Head Case
“I'm very brave generally, he went on in a low voice: only today I happen to have a headache.”
- Lewis Carroll
Jaw pain. Head ache. Toothache (but wait, the dentist said my teeth are fine). Clicking in the jaw. Yawning hurts. Chewing is Exhausting (or painful). Can’t open my mouth. Can’t close my mouth. Numbness in head or face. No pain. Weird noises. Jaw locks. Talking hurts my head. I wake up with headaches. Resting helps. I grind my teeth. I don’t grind my teeth. I clench my jaws. My ears hurt. My ears are “stuffy,” Flying gives me a head-ache. My neck hurts. My shoulders hurt. I get migraines. I don’t get head-aches.
What is going on here? The list of symptoms looks like a mixed bag of unrelated, even contradictory sensations. But, for people suffering with TMD, or TMJ syndromes, this list will look really familiar.
The TMJ (tempormandibular joint) is the joint that attaches your lower jaw to your head. Like the joints that connect your spine, the two sides work in tandem. Damage to one side, will cause dysfunction in the other. And the most debilitating symptoms may show up in the side with the least damage. The muscular attachments, nerve pathways and patterns of use are a complicated system that delivers a wide range of symptoms if things go awry. Most confusing is that the symptoms listed above may all be present in the same person at different times. This makes it very difficult to diagnose, and treat. There are as many treatment options available as there are symptoms, and the results vary just as widely.
The TMJ association has a new forum for patients that I found to be very interesting. This site is a wonderful place to share information and learn about TMJ dysfunction. The Forum is running a couple of polls on “what has helped you the least?” and “what has helped you the most?” At last count physical therapy was least helpful for 11.1% of those reporting, and most helpful for 33% of those reporting. Interesting. Unfortunately with many of the conditions I treat, nothing works for everyone. On the reverse, something works for everyone. People with chronic pain conditions have to be constantly on the watch for something that will work for them. I would also like to add that some things will work, even if they didn’t work the first time.
For someone in constant, everyday, debilitating agony, I am probably not the best front line of treatment. Having a team of good, supportive doctors on board is essential. Sometimes drug therapy is essential to help with the intense pain while we work on the mechanical imbalances that cause the problem. Having good, compassionate dental or orthodontal care is important. Be warned that some studies have shown bite therapy to be causative, not curative for TMJ. Other studies have shown that it is the best treatment. I have had many patients whose first symptoms came after orhtodontal or dental work to correct a bite, or repair teeth. I have had patients that swear their orthodontist cured them. Jaw surgery is another question mark for cure. I treat a lot of post-surgical patients. Many of them consider the implants to be a miracle cure. Many of them show up in my office 3-5 years later in the same (or worse) pain than they started with. At least the surgical interventions have improved over the years, 15 years ago some of the common practices bordered on barbaric. Be very cautious before undertaking a treatment plan that is very expensive, and irreversible.
As for physical therapy being least helpful (it pains me that we don’t help everybody – but I get it), it is also one of the least invasive. My practice focuses on improving musculoskeletal function, which means a lot of postural retraining, manual therapy and modalities to reduce muscular tensions, and a home program of stretching and strengthening to improve mechanics of the spine, jaw, and upper extremities. Even if it doesn’t help the TMJ, the program will prevent other postural problems in the future.
Please feel free to add a comment, tell us your story, or let us know what was most helpful for you!
- Lewis Carroll
Jaw pain. Head ache. Toothache (but wait, the dentist said my teeth are fine). Clicking in the jaw. Yawning hurts. Chewing is Exhausting (or painful). Can’t open my mouth. Can’t close my mouth. Numbness in head or face. No pain. Weird noises. Jaw locks. Talking hurts my head. I wake up with headaches. Resting helps. I grind my teeth. I don’t grind my teeth. I clench my jaws. My ears hurt. My ears are “stuffy,” Flying gives me a head-ache. My neck hurts. My shoulders hurt. I get migraines. I don’t get head-aches.
What is going on here? The list of symptoms looks like a mixed bag of unrelated, even contradictory sensations. But, for people suffering with TMD, or TMJ syndromes, this list will look really familiar.
The TMJ (tempormandibular joint) is the joint that attaches your lower jaw to your head. Like the joints that connect your spine, the two sides work in tandem. Damage to one side, will cause dysfunction in the other. And the most debilitating symptoms may show up in the side with the least damage. The muscular attachments, nerve pathways and patterns of use are a complicated system that delivers a wide range of symptoms if things go awry. Most confusing is that the symptoms listed above may all be present in the same person at different times. This makes it very difficult to diagnose, and treat. There are as many treatment options available as there are symptoms, and the results vary just as widely.
The TMJ association has a new forum for patients that I found to be very interesting. This site is a wonderful place to share information and learn about TMJ dysfunction. The Forum is running a couple of polls on “what has helped you the least?” and “what has helped you the most?” At last count physical therapy was least helpful for 11.1% of those reporting, and most helpful for 33% of those reporting. Interesting. Unfortunately with many of the conditions I treat, nothing works for everyone. On the reverse, something works for everyone. People with chronic pain conditions have to be constantly on the watch for something that will work for them. I would also like to add that some things will work, even if they didn’t work the first time.
For someone in constant, everyday, debilitating agony, I am probably not the best front line of treatment. Having a team of good, supportive doctors on board is essential. Sometimes drug therapy is essential to help with the intense pain while we work on the mechanical imbalances that cause the problem. Having good, compassionate dental or orthodontal care is important. Be warned that some studies have shown bite therapy to be causative, not curative for TMJ. Other studies have shown that it is the best treatment. I have had many patients whose first symptoms came after orhtodontal or dental work to correct a bite, or repair teeth. I have had patients that swear their orthodontist cured them. Jaw surgery is another question mark for cure. I treat a lot of post-surgical patients. Many of them consider the implants to be a miracle cure. Many of them show up in my office 3-5 years later in the same (or worse) pain than they started with. At least the surgical interventions have improved over the years, 15 years ago some of the common practices bordered on barbaric. Be very cautious before undertaking a treatment plan that is very expensive, and irreversible.
As for physical therapy being least helpful (it pains me that we don’t help everybody – but I get it), it is also one of the least invasive. My practice focuses on improving musculoskeletal function, which means a lot of postural retraining, manual therapy and modalities to reduce muscular tensions, and a home program of stretching and strengthening to improve mechanics of the spine, jaw, and upper extremities. Even if it doesn’t help the TMJ, the program will prevent other postural problems in the future.
Please feel free to add a comment, tell us your story, or let us know what was most helpful for you!
Labels: jaw pain. manual therpay, physical therapy, tampa, temporomandibular joint, TMD, tmj
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