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’sworked.”

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One of the most frustrating things dealing with a TMJ problem isknowing 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? oracupuncturist?

Let me see if I can ask you a few different questions to see ifwe can narrow it down. Not necessarily to diagnose your TMJcondition, but to at least get some sense of what category you arein.

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  1. What is the TMJ symptom you experience? Local pain? Referredpain? Clicking? Grinding? Popping?
  2. Do you experience any other symptoms in your head, neckface, or shoulders even if they do not seem to be connected withyour 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 jawmoves. Does it open or close in a straight line? Does it veersideways? Or does it zig sideways, but then zig back tomidline?

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

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

“What is the TMJ symptom that youexperience?”

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

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

The meniscus and the joint capsule receive nervesupply via the mandibular branchof the trigeminal nerve. This nerve supplies a variety ofsensations including pain, temperature, joint positionsense (called proprioception).

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

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

 

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

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

One thing that all these conditions have in common is that thereis a mechanical disruption to the normal movement of the TMJ, whichis often the underlying issue that leads to TMJ damage and pain. Inother words, something about the MOVEMENT of the jawis not correct.

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

Do you experience any other symptoms even if they donot 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 notuncommon for people to experience 3, 6, 12, or even a few dozendifferent things. However, based on simple math, it is more likelythat there are 1 or 2 things that are causing a dozen differentsymptoms than there are a dozen different things all happening atonce!

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

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

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

Therefore, it is not uncommon for people who experience TMJissues to also experiences varying degreesof headaches, migraines, neck pain, shoulder pain, andeven myofascial pain syndromes such as fibromyalgia, which isclosely related with chronic fatigue syndrome.

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

As a couple of quick but important additional comments, thenerves of your TMJ are sent balanceinformation to a structure known as the principaltrigeminal nucleus, which relays this information to the partsof the brain responsible for your upright posture and sense ofbalance.

Disruptions to this nerve transmission may be associatedwith vertigo, dizziness, dysequilibrium, and othertypes of balance and/or muscle posture problems..

In addition, the muscles that control your TMJ position are allcontrolled from a brainstem center known as the trigeminalmotor nucleus.

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

Often, these types of motor issues are also associatedwith the clicking and grinding that occur when you open or closeyour mouth.

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

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

This is especially important as we move forward into the teststhat you can do to identify where the problem may be comingfrom.

How does your TMJ actually move?

Here is the short of it:

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

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

The jaw position is especially influenced by the position of theC2 vertebra (aka the axis), which actually representsthe center of gravity of the TMJ. In other words, ifthe C2 vertebra moves one way, the TMJ will move withit. And visa versa!

How do you know if your neck is connected with your TMJissue?

Not always, but many people with TMJ issues also have acombination of tight muscles and/or pain at the base of their skullat 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. Ithas the greatest degree of flexibility in your entire spine butalso 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 - butcertainly the kind that can disrupt the normal position and axis ofmotion of this vertebra. If this happens, your body doesn’t usuallyfall apart all at once. Instead, your body makes intelligentadaptations so that you can continue to function as well aspossible.

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

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

Imagine that you have a cavity in your mouth that you haven’tattended to. Or that you thought was “just because your teeth aregetting 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 thealignment of the bones in your upper neck and how they affect thenormal function of your brain and nervous system including thatall-important spinal trigeminal nucleus that has such a profoundimpact on your TMJ pain and movement.

Maybe you have considered a connection between your upper neckand your TMJ before but weren’t able to find the answers you werelooking for.

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

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

Unlike general spinal manipulation, the Blair procedure does notinvolve any twisting or cracking and uses instead a custom-tailoredcorrection to restore movement through the joints in your upperneck.

The process begins with a detailed examination of your bonestructure in order to identify your normal. According to researchdone by Dr. William Blair back in the 1960s, 77% ofpeople have a turn in the normal orientation of their skull thataffects the position of C2 and also the TMJ.

When this difference is significant, it can have a majorimpact on the TMJ!! And unless it is taken into properconsideration, it is possible that many TMJ problems are norcorrectly addressed.

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

Where can I find an upper cervical chiropractor nearme?

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

Dr Jeffrey Hannah is out resident Blair upper cervicalchiropractor, who has done advanced studies in a variety of uppercervical methods including Atlas Orthogonal, QSM3 and NUCCA. He isadvanced certified in the Blair chiropractic technique and teachesseminars for doctors in Australia and New Zealand to learn thework.

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

Even though there are a variety of allied health professionalsacross Brisbane it is common for many of our practicemembers to travel 60-90 minutes. Through our teachingefforts, we are still working to get other chiropractic doctorsinterested in the work so that we can make it more availablethroughout Brisbane and Australia.

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

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

If so, we would like to invite you fora complimentary 15-minute over the phone consultationwhere we would happen to speak with you to discuss the details ofyour condition, answer any question you may have, and explain theprocess so that you can find out if upper cervical care may beright 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 atime.

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

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

 

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Grondin F, Hall T, von Piekartz H. Does altered mandibularposition and dental occlusion influence upper cervical movement: Across-sectional study in asymptomaticpeople. Musculoskelet Sci Pract. 2017Feb;27:85-90. doi: 10.1016/j.math.2016.06.007. Epub 2016 Jun15. https://www.ncbi.nlm.nih.gov/pubmed/27847242

Häggman-Henrikson B, Rezvani M, List T. Prevalence of whiplashtrauma in TMD patients: a systematic review. J Oral Rehabil. 2014Jan;41(1):59-68. doi: 10.1111/joor.12123. Epub 2013 Dec30. https://www.ncbi.nlm.nih.gov/pubmed/24443899

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

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

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Westersund CD, Scholten J, Turner RJ. Relationship betweencraniocervical orientation and center of force of occlusion inadults. Cranio. 2016 Oct 20:1-7. doi:10.1080/08869634.2016.1235254.  https://www.ncbi.nlm.nih.gov/pubmed/27760504

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