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Temporomandibular Joint (TMJ) Disorder

What is the TMJ?

The temporomandibular joint is a hinge joint that connects your mandible (jaw) with the temporal bones of your skull which sit in front of your ear. It allows you to move your jaw side to side and up and down so as you can eat, talk and yawn. Pain caused by the TMJ is referred to as TMJ disorder.

What are the symptoms of TMJ Disorder?

  • Pain or tenderness of your jaw
  • Aching pain in and around your ear including ringing sounds in the ears (tinnitus)
  • Neck or shoulder pain
  • Headaches
  • Blurred vision
  • Difficulty opening/closing mouth, e.g. difficulty chewing
  • Clicking/popping sensation
  • Swelling on side of your face
  • Jaws that get stuck/locked in an open or closed mouth position

What are the causes?

  • Acute injury to your jaw
  • Arthritis in the joint
  • Displaced disc
  • Poor posture
  • Long term chronic grinding (bruxism) or clenching of teeth
  • Malocclusion – teeth that don’t fit together properly
  • Stress
  • Higher risk in females aged 20-40years

How is it Disorder diagnosed?

Your physiotherapist will first take a thorough history and conduct a physical exam to rule out other conditions and correctly diagnose TMJ Disorder. This examination may include:

  • Palpation of the joint and surrounding muscles
  • Observation of posture, jaw deviation
  • TMJ movements, taking note of any clicking, pain, popping that may occur
  • Assessment of neck/shoulder to rule out other potential conditions
  • Referral for an x-ray if an acute injury or occasionally for an MRI to rule out any other medical problems
  • Referral to dentist/orthodontist to exclude any dental causes

How is TMJ Disorder treated?

Address contributing factors

  • Avoid excessive chewing – where possible try to eat a soft diet to avoid foods that are difficult to chew, avoid chewing gum and biting fingernails
  • Correct posture
  • Relaxation techniques to manage stress and ease muscle tension
  • Avoid pressure on your TMJ, e.g. avoid lying on your painful TMJ during sleep or resting your chin in your hand
  • Avoid extreme jaw movements
  • Keep your jaw in a relaxed position with your teeth slightly apart to avoid clenching/grinding your teeth

 

Manual Therapy

  • Massage of muscles around the joint including masseter and temporalis
  • TMJ mobilisations to relieve stiffness
  • Addressing any issues within the neck/shoulder region

Exercises

  • Postural correction exercises
  • Gentle stretching exercises
  • Strengthening exercises of the muscles that act on the joint
  • Exercises to address issues within the neck/shoulder region

Other pain management techniques

  • Ice packs can be placed on the jaw for up to 15minutes at a time
  • Over the counter anti-inflammatory medications
  • Self massage

Referral

  • Referral to an orthodontist/dentist for an oral splint or night mouth guard to hold your jaw in a more relaxed position, correct your bite by putting your teeth position and reduce the effects of clenching/grinding. Your dentist may also wish to perform other treatments.
  • Very severe cases may require surgical opinion

What is the prognosis for TMJ Disorder?

Most cases of TMJ Disorder respond really well to conservative management. Less than 1% of cases require surgery.

Book an appointment today for your assessment!

Blog By Kara Giannone (Physiotherapist)

Concussion

Louise represented in the hurling team in the world championship in Dublin this year gives us her insight about concussion.

concussion

A hot topic at present in the media/ world front as more and more concussions especially in playing sport are coming to the fore and evidence & management/ views are changing to not take this matter lightly. As a sufferer of a few concussions in the past I know exactly how it can affect you in the long run if not treated effectively and respectfully when first occurs. After all your brain is the most important part of your body, it is the control centre for everything else. Treat it with respect.

So what is a Concussion or Acquired Brain Injury (ABI), it is a temporary unconsciousness or confusion & other symptoms caused by a blow to the head.

Another definition is a brain injury and is defined as a complex physiological process affecting the brain, induced by biomechanical forces.

Maybe caused by direct or indirect blow to the head/ face/ neck or body causing an impulsive force transmitted through to the head.

Symptoms including

  • Short period of unconsciousness
  • Confusion
  • Dizziness
  • Amnesia/ Loss of memory
  • Persistent headaches
  • Nausea/ vomiting
  • Blurred vision
  • Sensitivity to light and noise
  • Feeling foggy/heaviness in the head
  • Neck pain
  • Fatigue/ low energy

concussion2

Anyone with a suspected Concussion should immediately be removed from play in sport, and should not return to activity until assessed fully by a medical professional. They should not be left alone and should not drive/operate any machinery. A SCAT2 or 3 (Sports Concussion Assessment Tool) form should be carried out immediately post-concussion and furthermore to assess recovery to return to sport adequately.

 

concussion3

Managed return to work/ school and or sport should be approached with a professional practitioner and not to be rushed back into a hectic daily lifestyle. Take rests periods regularly and limit your exertion. Cognitive function as well as the physical function should be assessed during return to activities. Studies are now coming to the forefront that individuals who continue to play on after receiving a concussion, DOUBLE the recovery time.

concussion4

Personally a sufferer of post-concussion syndrome/ injury I know firsthand how individuals can feel and the affects it can have on a person’s whole life. Protect your head wear a helmet in sport such as cycling, snow sports etc. For any further assistance with concussions please contact the Total Physiocare for an appointment!

Blog by Louise Holland (Physiotherapist)

Cervicogenic Headaches

Cervicogenic headaches are headaches that originate from the cervical spine (neck). Patients with this condition usually experience a gradual onset of head and neck pain associated with a sustained posture or causative movement. Pain is typically experienced on one side of the head, usually at the back of the head, but it may radiate over the temple or behind the eye and spread to both sides of the head.

Most patients will experience tenderness upon palpation of their upper neck joints and tenderness through the surrounding muscles.
Cervicogenic headaches are often accompanied by stiffness and pain in their neck, particularly in the upper three vertebrae. Some patients may also experience associated pain, pins and needles or numbness radiating into their upper back, shoulders or arms.

Contributing Factors:

There are many factors that may cause patients to experience cervicogenic headaches. Your physiotherapist will thoroughly assess and help you to address these factors. Such factors may include:
• Poor sitting posture, excess slouching and rounded shoulders.
• Inappropriate desk set up
• Poor lifting technique or poor workplace ergonomics
• Previous history of whiplash injury
• Poor sleeping posture or inappropriate mattress/pillow
• Muscle imbalances
• Muscle weakness
• Muscle tightness
• Neck and upper back stiffness
• Increase in stress

Diagnosis:

In most cases a thorough clinical history and physical examination by your physiotherapist will be sufficient to diagnose cervicogenic headaches. In some cases your physiotherapist or GP may request an MRI, X-Ray or CT scan to confirm the diagnosis. Specialists and surgeons may also request a diagnostic nerve or joint block in some cases, where pain is chronic and does not respond to conservative.

Treatment:

Treatment for cervicogenic headache is multi-faceted and will depend on each individual’s contributing factors. Treatments often will include:
• Postural re-education including exercises, taping and/or bracing
• Clinical pilates
• Exercises to strengthen postural muscles, improve flexibility and strengthen the deep cervical neck flexors
• Soft tissue work and trigger point therapy
• Joint mobilisation or manipulation
• Dry needling
• Ergonomic advice
• Recommendation of appropriate pillow and sleeping posture
• Advice regarding analgesia and referral to pharmacist or GP where appropriate

Prognosis:

Most patients who experience cervicogenic headache will make a full recovery with appropriate physiotherapy intervention. Rate of recovery may vary depending on severity of pain, how long it has been happening, and compliance to treatment. In the case of acute cervicogenic headache you should experience relief in symptoms within a few days, although pain may take several weeks to resolve completely. More chronic pain will generally take longer to resolve and may take weeks to months.

In the event that despite appropriate physiotherapy management symptoms remain persistent,  your physiotherapist may suggest referral to a specialist who can offer other treatments including injections and in some cases, surgery.

Feel free to contact our clinics to help relieve some of your neck pain.

Blog by Claire De Vos.