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Can Chiropractic Help Temporomandibular Joint Disorders

Posted in Head Pain Disorders, TMJ Disorder on Dec 22, 2019

Can Chiropractic Help TMJ?

Can upper cervical chiropractic help TMJ?

"I’ve tried everything for my TMJ but nothing’s worked.”

One of the most frustrating things dealing with a TMJ problem is knowing where to go for help.

  • Do I need to go to a TMJ dentist?
  • Do I need to go to a TMJ specialist?
  • Do I need to go to a TMJ physiotherapist? or acupuncturist?

Let me see if I can ask you a few different questions to see if we can narrow it down. Not necessarily to diagnose your TMJ condition, but to at least get some sense of what category you are in.

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  1. What is the TMJ symptom you experience? Local pain? Referred pain? Clicking? Grinding? Popping?
  2. Do you experience any other symptoms in your head, neck face, or shoulders even if they do not seem to be connected with your jaw?

Now a bit of self-assessment.

      3. Go stand in front of a mirror. Slowly open and close your mouth. Watch the way that your jaw moves. Does it open or close in a straight line? Does it veer sideways? Or does it zig sideways, but then zig back to midline?

      4. Now feel the back of your neck just below your skull. Are there tight muscles or sore spots?

For al the complexities that TMJ issues can involve, these simple questions can really help narrow down what is actually going on, and what you can do to help your TMJ issue.

“What is the TMJ symptom that you experience?”

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I’m going to go through these questions - one at a time - to see if we can narrow things down.

Your TMJ - aka temporomandibular joint or jaw - is similar to your knee joint. Each TMJ is a fluid-filled joint with a thin piece of fibrocartilage (called a meniscus) on the inside, which helps to guide the movement of your jaw. The joint is also surrounded by a protective capsule.

The meniscus and the joint capsule receive nerve supply via the mandibular branch of the trigeminal nerve. This nerve supplies a variety of sensations including pain, temperature, joint position sense (called proprioception).

Now, there are a few things to consider here when it comes to TMJ pain.

First, it is possible that the pain is coming from irritation or damage to the tissues directly.

 

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  • Synovitis is inflammation of the jaw tissues including the fluid and articular surfaces on the inside. TMJ pain is typically aggravated with all movements.
  • Capsulitis is inflammation of the jaw-joint articular capsule. TMJ pain is typically aggravated when stretching the mouth wide open (e.g., yawning).
  • Meniscus damage is irritation to the tissue inside the jaw joint. TMJ pain is typically aggravated when compressing the jaw (i.e., biting down).

In addition, if the position of the meniscus shifts even a couple of millimeters, it can cause a clicking or popping noise (like a “flick) that happens inside the joint when you open or close your mouth.

One thing that all these conditions have in common is that there is a mechanical disruption to the normal movement of the TMJ, which is often the underlying issue that leads to TMJ damage and pain. In other words, something about the MOVEMENT of the jaw is not correct.

We will address that in a little bit, but I first want to address the other ways that is is possible to experience TMJ pain or problems.

Do you experience any other symptoms even if they do not seem to be connected with your TMJ?

Are you more likely to win the lottery once or twice?

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This is not meant to be a trick question. The answer, of course, is “Once.”

When we are dealing with symptoms in the body, it is not uncommon for people to experience 3, 6, 12, or even a few dozen different things. However, based on simple math, it is more likely that there are 1 or 2 things that are causing a dozen different symptoms than there are a dozen different things all happening at once!

So if you experience issues with your TMJ, let me ask you again, do you experience any other symptoms, even if they don’t seem connected. Because odds are is that there IS a connection, even if it doesn’t seem obvious.

(NOTE: The next few paragraphs are a bit technical, so feel free to skip if you are so inclined … or just read the BOLD FACED areas)

The nerves that supply your jaw process the primary pain information in a part of the brain known as the spinal trigeminal nucleus, which actually descends into the upper part of your neck, knows as the upper cervical spine. This exact same part of your brain is also responsible for processing all the information about the muscles, ligaments, and nerves of your face, brain, and head.

Therefore, it is not uncommon for people who experience TMJ issues to also experiences varying degrees of headaches, migraines, neck pain, shoulder pain, and even myofascial pain syndromes such as fibromyalgia, which is closely related with chronic fatigue syndrome.

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It is also possible to experience the pain of a condition known as “trigeminal neuralgia” due to a problem with the processing of information in the brainstem.

As a couple of quick but important additional comments, the nerves of your TMJ are sent balance information to a structure known as the principal trigeminal nucleus, which relays this information to the parts of the brain responsible for your upright posture and sense of balance.

Disruptions to this nerve transmission may be associated with vertigo, dizziness, dysequilibrium, and other types of balance and/or muscle posture problems..

In addition, the muscles that control your TMJ position are all controlled from a brainstem center known as the trigeminal motor nucleus.

This particular part of the brain may be important because if nerve signals do not allow the muscles to control the TMJ position or movement properly, it can lead to those TMJ mechanical issues that we mentioned before (i.e., capsulitis, meniscus damage, etc).

Often, these types of motor issues are also associated with the clicking and grinding that occur when you open or close your mouth.

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Think of it like the mechanical grading that happens if you don’t properly shift gears in a manual car. It doesn’t cause your car to blow up, but it can certainly damage the transmission and cause your car to jerk and stall in the process. 

Now, do you need to know about all the technical details in there? Now. Nevertheless, the important point raising here is that we’ve just illustrated that it is entirely possible to experience TMJ problems even though the actual origin of the pain or problem did not start at the TMJ itself!

This is especially important as we move forward into the tests that you can do to identify where the problem may be coming from.

How does your TMJ actually move?

Here is the short of it:

  1. Your mouth is supposed to open and close in a straight line.
  2. If your mouth veers straight left or straight right sideways when you open your mouth, this is called a “TMJ DEFLECTION,” A deflection indicates that you most likely have a structural issue involving the cranial bones and the alignment of your upper palate and your teeth. If so, the nature of this problem is often craniodental in origin and likely requires the assistance of a specialist dentist who works with TMJ issues or what is known as a craniopath, which may be a chiropractor, osteopath or physiotherapist, who specializes in facilitating the normal movement of the bones of your skull.
  3. If your mouth zigs sideways but then comes back towards the middle, this is called a “TMJ DEVIATION.” A deviation indicates that you most likely have a neuromuscular issue involving the nerves and muscles that control your jaw position. If so, the nature of the problem is often craniocervical in eroding and likely requires the assistance of an upper cervical chiropractor, who focuses on the alignment of the head, neck, and jaw.

Remember when we mentioned those muscles that control your jaw position? They are all highly influences by the position of the upper neck, which has been linked to migraines, headaches, fibromyalgia pain, dizziness, vertigo, trigeminal neuralgia, and TMJ pain among many other symptoms.

The jaw position is especially influenced by the position of the C2 vertebra (aka the axis), which actually represents the center of gravity of the TMJ. In other words, if the C2 vertebra moves one way, the TMJ will move with it. And visa versa!

How do you know if your neck is connected with your TMJ issue?

Not always, but many people with TMJ issues also have a combination of tight muscles and/or pain at the base of their skull at the back of their neck.

This area is the upper cervical spine: the C1 (atlas) and C2 (axis) vertebrae. This particular area of your spine is unique. It has the greatest degree of flexibility in your entire spine but also represents the most fragile area.

It is not uncommon for people to experience injuries in like - not necessarily the kind that break or dislocate anything - but certainly the kind that can disrupt the normal position and axis of motion of this vertebra. If this happens, your body doesn’t usually fall apart all at once. Instead, your body makes intelligent adaptations so that you can continue to function as well as possible.

However, these small things - like a tiny snowball at the top of a mountain - can accumulate into much bigger problems years or even decades later. Many TMJ problems fall into this category of chronic neuromuscular issues including headaches, migraines, degenerative arthritis, etc.

It is because they are not necessarily caused by a recent, acute event, but more commonly as the result of damage that has added up over a long period of time.

Imagine that you have a cavity in your mouth that you haven’t attended to. Or that you thought was “just because your teeth are getting older.” Or that you thought would “just go away on its own” even though it hasn’t gone away for 5 years

Often this is the same type of underlying issue with the alignment of the bones in your upper neck and how they affect the normal function of your brain and nervous system including that all-important spinal trigeminal nucleus that has such a profound impact on your TMJ pain and movement.

Maybe you have considered a connection between your upper neck and your TMJ before but weren’t able to find the answers you were looking for.

If so, let me ask you: have you seen a Blair upper cervical chiropractor?

Blair upper cervical chiropractic is a special division of chiropractic developed in the USA that focuses on the particular alignment of the bones in your neck and how that relationship affects the nerves of your brain, face, head, and TMJ.

Unlike general spinal manipulation, the Blair procedure does not involve any twisting or cracking and uses instead a custom-tailored correction to restore movement through the joints in your upper neck.

The process begins with a detailed examination of your bone structure in order to identify your normal. According to research done by Dr. William Blair back in the 1960s, 77% of people have a turn in the normal orientation of their skull that affects the position of C2 and also the TMJ.

When this difference is significant, it can have a major impact on the TMJ!! And unless it is taken into proper consideration, it is possible that many TMJ problems are nor correctly addressed.

So what we do first perform a series of tests assessing your muscle tone and tension patterns, neurological functioning and specific 3D x-rays to identify the exact direction and degree of misalignment in your neck in order to develop a customized approach to help you get the best possible chance for a positive outcome with regards your TMJ symptoms.

Where can I find an upper cervical chiropractor near me?

In Australia, there are only a small handful of chiropractors using what is collectively known as an “upper cervical specific approach.” We are one of 5 chiropractic doctors in Australia using the Blair upper cervical approach, and the only practicing doctor in Brisbane.

Dr Jeffrey Hannah is out resident Blair upper cervical chiropractor, who has done advanced studies in a variety of upper cervical methods including Atlas Orthogonal, QSM3 and NUCCA. He is advanced certified in the Blair chiropractic technique and teaches seminars for doctors in Australia and New Zealand to learn the work.

Dr Hannah is the Blair upper cervical chiropractor serving the local Brisbane communities of North Lakes, Narangba, Burpengary, North Harbour, Albion, Aspley, Newstead, Scarborough, Newport, Toowong, Coorparoo, and Windsor. Our practice is located just off the Bruce Highway in North Lakes for convenient access from Brisbane city and also the Sunshine Coast.

Even though there are a variety of allied health professionals across Brisbane it is common for many of our practice members to travel 60-90 minutes. Through our teaching efforts, we are still working to get other chiropractic doctors interested in the work so that we can make it more available throughout Brisbane and Australia.

So where you can find more information if we may be able to help your TMJ condition?

If you are like many people with TMJ issues, you would prefer a natural solution that addresses the underlying cause of your TMJ issue, and not just treats the symptoms.

If so, we would like to invite you for a complimentary 15-minute over the phone consultation where we would happen to speak with you to discuss the details of your condition, answer any question you may have, and explain the process so that you can find out if upper cervical care may be right for you.

Simply call us at 3188 9329, or click the Contact Us, and one of our staff members will get back to you to arrange a time.

Even if you are outside the Brisbane area, we would still like to invite you to have a chat s that we might be able to direct you to your nearest upper cervical chiropractic doctor.

Atlas Health Australia - “A passion and purpose for helping people get their lives back."

 

References

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Delgado de la Serna P, Plaza-Manzano G, Cleland J, Effects of Cervico-Mandibular Manual Therapy in Patients with Temporomandibular Pain Disorders and Associated Somatic Tinnitus: A Randomized Clinical Trial. Pain Med. 2019 Oct 29. pii: pnz278. doi: 10.1093/pm/pnz278. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/31665507

Greenbaum T, Dvir Z, Reiter S, Winocur E. Cervical flexion-rotation test and physiological range of motion - A comparative study of patients with myogenic temporomandibular disorder versus healthy subjects. Musculoskelet Sci Pract. 2017 Feb;27:7-13. doi: 10.1016/j.msksp.2016.11.010. Epub 2016 Dec 11. https://www.ncbi.nlm.nih.gov/pubmed/28637604

Grondin F, Hall T, von Piekartz H. Does altered mandibular position and dental occlusion influence upper cervical movement: A cross-sectional study in asymptomatic people. Musculoskelet Sci Pract. 2017 Feb;27:85-90. doi: 10.1016/j.math.2016.06.007. Epub 2016 Jun 15. https://www.ncbi.nlm.nih.gov/pubmed/27847242

Häggman-Henrikson B, Rezvani M, List T. Prevalence of whiplash trauma in TMD patients: a systematic review. J Oral Rehabil. 2014 Jan;41(1):59-68. doi: 10.1111/joor.12123. Epub 2013 Dec 30. https://www.ncbi.nlm.nih.gov/pubmed/24443899

Kim JR, Jo JH, Chung JW, Park JW. Upper cervical spine abnormalities as a radiographic index in the diagnosis and treatment of temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol. 2019 Oct 25. pii: S2212-4403(19)31536-6. doi: 10.1016/j.oooo.2019.10.004. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/31780398

Knutson GA, Moses J. Possible manifestation of temporomandibular joint dysfunction on chiropractic cervical x-ray studies. J Manip Physiol Ther. 1999 (Jan);22(1):32-7. https://www.ncbi.nlm.nih.gov/pubmed/10029948

Losert-Bruggner B, Hülse M, Hülse R. Fibromyalgia in patients with chronic CCD and CMD - a retrospective study of 555 patients. Cranio. 2017 Jun 5:1-9. doi: 10.1080/08869634.2017.1334376. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/28580880

Westersund CD, Scholten J, Turner RJ. Relationship between craniocervical orientation and center of force of occlusion in adults. Cranio. 2016 Oct 20:1-7. doi: 10.1080/08869634.2016.1235254. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/27760504

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