Welcome to Advance Physical Therapy, Inc. Newsletter

It's amazing how the year is passing by. Summer is coming to an end and Fall is just around the corner. We had the opportunity to travel to Seattle earlier this month to attend our annual orthopedic manual therapy conference through the Ola Grimbsy Institute. Renowned master clinicians were among colleagues presenting latest research, techniques and assessment tools in physical therapy. One particular clinician, Mariano Rocabado, DPT, OMT is internationally recognized as the leading authority in assessment and treatment of craniomandibular disorders (TMJ). His presentation not only affirmed everything that we currently do in the clinic to treat our TMJ patients but that successful treatment intervention is actually teaching prevention from the development of TMJ disorders.

Often times, we are more reactive to an injury. A chronic problem almost needs to get worse before we are called to action. Being more proactive about preventing injury, eating and exercising right with good habits and not stressing too much goes a long way.

In this newsletter, we like to revisit the temporomandibular joint (TMJ) and share some insight on how to prevent and treat it since TMJ has an incidence of affecting 75% of us at some point in our lifetime.

To your health,

Advance Physical Therapy, Inc.
Do TMJ Disorders Affect Stress Levels, Headaches & Neck Pain?


How well do you know your dentist? Fairly well? Chances are, even though your dentist has hundreds of patients, he or she probably understands more about your health than you realize. The condition of your teeth and bite may tip him off that you are possibly grinding your teeth at night or during the day (bruxism). He may notice a change in the way the upper and lower teeth fit together. As well, if you don't tolerate keeping your mouth open very long for an exam or cleaning, he may tell you that you have a temporomandibular disorder (TMD). Other symptoms you may notice are:

  • radiating pain in the face, jaw, or neck,
  • jaw muscle stiffness, soreness, achiness
  • limited movement or locking of the jaw,
  • painful clicking, popping or grating in the jaw joint when opening or closing the mouth
The temporomandibular joint (TMJ) is the junction of the skull and the lower jaw, or mandible (see the diagram). The muscles that allow us to chew, swallow, and talk attach the mandible to the skull. The skull's position affects the proper position and function of the TMJ. The nerves that control these muscles are one of 12 nerves that originate in the brain. The skull's position is determined by the first two neck vertebrae, called the atlas and the axis. Nerve endings that pick up sensation from the upper neck mingle with the nerves that are going to and from the chewing muscles. In this way, problems with movement and position of the upper neck can cause jaw pain and vice versa. Your dentist and your physical therapist may even understand the cause of those persistent headaches.

Primary headaches
A primary headache is caused by problems with over-activity of pain-sensitive structures in your head. They are better known as "cluster," "tension," or "migraines." They are not caused by an underlying disease or problem.

Secondary headaches
Secondary headaches are caused by an underlying disease that can sensitize the nerves in your head. There are hundreds of examples, such as acute sinusitis, concussion and a hangover.

Many of the people we see in physical therapy have cervicogenic headaches, another type of secondary headache. Degenerative joints in the neck, or osteoarthritis is the causative factor. This common problem can often occur in our TMD population. In fact, we know that the nerves that carry pain (sensation) from the chewing muscles mingling with the nerves that carry pain impulses from the neck joints. Because of this, almost all of our TMD and headache patients receive treatment to address the restricted movement of their cervical joints. This confluence of nerves occurs in an area of the brain associated with certain types of migraines. It's not unusual for our migraine-suffering patients to experience relief with manual therapy, neck exercises and postural reeducation.

Contributing Factors to TMD and Headaches

Certain lifestyle factors can make migraines and other primary headaches more likely. They include stress, lack of sleep (which often occur together), poor posture and alcohol. In physical therapy, our patients train their postural muscles so they can begin to position themselves better for seated work and driving. They are also taught how to manage stress better through proper breathing, relaxation exercises and postural stabilization exercises.

At Advance Physical Therapy, Inc., treating TMJ that are associated with headaches, migraines and neck pain involves a team approach with your dentist. We are committed to finding all causes of your TMJ/headache pain by implementing the most detailed and comprehensive evaluation and treatment plan necessary to address this dysfunction.
Physical Therapy Treatment for TMJ Disorders

We treat many patients with complaints associated with temporomandibular disorder (TMJ or TMD). Symptoms can include jaw and facial pain/tension, jaw cracking and popping, ear pain, toothaches, neck pain , headaches and migraines. The challenge to treating TMJ effectively starts with determining the causes of TMJ that can affect jaw alignment, bite, chewing, swallowing, talking, opening and/or yawning. Approximately 80 million people in the U.S. are afflicted with these symptoms and the bottom line is that we can not take our jaws for granted! 

The key factor to treating the TMJ successfully is prevention. Knowing the proper prevention strategies and applying them on a daily basis can, in fact, minimize this disorder from becoming a real problem. Seeking early intervention when you notice symptoms developing, can be more easily treated than a chronic TMJ condition that has been active for months or even years. It's important to consult with your physical therapist and dentist early on when you sense that you may have TMJ symptoms. If you are consulting your primary care physician, ask to be referred to a physical therapist that specializes in TMJ treatment or consult with your dentist who can provide you with referrals to the appropriate physical therapists.

So are there things that you can do at home that will help relieve your facial or TMD pain?
Definitely. There are many things you can do to reduce headaches and the constant muscle fatigue and stress on the face and jaw joints.
  • Avoid jutting your jaw forward - for example, when concentrating, staring at the computer, during conversation etc.
  • Make every effort not to strain the ligaments of the jaw unnecessarily - such as clinching while working.
  • Do not eat foods that require prolonged or excessive chewing such popcorn, bread crusts, gum, or tough meat.
  • Cut all foods into smaller pieces - avoid opening your mouth wide.
  • Avoid pressure on your jaw during sleep. Sleep on your back if possible or, when on your side do not sleep with your arm or pillow under your jaw.
  • Pay attention to your posture if you spend a lot of time sitting at your desk in front of a computer, and take frequent breaks to relieve stressed muscles.
  • Implement a postural (head, neck, shoulder and back) strengthening exercise program
Our physical therapy treatment for the TMJ first starts with a thorough examination to determine the triggers that causes TMJ symptoms that perpetuate a viscous pain-tension-headache cycle.  We often find it necessary to gently mobilize the jaw joint to create space or decompress the joint so that the jaw can open and close smoother. The neck (cervical spine) and upper back (thoracic spine) may also need to be adjusted with soft tissue and joint mobilization implemented towards regaining better postural alignment. This is extremely important since the head, neck and jaw depends on being stacked upright with proper postural alignment to minimize all muscle strain and tension in the jaw, neck and shoulders. Stretching and strengthening exercises for the jaw, neck, shoulders and back are implemented to retrain muscles and joints to hold in new positions from which the TMJ can work best. Stabilizing exercises for the TMJ opening and closing muscles are also necessary, since these muscles need to learn how to coordinate movement for chewing, opening/closing and talking. All treatment is tailored specifically for each person's unique presentation since no two TMJ disorders are the same.

It is important to find a practitioner that specializes in TMJ treatment in order to ensure a comprehensive assessment necessary to treat TMJ effectively.  At Advance Physical Therapy, Inc., our clinicians will provide you the care necessary to treat the cause and symptoms of this disorder and assist you towards restoring a more pain-free quality of life.

If we can answer any questions or field any topics of interest regarding  physical therapy, health and wellness or about our programs, please contact us. We'd love to hear from you.
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2944 Broadway Street                         1208 E. Arques Avenue Suite #105
Redwood City, CA 94062                     Sunnyvale, CA 94085

(W) 650.261.0330                                 (W) 408.720.8225
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