About 1/3 of the population suffer from musculo–skeletal problems and imbalances. Frequently these problems can cause pain. Most of us know of people with chronic pain headaches, back aches or neck pain and migraines
Usually, people see chiropractors or osteopaths for the spinal issues. They may see a dentist for the headaches. Commonly, people self medicate with Nurofen to manage pain. People often report that their back is okay if they have weekly adjustments. If they stop, they regress as the adjustments ‘do not hold’.
With chronic pain, the part that hurts is rarely the cause of the pain eg: if you have a sore right foot you transfer weight to the left foot and soon it will become the sorest foot (with over use). The real cause of the pain therefore is the opposite foot to that which you complain about. The usual scenario is that the practitioner treats the area you complain about. That works with acute pain eg, abscessed tooth or broken finger. It rarely works with chronic pain or conditions as the part that hurts is not the cause (but a symptom).
Approximately 30% of people with head, neck and low back pain have the cause in the Temporo–mandibular joint (TMJ) just in front of your ear. If this is the cause we can treat it. If it is a symptom, we refer to the practitioner most qualified to treat the primary cause, so the right practitioner treats the right area and success is therefore greater.
The usual sequence of events (in TMJ cases) is that the person clenches or grinds and develops painful jaw joints. To protect the joints they unconsciously move their chin forward and adopt a forward head position. The top of the back of the neck is constricted and this can refer pain to the forehead i.e.: frontal headaches.
Simultaneously the distortions in the neck create compensating shifts in the shoulders, spine and lower back and the problem spreads i.e. we have a cause for the low back pain that is a long way from the low back. This is why treatment aimed at the low back pain often only temporarily “holds” as only the symptoms are being treated.
If we wish to treat such a TMJ initiated case, we would place appliances such as splints to decompress the joints and protect them (especially during sleep). Often the forward head position can then resolve in days, but it commonly takes a week or two.
The TMJ is no longer the cause, now the compensation e.g. tilted shoulders or the low back can now unravel, and chiropractors, osteopaths or physiotherapists skilled in the sacro-occipital technique can help heal and “unstick” any recalcitrant areas.
We keep testing and treating the ever more minor compensations and if properly done the treatment holds.
If you tend to be a mouth breather, you may have some sort of nasal obstruction from allergies or a deviated septum. This, too, may aggravate your TMJ syndrome and needs to be addressed. I recommend that my patients see their GP for evaluation and treatment, get a sleep study for sleep apnea, and/or see an ENT specialist to resolve any potential nasal or tonsil obstruction
The pain in the TMJ is from tissue trauma and inflammation. When the head moves forward, nerves in the neck are traumatised and become inflamed.
When this is prolonged (as in chronic pain) the nerves becomes sensitized and at a certain point the system goes into Reflex Sympathetic Dystrophy (fight or flight mode). The symptoms here are broad but routinely you may experience cold hands and feet, dilated pupils (do not like glare), stomach upsets and adrenal overload as your system is overloaded with adrenal stress hormones such as cortisol, which disrupts sleep.
However, if we can treat the cause that initiates the structural imbalances, (forward head position and spinal compensations) and reduce inflammation of the nervous system, people can get some rest. Their ability to cope with stress (adaptive range) increases. Frequently sleep improves. Correct jaw positioning and the consequent changes in the position of the cranial bones can improve nasal and pharyngeal airways. This can improve snoring and sleep apnoea issues.
