What does physical therapy have to do with the jaw?

The title of this post is a question I usually get in social situations whenever I tell people about my job. Physical therapy is usually associated with "torturing" post-surgical patients (apparently this is how the patients see it!), treating patients for back pain following car accidents, or providing massage therapy and ultrasound for painful muscles and joints. Since most people don't consider the jaw to be a "joint" like the shoulder, knee or elbow, this is a frequently overlooked area of rehab.

I am lucky enough to have discovered group of health care providers who value my contribution to the overall care of patients with TMD. Whereas TMJ specialists introduce the concepts of recognizing muscle tension, avoiding chronic behaviors that stress and strain the jaw joint, and stretching/strengthening the jaw, it is my job to teach patients HOW to do some of these things. Since TMD is frequently a contributor to headache and neck pain complaints, I also provide rehab for these areas of management. I find that the team approach is vital to improving patient outcomes, especially for an area with so many contributing factors to pain.

I am flattered to have been invited to contribute to this blog - I will try to contribute interesting tidbits and information to increase the available information about this condition!

Invited guest writers - The Team..

Talking about managing chronic pain is always incomplete without discussions on the need for multidisciplinary team intervention to treat pain. To reinforce this idea and to add in their thoughts about this field,  I have invited some wonderful health care professionals, I work with, to contribute to this blog. I look forward to engaging comments and discussions on the upcoming posts.

“ A marathon to run…” – Fibromyalgia and TMJ

It was a routine follow-up with Ms. G. I have seen her every three months for the past four years. Each time the interview begins with the same question: “ How are you feeling today?” "I still want to run that marathon" she said.  For Ms. G, her days are usually in shades of bad, very bad or better and having a good day was a dream she cherished, like her dream to run a 10K marathon once her health improves.

Ms. G is our everyday woman with a career and family to balance and an avid explorer of the outdoors. She loves hiking up on trails along the north shore and skiing cross-country in winter. But in the past four years, she has mostly spent her time indoor, on her recliner or in her bed, suffering in pain – in silence; and it was on one of those days spent in her recliner she dreamt of running her marathon.

Ms. G has a diagnosis of fibromyalgia.  The term was used to describe widespread pain, more as a “waste-basket” term, up until recent research has suggested it to be chronic pain condition with its own unique central mechanism (In Neuroscience, the word “central” is always indicative of having a closer relationship to brain and the neuronal networks).  Over three to six million Americans have Fibromyalgia. Sometimes, doctors feeling the pressure to have answers for every illness, try to escape the responsibility to support their patients with illness that have no answers.  Ms. G’s experience with doctors was unfortunately that for her fibromyalgia. Ms. G also had jaw pain on and off, which interestingly overlapped with her pain flare-up. Even the act of opening her mouth and eating hurt. Fibromyalgia and TMJ pain are co-morbid or conditions that can co-exist more often than others. 

So, in Ms. G’s treatment plan, there was pain management for her TMJ disorder, there was a good dose of motivation three times a day to cherish her dream and one day her discharge summary is sure to include the story of her finishing her 10K run. Until then, we look for answers and give her support so as to give her more “better” days than “bad” days.

Do you know any one who has fibromyalgia? If you do, may be we can choose to be sensitive and supportive of their pain instead of mocking and blowing it off to be mental illness.  Because, their pain is as legitimate as their dreams… as real as your dreams.  If you are some one with Fibromyalgia, do share your experiences with your comments.

 

So... do you clench?!!... Stress and TMJ

A few months ago, this is how my conversation with Ms. M began in my clinic...

"So since when has your jaw pain been a concern for you?"... She promptly retorted back."Since my 23-year-old moved back in with us."

The relationship between stress and pain has been well research and published over the years. Stress overload can result in a compromised immune system and result in poor healing and recovery from injury. Stress also affects sleep quality which in turn also prevents speedy recovery from physical ailments. So, here is the analogy I used to explain this to Ms. M or for that matter to many of my patients in similar situations... Our present day stress response mechanism is an highly evolved version of its primitive past in our prehistoric ancestors... Our cave dwelling ancestors, when under stress, like while facing a grizzly bear in the wild, their stress response kicked in, their eyes dilated, ears perked up and their arms flexed to fight or flight from danger. This does not happen as a clearly thought out process, they do not think to themselves "Okay, so now I dilate both my eyes and flex the biceps and elevate my pulse rate!" No, this just happens. Just like that, today, when we face danger, our muscles tense up, flex and we tense and clench by reflex, this is our natural protective survival reflex. Thankfully our stressors are not usually as grave as the grizzly bear but they come pretty close to it... like the recent financial turmoil in our society, or like in Ms. M's case, the 23-year-old that moved back in!! The key is to not fight the stressor but learn and build skills to respond to stressors appropriately so as to not hurt ourselves in the process: to systematically learn to unclench and relax as and when stressors affect us. So, for Ms. M the treatment plan included stress management strategies along side pain management strategies. She even got a mouthguard for her symptoms...I know!.. mouth-guards! I'll talk about those in my upcoming post. Meanwhile, you may be interested in knowing during my recent follow-up with Ms. M she mentioned that her 23-year-old has found a job and is planning to move- to Afghanistan as he had enlisted for the Army- and she had thought that the move-in was stressful!! Anyways, so what makes you clench? Is it the rush our traffic? Is it the neighbor's dog that barked all night? Please share your thoughts and comments!!!

..with an intent to treat..

Being a dentist pain clinician in the mid-west, I have the opportunity to help and guide several of my patients suffering in silence with their TMJ disorders. It amazes me how,even in this day and age of technology and internet there is so much resistance in acknowledging these disorders even within the medical community. This I believe has paved the way to loads of non-standardized, non-authenticated misinformation that is out there about TMJ disorders. With this blog, I'm hoping to provide my friends and readers in this community, some support, some answers about TMJ disorders and do so in an evidence based manner.  With this blog, I'm hoping to provide a reliable resource for people in pain as well as those who are seeking answers for their loved ones in pain.