality self application later…and less wasted tape.


Call: 770-922-1212 for an appointment!

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Low Level Laser Therapy

This is a continuation of the therapeutic procedures that we employ at this office to give you an explanation that can be referred back to at your convenience.



Low level laser is an FDA approved laser for treating pain and increasing range of motion on the market.  It has been found to be extremely beneficial for enhancing and accelerating wound healing and reducing acute inflammation.

The research has been done and more is planned.  With over 200 clinical studies – many of which are double-blind, placebo-controlled – and in excess of 2000 published articles on LLLT (low level laser therapy), this innovative new technology has a well-documented research and application history.  Having grown far beyond its distant Institutional Review Board (IRB) and experimental treatment status, LLLT is now being considered a therapy of choice for difficult pain management challenges such as fibromyalgia and myofascial pain.

Its positive effects are many and well-researched.  For example, research demonstrates that the laser increases oxygen, healing and tensile strength of healed tissue.  It reduces swelling, increases blood flow, reduces inflammation, increases cellular metabolism and repair, promotes collagen formation, and much more.

But how does it work?  If you are like most people, when you first see a demonstration of the laser you might find yourself thinking, “How is this possible?  All you are doing is shining a blinking red light on patients and they are getting quick and often amazing results.”  To answer that question properly you would have to investigate the fascinating interface between biology and quantum mechanics – a huge undertaking.

Stated in its simplest form the cold laser is a biomodulator.  If the body is doing too much of something or not enough of something else, then the laser will up-regulate or down-regulate it accordingly.  It accomplishes this regulation by returning the targeted area of the body back to normal frequency.  The concept of entrainment comes from physics.

Entrainment is defined as a situation in which two rhythms that have nearly the same frequency become coupled to each other so that both have the same rhythm.  For example, a number of pendulum clocks mounted on the same wall will eventually entrain, so that all the pendulums swing in precise synchrony.  For this to happen, the pendulums must have about the same period, which is determined by their length.  What couples the pendulums are vibrations (elastic or sound waves) conducted through the structure of the wall.

The laser restores balance, harmony, and order by entraining the out-of-step frequencies back to their proper oscillations.  The laser is actually integrative in its effects.  You simply program in the appropriate frequencies, laser the affected areas, and the body is entrained back to coherence, and hence, normal functioning.

To date, there have been no adverse side effects reported in over 2000 publications.  However, individuals with the following contraindicated conditions should avoid laser therapy:  cancer, photophobia (sensitivity to light) and pregnancy.  Also, laser therapy should not be directed toward the thyroid, endocrine glands, or eye (we utilize special protective goggles), be used on individuals that take photosensitizing medications (i.e. antibiotics, Retin A) or on areas of hemorrhage.

While the FDA has approved LLLT devices for treatment of:  Carpal Tunnel Syndrome as well as neck and shoulder pain of musculoskeletal origin, insurance companies consider the treatment “experimental” and therefore may not cover or reimburse the cost.



Call: 770-922-1212 for an appointment!


Please visit our website: chiroserra.com