Latest / The Driven Athlete / TMJ & Neck Pain | Ep 16

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TMJ & Neck Pain | Ep 16 · The Driven Athlete

• 0:00
  Speaker 1: If you're a driven, active person who wants to reach and pursue a higher quality life with some ambition, then guess what this podcast is for you.
• 0:07
  Speaker 1: This is the Driven Athlete Podcast.
• 0:10
  Speaker 1: What's up y'all?
• 0:13
  Speaker 1: It's your man.
• 0:14
  Speaker 1: Dr Kyle back today with a cool topic of the temporal mandibular joint, which is the joint in your jaw, and it's a very overlooked diagnosis in my opinion, sometimes when it comes to like upper face neck pain and suboxyprol, like the base of your neck type pain.
• 0:32
  Speaker 1: But it's a big source of discomfort and it gets overlooked and it's just something that we have to consider as part of our investigation process because it can be very debilitating and really painful and it can really contribute to debilitating life and it needs to be treated right and it can be treated.
• 0:46
  Speaker 1: So I just want to educate or just bring the light and shed some light to people that it's okay.
• 0:52
  Speaker 1: It left untreated, it can be definitely a lot of a problem.
• 0:55
  Speaker 1: However, there is treatment and there's physical therapy treatment.
• 0:58
  Speaker 1: We can do manual therapy, soft tissue stuff like dry needling and corrective exercises, especially with the cervical spine on your neck as well.
• 1:05
  Speaker 1: So that is something that it can be treated.
• 1:07
  Speaker 1: It doesn't have to just be surgical.
• 1:08
  Speaker 1: So I will definitely investigate and consider to get this checked out if it's a problem for you.
• 1:14
  Speaker 1: But a little bit of background, okay.
• 1:16
  Speaker 1: So the TMJ when someone says TMJ, what they're talking about is the temporal mandibular joint and it's joint in your jaw and it contributes and can refer pain to the face, the jaw, the ear, the base of the skull the suboccipital region is what you would call that and the upper neck and it contributes to headaches too, like cervical genic headaches and ram's horn headache.
• 1:37
  Speaker 1: The ram's horn is a pattern that goes from the base of your neck over your head and to your eyes and the side of your head.
• 1:42
  Speaker 1: But that's like the ram's horn type of distribution type of headaches and cervical genic headaches.
• 1:47
  Speaker 1: So if somebody presenting with those regions of pain we have to investigate on the table, hey, is TMJ contributing to this and is it part of it?
• 1:57
  Speaker 1: So that's what you have to investigate and check it out.
• 1:58
  Speaker 1: We would be doing our job if we didn't, okay, so it's just interesting to consider that so many referral patterns and points can be contributed from TMJ issues, temporal mandibular joint issues.
• 2:11
  Speaker 1: Another thing to interesting to consider is that the TMJ is one of the most frequently used joints throughout the day all the time, talking, eating, chewing, yawning, singing, playing musical instruments, yelling at your kids, yelling at a sports game, whatever right.
• 2:26
  Speaker 1: We use your TMJ a lot, a lot more than a person might think.
• 2:31
  Speaker 1: So it's really used, so it gets really involved all the time.
• 2:36
  Speaker 1: And if it leads to, like a person experiencing constant nagging neck pain or constant nagging jaw, ear, oral, facial type pain, that's something we have to investigate and it really can be irritated chronically, so that chronic irritation can cause a lot of issues which we'll get into in a second.
• 2:55
  Speaker 1: Major factors that can increase problems at the TMJ or at least allow things to stay heightened in an irritated state constantly, is sleeping position.
• 3:05
  Speaker 1: Okay, we talked about how important sleeping position is, but with a TMJ and jaw pain, think about someone laying on their stomach or on their side and they're compressing their jaw to one side for eight hours or six hours.
• 3:17
  Speaker 1: That contributes a lot to keeping things irritated, in a heightened irritated state.
• 3:21
  Speaker 1: So we have to consider that sleeping position can allow things to stay irritated and constantly keep things at a heightened state of pain and contribute to that.
• 3:30
  Speaker 1: Okay, the other one is at work, so, or students too, but anyway, work posture and resting your jaw or your head on your hand or your fist and it compresses one side or over stretches and other side over stretching is another issue with this too.
• 3:46
  Speaker 1: That can contribute to symptoms as well.
• 3:48
  Speaker 1: All right, so sitting at work with your hand on your your hand resting underneath your jaw and you're resting your head on your hand and then phone talking.
• 3:58
  Speaker 1: So if somebody compresses one shoulder to the ear to talk on the phone while they're typing or working on stuff, we have to consider that awkward neck position and then compressive or over stretching position for the TMJ or the opposite TMJ can cause a problem.
• 4:11
  Speaker 1: So that's just something we have to consider, right?
• 4:14
  Speaker 1: So work posture, sleeping posture, sitting posture, desk posture, sleeping on your desk for students right, definitely was not me.
• 4:21
  Speaker 1: We have to consider that.
• 4:23
  Speaker 1: It's a.
• 4:24
  Speaker 1: It's a factor that we're going to investigate during an evaluation process.
• 4:27
  Speaker 1: There is an articular disc that helps with the congruency and stability of the TMJ for for the joint articulation and the joint mechanics.
• 4:37
  Speaker 1: So it's kind of like a meniscus, almost If you think about that, with a knee, but it's inside the, the your temporal mandibular joint, and this articular disc helps with congruency and just allow things to disperse compressive forces and compressive loads, with chewing, clenching is a big problem and bruxing during the night bruxism, which we'll talk about in a second.
• 4:56
  Speaker 1: But the articular disc is is comprised of dense fibrous connective tissue and essentially is doesn't have any innervation for vascular supply, except for the small part of the periphery.
• 5:08
  Speaker 1: So unfortunately, if it does get broken down or frayed over time like fraying the vascular supply, the blood supply isn't really great, so the healing potential isn't awesome.
• 5:17
  Speaker 1: So we have to consider if this is getting to be a factor and there's a lot of clicking, because clicking can be a sign of your inflammation and irritation in the in the disc can be a part of that.
• 5:28
  Speaker 1: If there is clicking and stuff involved in pain, we have to consider disc issues sometimes and that's where it's to investigate and manual therapy for joint mobilizations and distractions and lateral deviation can help alleviate that and and maybe correct and improve some of the joint mechanics of your TMJ joint.
• 5:47
  Speaker 1: But we have to consider the, the, the articular disc, and something else we have to consider is why did the disc start getting irritated in the first place?
• 5:54
  Speaker 1: It just came out of nowhere.
• 5:55
  Speaker 1: What was being done that led this person to have this articular disc and TMJ pain right.
• 6:00
  Speaker 1: In general, we had to stop that stuff and intervene appropriately If it's chronic postural positioning, bruxing and clenching during the night, where a bike cart can be helpful, and then a lack of, maybe, postural stability and postural endurance with the neck, and then sleeping positions and resting positions during the day at the desk, at the work and sleeping and stuff.
• 6:22
  Speaker 1: So that's all the things we have to consider right and, as it plays, all these contributing factors that lead to man now my jaw hurts and I don't know what the heck is going on and my neck hurts.
• 6:30
  Speaker 1: It's just something we have to look into and intervene appropriately.
• 6:33
  Speaker 1: And that's where we come in.
• 6:34
  Speaker 1: And if we can catch it early enough or have the right mindset going into treatment and with the right dedication, hopefully avoid surgery, right, and we would always refer out when it's necessary.
• 6:44
  Speaker 1: But like, hey, this isn't getting better, this smells different than when what we think is maybe within our scope would definitely refer out to people as appropriate, but we can intervene at least and check it out and do an evaluation.
• 6:55
  Speaker 1: So clicking can occur at this joint and if it gets chronically displaced and joint mechanics get continually more altered, that's where it can get more pronounced and maybe more irritation and, like I said, that's where we have to intervene and maybe why it happened in the first place and that's what we need to treat right.
• 7:11
  Speaker 1: This, however, can put more tension requirements on the surrounding muscular tissue and the musculature is going to get very tense and guarded and chronically tense and hypertonic, as a term we use of the tone of the muscle.
• 7:28
  Speaker 1: The resting tone is just increased and heightened, makes it feel always tight or compressed, and we would investigate like why are the muscles feeling like that?
• 7:36
  Speaker 1: There must be a reason, otherwise that led to the muscles doing like that, because the muscle tissue follows suit from something else going on and if it's a joint problem and a postural endurance, a stability problem and then a compressive posture problem, like it's sleeping or desk, that's what we have to intervene, right.
• 7:52
  Speaker 1: But anyway, so yeah for you, ken, okay guys, this puts more tension on the musculature and muscle tension is definitely one of the first contributing signs and symptoms that we see with pain experience regarding the TMJ.
• 8:03
  Speaker 1: So, but like I said, the muscle tissue is really a tertiary problem and not the primary cause of the problem.
• 8:10
  Speaker 1: We have to figure out why the muscle is getting tense on the first place that's causing this pain and that's where we intervene and the manual therapy can be huge for that.
• 8:17
  Speaker 1: But anyway, there's a lot of muscles that connect around your TMJ, your temporal mandibular joint, all the muscles of mastication that we would call, all the chewing muscles, your temporalis muscle, which is up here, your masseter, which is a big muscle in the jaw right here.
• 8:31
  Speaker 1: That's the main force driver for chewing and clenching.
• 8:34
  Speaker 1: And then your pterigoids.
• 8:36
  Speaker 1: You have remedial and lateral pterigoids and those contribute to opening and closing your jaw as well and then we can intervene with those muscle tissues.
• 8:42
  Speaker 1: However, if we don't fix the sleeping positions or the work postures that chronically irritate stuff, it just won't allow things to get better.
• 8:52
  Speaker 1: Another interesting topic and approach that we have to consider if clenching and broxing is a problem for people at night, during the day and not realizing that you're clenching your teeth a lot and that causes more tension and maybe contributes to more pain in the jaw or neck, I would investigate.
• 9:09
  Speaker 1: And this is not our realm.
• 9:10
  Speaker 1: Why is that person clenching and broxing in the first place?
• 9:13
  Speaker 1: If that's a mental health problem stress and anxiety we can't neglect, that plays a role.
• 9:16
  Speaker 1: We can't separate the mind from the body and that plays a.
• 9:19
  Speaker 1: It contributes right to the experience of creating more muscle tension and more pain.
• 9:23
  Speaker 1: However, if that is a thing, we have to investigate what's causing that in the first place, and that's maybe where a mental health professional can intervene.
• 9:30
  Speaker 1: So imagine this person, a patient that comes in that has jaw pain chronically and they have a lot of tension or clenching all the time and they're biting their teeth, especially at night.
• 9:38
  Speaker 1: A bite guard could be helpful.
• 9:40
  Speaker 1: I could do that with their dentist.
• 9:41
  Speaker 1: I would investigate the mental health component for stress and anxiety that might be causing the clenching in the first place, and then also the manual therapy, corrective exercises and stability exercises that we could do to help with the actual joint mechanics.
• 9:56
  Speaker 1: That triple approach might be a really, really great approach to help solve the underlying problem versus just jumping into surgery right away.
• 10:03
  Speaker 1: Does that make sense?
• 10:04
  Speaker 1: Because if we dumped into the surgery right away, we didn't fix the posture issue, we didn't fix the mental health component issue and we also didn't fix the bite guard issue or just the sleeping position right.
• 10:13
  Speaker 1: If we fix all that stuff, or maybe at least try that stuff first conservatively and then maybe, if it's not working for sure.
• 10:19
  Speaker 1: Well, we're fur out not getting better man, that's for all.
• 10:21
  Speaker 1: Get another opinion, get some imaging, get us, and then surgery might be on the table.
• 10:25
  Speaker 1: But versus just jumping right into surgery, we can intervene with those things too first and imagine like the life trajectory change that might be for that person, that life change and their trajectory could be way different.
• 10:36
  Speaker 1: It's just something to consider that we want to bring to the table.
• 10:39
  Speaker 1: You don't have to go any routes, but we would love to help and we would love to at least instill this mindset to maybe help in this approach and versus avoiding something drastic.
• 10:48
  Speaker 1: That's just my humble opinion and again, I'm always open to suggestions and conversations with people and comments, questions, concerns but that's just where our heads at first and to help people as best as we can, but anyway.
• 11:00
  Speaker 1: So from our standpoint, how can we treat this right?
• 11:05
  Speaker 1: What do we do for treatment?
• 11:06
  Speaker 1: Because there is physical therapy treatment for this, and the best ways to intervene with this seem to be, first and foremost, we have to evaluate you.
• 11:15
  Speaker 1: We have to evaluate where exactly is the pain coming from?
• 11:19
  Speaker 1: What seems to be the angry tissue that's contributing to the pain?
• 11:21
  Speaker 1: What causes tissue to get angry in the first place, like what caused the joint itself to get all lit up and irritated.
• 11:27
  Speaker 1: Is there a cervical component like your neck, is there a neck contribution that's that may be referring pain to the ear, the jaw, the face.
• 11:35
  Speaker 1: That might not actually be your TMJ.
• 11:37
  Speaker 1: So we have to look at the cervical, the cervical spine, your neck.
• 11:40
  Speaker 1: There's a lot of, and the reason why I say that is there's a lot of neural interplay and neural overlay that occurs between the cervical spine, the neck, the upper cervical spine and the jaw and the mouth and the face and the ear and also headaches.
• 11:55
  Speaker 1: And the suboccipital joint also plays region, plays a role with that too for cervical genetic headaches, tension headaches.
• 12:02
  Speaker 1: So we have to investigate, we have to look into the cervical spine, the suboccipital joint and region and your TMJ and those three things.
• 12:12
  Speaker 1: We definitely have to deep dive to figure out exactly what the problem is, for an accurate diagnosis and then that is going to trigger the best treatment approach and how we can intervene appropriately there.
• 12:25
  Speaker 1: Another interesting thing that to expose and shed some light on the interplay between the cervical spine and the TMJ, your TMJ, your temporal mandibular joint, the muscles that involve chewing, the muscles of mastication, are innervated by cranial nerve 5, called your trigeminal nerve, specifically the third branch of your trigeminal nerve, and that's a cranial nerve.
• 12:48
  Speaker 1: There's a trigeminal nuclei located at the anterior part of your neck at C1, 2, and 3, that region of your neck C1, c2, C3 of your cervical spine is a trigeminal nuclei and that's located on those joints in your cervical spine and it's the same muscles that innervate the chewing muscles that connect to your jaw.
• 13:11
  Speaker 1: So there's a huge interplay of neural translation and neural communication between the cervical spine and the jaw via the trigeminal nerve and then also with the suboccipital joint and the upper cervical for headaches.
• 13:25
  Speaker 1: So imagine, like the interplay there between the upper cervical, suboccipital to the jaw, and the trigeminal nerve as they innervate the muscles and they have a nuclei that's located at the cervical spine.
• 13:35
  Speaker 1: That's huge.
• 13:37
  Speaker 1: We can't neglect that and we have to therefore investigate and evaluate that stuff.
• 13:40
  Speaker 1: So there's a huge neural overlay between those two things.
• 13:44
  Speaker 1: And I'll also refer pain, referred pain from the neck and the upper cervical can go across the head for cervical genetic headaches, across the jaw and the ear and also down the neck.
• 13:54
  Speaker 1: So it might mimic or maybe substitute pain that might think that it's the TMJ, when actually it's coming from the neck.
• 14:02
  Speaker 1: So how can we treat this?
• 14:04
  Speaker 1: Alright.
• 14:05
  Speaker 1: So that's step one is evaluate, how can we treat it.
• 14:06
  Speaker 1: Number one we can do manual therapy for the TMJ, the temporal mandibular joint, because it is a joint and there are joint mechanics involved with that, so we can mobilize an internal mobilization in the mouth.
• 14:17
  Speaker 1: Alright, we can put our thumb in the mandible and we can distract the TMJ to maybe improve the articulation between the disc and the mandible and the temporal bone and improve the joint mechanics, lateral deviations, protrusions, manual therapy and the distractions and that's the best way we can help intervene directly at that joint.
• 14:39
  Speaker 1: Then we can intervene with corrective exercises and postural education.
• 14:45
  Speaker 1: So postural endurance is what we would call a posture for the cervical spine in the neck.
• 14:51
  Speaker 1: Postural endurance during the day is really important.
• 14:54
  Speaker 1: And corrective exercises to strengthen the TMJ and strengthen the cervical spine in your neck, For the postural stability strength and then also the endurance and the corrective exercises for that and the therapeutic exercises seem to be really helpful in the research, especially for TMJ and upper neck problems.
• 15:12
  Speaker 1: The other really golden ticket that seems to be really helpful in the research that describes is dry needling, so we can dry needle the muscles in your TMJ, their masseter, your temporalis muscle and then also the lateral pteragoid, and we use tiny little needles there's little guys that go in and we can find trigger points in the muscle tissue of your masseter temporalis and your lateral pteragoid and we can directly and internally intervene at those muscle tissues.
• 15:36
  Speaker 1: And some of the benefits of dry needling which we've touched on a little bit in the past.
• 15:40
  Speaker 1: Some of the benefits of dry needling like what does a dry needling do and why it can help break up muscle tension and the trigger points and break up trigger points in the actual muscle tissue.
• 15:51
  Speaker 1: It helps to re-regulate acetylcholine, which is the neurotransmitter that helps with activation of muscles.
• 15:57
  Speaker 1: So imagine like if muscles are chronically tense and hypertonic and they're always clenching, the dry needling helps to lower the acetylcholine for actually contributing to contraction of the muscles.
• 16:08
  Speaker 1: So we can help improve the tone of the resting muscle tone in the muscle tissue.
• 16:13
  Speaker 1: And the other thing is we can help create more angiogenesis for vascularity, for healing response in the blood flow and it helps to stimulate fibroblast activity, which is the cells in your tissue that help lay down new collagen fibers.
• 16:28
  Speaker 1: So we can help lay down new collagen fibers, more blood flow and angiogenesis of vascular tissue, decrease the tonicity and the tone, the rest of the muscle tension of the muscle tissue with acetylcholine being re-regulated and then also break up the trigger points.
• 16:42
  Speaker 1: The last thing, that's the benefit, is dry needling in the research helps seems to be finding that it helps to recruit endogenous opioids for pain modulation.
• 16:51
  Speaker 1: So it helps with pain and helps with the muscle tissue integrity, blood flow and new blood flow development and angiogenesis and then break up the muscle trigger points.
• 17:00
  Speaker 1: So those are what the dry needling can do.
• 17:02
  Speaker 1: Then we can hook up the electrical stim to those dry needles in those muscles and it helps to amplify those effects.
• 17:08
  Speaker 1: And so we do dry needling pretty often with a lot of patients where it's appropriate, and we always investigate and do our due diligence of who's appropriate for dry needling and who's not.
• 17:18
  Speaker 1: But dry needling seems to be really helpful for TMJ.
• 17:21
  Speaker 1: So we have a combination of joint mobilizations and distractions for the TMJ, soft tissue and dry needling with stimulation for the muscle tissue and then corrective exercises.
• 17:33
  Speaker 1: We'll also manually intervene at the cervical spine to mobilize and intervene at the suboccipital joint and the upper cervical joints and then stability exercises for postural stability and postural endurance.
• 17:45
  Speaker 1: And imagine how important that is for somebody that has a job and they're at a desk all day and they're sitting chronically and that chronic position and posture, that the mobility of the joints or the way that the joints are seated might not allow the best positions in the first place, and then the muscles that intervene, those areas aren't even active or strong enough to even do that.
• 18:07
  Speaker 1: So that's just a great recipe for failure.
• 18:08
  Speaker 1: But we can intervene and stop that from happening and at least maybe change the trajectory and course of this person's pain experience and in their life.
• 18:15
  Speaker 1: Because anyway that's what we do right and we would love to help you.
• 18:20
  Speaker 1: The exercises are really important.
• 18:21
  Speaker 1: That's what helps to solidify the changes that we do with the manual therapy.
• 18:25
  Speaker 1: Manual therapy is definitely a huge component to make things move better and Improve the joint mechanics and the range of motion and get things feeling better, of course.
• 18:33
  Speaker 1: And then the muscle tissue, the soft tissue that surrounds it.
• 18:35
  Speaker 1: We can help settle that stuff down so everything feels better and it's moving better.
• 18:38
  Speaker 1: But the corrective exercises is what helps us solidify those changes and actually hardens those, those new changes, and and it really solidifies the habits and of the muscle and activation and Repurpose the posture stability and endurance and the stability and strength of your neck and jaw.
• 18:57
  Speaker 1: So those are the exercises really is the key, after the manual therapy, to help really hone in the changes that we're looking for, mainly for the long-term benefit because, well as for practitioners in physical therapy, the sports PT's that we are, our main goal is to help improve things for the long term versus such like a short Benefit, and the only way we can really intervene to help with a long-term benefit We'll completely life-change trajectory is if we improve the corrective exercises, the posture endurance and posture awareness For these type of specific problems, maybe change their sleeping positions, which is a tough one to do, which we've talked about and then also educate people.
• 19:33
  Speaker 1: We have to educate we.
• 19:34
  Speaker 1: The education component is maybe the most important component because we teach people and show them what to do, what things to avoid and maybe why things are coming in the first place, and it changes their whole perspective of reference, because your perspectives and your beliefs Dictate your life and change your world.
• 19:48
  Speaker 1: So we can at least maybe intervene there too and it's going to change the approach in the, the perspective on this issue and that's really we're going to help you change a long-term benefit, which is what we want to help with people.
• 20:00
  Speaker 1: So if you are battling TMJ issues our upper cervical, upper neck issues and headaches we would love to help, and TMJ temporal manipular joint issues is something that's on the table that we can't neglect.
• 20:15
  Speaker 1: We have to investigate that to see, maybe, what what's actually going on right.
• 20:19
  Speaker 1: So we would love to help.
• 20:21
  Speaker 1: If you have any questions, definitely please reach out and we're always open to helping people and answer questions, comments, questions, concerns that you hear in this podcast, so feel free to give us a shout.
• 20:31
  Speaker 1: The best number you can reach us on is 561 899 8725 and the best email you can reach out to us to is our team email, tam, at athlete RC calm.
• 20:43
  Speaker 1: You can also see us on Instagram at athlete restoration code in our website.
• 20:47
  Speaker 1: You just Google us.
• 20:47
  Speaker 1: But we'd love to help.
• 20:49
  Speaker 1: So feel free to reach out whenever you need to and Always reach out for questions and we'll catch y'all next time.
• 20:54
  Speaker 1: Hey, hold up.
• 20:56
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