Temporomandibular Joint Disorder

Temporomandibular Joint Disorder

Does it hurt when you chew, open wide to yawn or use your jaws? Do you have pain or soreness in front of the ear, in the jaw muscle, cheek, the teeth or the temples? Do you have pain or soreness in your teeth? Do your jaws make noises loud enough to bother you or others? Do you find it difficult to open your mouth wide? Does your jaw ever get stuck/locked as you open it?

If you answered “yes” to some of these questions, you may have a temporomandibular joint disorder, or TMD. TMD is a group of conditions, often painful, that affect the jaw joint.

Signs may include:

• Radiating pain in the face, neck, or shoulders;
• Limited movement or locking of the jaw;
• Painful clicking or grating when opening or closing the mouth;
• A significant change in the way the upper and lower teeth fit together;
• Headaches, earaches, dizziness, hearing problems and difficulty swallowing.
For most people, pain or discomfort in the jaw muscles or joints is temporary, often occurs in cycles, and resolves once you stop moving the area. Some people with TMD pain, however, can develop chronic symptoms. Your doctor of chiropractic can help you establish whether your pain is due to TMD and can provide conservative treatment if needed.
What Causes TMD?
Researchers agree that TMD falls into three categories:
• Myofascial pain—discomfort or pain in the muscles of the jaw, neck, and shoulders;
• A dislocated jaw or displaced disc;
• Degenerative joint disease—rheumatoid arthritis or osteoarthritis in the jaw joint.

Severe injury to the jaw is a leading cause of TMD. For example, anything from a hit in the jaw during a sporting activity to overuse syndromes, such as chewing gum excessively or chewing on one side of the mouth too frequently, may cause TMD.

Both physical and emotional stress can lead to TMD, as well. The once-common practice of sitting in a dentist's chair for several hours with the mouth wide open may have contributed to TMD in the past. Now, most dentists are aware that this is harmful to the jaw. In addition to taking breaks while they do dental work, today’s dentists also screen patients for any weaknesses in the jaw structure that would make physical injury likely if they keep their mouths open very long. In that case, they may use medications during the procedure to minimize the injury potential, or they may send the patient to physical therapy immediately after treatment. In less severe cases, they instruct patients in exercises they can do at home to loosen up the joint after the visit.

While emotional stress itself is not usually a cause of TMD, the way stress shows up in the body can be. When people are under psychological stress, they may clench their teeth, which can be a major factor in their TMD.
Some conditions once accepted as causes of TMD have been dismissed—moderate gum chewing, non-painful jaw clicking, orthodontic treatment (when it does not involve the prolonged opening of the mouth, as mentioned above), and upper and lower jaws that have never fit together well. Popular theory now holds that while these may be triggers, they are not causes.

Women experience TMD four times as often as men. Several factors may contribute to this higher ratio, posture and higher heels.

TMD Diagnosis and Treatment

To help diagnose or rule out TMD, your doctor of chiropractic (DC) may ask you to put three fingers in your mouth and bite down on them. You may also be asked to open and close your mouth and chew repeatedly while the doctor monitors the dimensions of the jaw joint and the balance of the muscles. If you have no problems while doing these things, then the problem is not likely to be TMD. Your DC can then look for signs of inflammation and abnormalities. Sometimes special imaging, an x-ray or an MRI may be needed to help confirm the diagnosis.

If you have TMD, your doctor may recommend chiropractic manipulation, massage, applying heat/ice and special exercises. In most cases, your doctor’s first goal is to relieve symptoms, particularly pain. If your doctor of chiropractic feels that you need special appliances or splints (with the exception of the “waterpack” and other guards against teeth grinding), he or she will refer you to a dentist or orthodontist for co-management.

In addition to treatment, your doctor of chiropractic can teach you how to:

• Apply heat and ice to lessen the pain. Ice is recommended shortly after the injury or after your pain has started. In the later stages of healing, you need to switch to heat, especially if you are still experiencing discomfort.
• Avoid harmful joint movements. For example, chomping into a hard apple is just as bad as crunching into hard candy (some hard candies are even called “jawbreakers”—for good reason). And giant sandwiches can cause the mouth to open too wide and have a destabilizing effect on the jaw.
• Perform TMD-specific exercises. Depending on your condition, your DC may recommend stretching or strengthening exercises. Stretching helps to loosen tight muscles and strengthening helps to tighten muscles that have become loose. Special feedback sensors in the jaw can be retrained, as well, if needed.


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How to Select Athletic Shoes

How to Select Athletic Shoes

Too many people choose fashion over function when purchasing athletic shoes, not realizing that poor-fitting shoes can lead to pain throughout the body. Because footwear plays such an important role in the function of bones and joints—especially for runners and other athletes—choosing the right shoe can help prevent pain in your back, hips, knees, and feet.

Unfortunately, there is no such thing as the very best athletic shoe—every pair of feet is different, every shoe has different features, and overall comfort is a very personal decision. For this reason, it is recommended that you first determine your foot type: normal, flat, or high-arched.

The Normal Foot

Normal feet have a normal-sized arch and will leave a wet footprint that has a flare, but shows the forefoot and heel connected by a broad band. A normal foot lands on the outside of the heel and rolls slightly inward to absorb shock.
Best shoes: Stability shoes with a slightly curved shape.

The Flat Foot

This type of foot has a low arch and leaves a print that looks like the whole sole of the foot. It usually indicates an over-pronated foot—one that strikes on the outside of the heel and rolls excessively inward (pronates). Over time, this can cause overuse injuries.
Best shoes: Motion-control shoes or high-stability shoes with firm midsoles. These shoes should be fairly resistant to twisting or bending. Stay away from highly cushioned, highly curved shoes, which lack stability features.

The High-Arched Foot

The high-arched foot leaves a print showing a very narrow band—or no band at all—between the forefoot and the heel. A curved, highly arched foot is generally supinated or under-pronated. Because the foot doesn’t pronate enough, usually it’s not an effective shock absorber.
Best shoes: Cushioned shoes with plenty of flexibility to encourage foot motion. Stay away from motion-control or stability shoes, which reduce foot mobility.

When determining your foot type, consult with your doctor of chiropractic. He or she can help determine your specific foot type, assess your gait, and then suggest the best shoe match.


Shoe Purchasing Tips
Consider the following tips before you purchase your next pair of athletic shoes:

• Match the shoe to the activity. Select a shoe specific for the sport in which you will participate. Running shoes are primarily made to absorb shock as the heel strikes the ground. In contrast, tennis shoes provide more side-to-side stability. Walking shoes allow the foot to roll and push off naturally during walking, and they usually have a fairly rigid arch, a well-cushioned sole, and a stiff heel support for stability.
• If possible, shop at a specialty store. It’s best to shop at a store that specializes in athletic shoes. Employees at these stores are often trained to recommend a shoe that best matches your foot type (shown above) and stride pattern.
• Shop late in the day. If possible, shop for shoes at the end of the day or after a workout when your feet are generally at their largest. Wear the type of socks you usually wear during exercise, and if you use orthotic devices for postural support, make sure you wear them when trying on shoes.
• Have your feet measured every time. It’s important to have the length and width of both feet measured every time you shop for shoes, since foot size often changes with age and most people have 1 foot that is larger than the other. Also, many podiatrists suggest that you measure your foot while standing in a weight bearing position because the foot elongates and flattens when you stand, affecting the measurement and the fit of the shoe.
• Make sure the shoe fits correctly. Choose shoes for their fit, not by the size you’ve worn in the past. The shoe should fit with an index finger’s width between the end of the shoe and the longest toe. The toe box should have adequate room and not feel tight. The heel of your foot should fit snugly against the back of the shoe without sliding up or down as you walk or run. If possible, keep the shoe on for 10 minutes to make sure it remains comfortable.

How Long Do Shoes Last?

Once you have purchased a pair of athletic shoes, don’t run them into the ground. While estimates vary as to when the best time to replace old shoes is, most experts agree that between 300 and 500 miles is optimal. In fact, most shoes should be replaced even before they begin to show signs of moderate wear. Once shoes show wear, especially in the cushioning layer called the midsole, they also begin to lose their shock absorption. Failure to replace worn shoes is a common cause of injuries like shin splints, heel spurs, and plantar fasciitis.

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Stress on the Job

Stress on the Job

Stress has been called the spice of life, the common cold of the psyche, and even a socially acceptable form of mental illness. No doubt, stress can be beneficial—for example, a deadline can help us focus and become more alert and efficient. Persistent or excessive stress, however, can undermine performance and make us vulnerable to health problems, from cancer and heart disease to substance abuse and obesity.

Stress is a physical and mental response to the difference between our expectations and our personal experience, real or imaginary. While reacting to stress, the body goes through alarm, resistance, and exhaustion. Released hormone epinephrine, or adrenaline, prepares the body for physical action (“fight or flight”) by increasing heart rate, blood pressure, and blood glucose levels. Then, the body releases glucocorticoid cortisol, or hydrocortisone, producing anti-inflammatory and immunosuppressing effects.

Consequences of Chronic Stress
Although occasional stress can be of benefit, too much stress is taxing on the body. Excessive levels of glucocorticoids can hinder growth, delay wound healing, and increase risk of infection. Chronic stressors—or their constant anticipation—can make us believe that we must always be on guard, leading to anxiety. Feelings of hopelessness or avoiding solving our problems can spark depression.

Past or present psychological distress can also lead to pain, particularly low-back pain, which often comes with leg pain, headaches, sleep problems, anxiety, and depression. Stress may even be a more powerful pain generator than strenuous physical activity or repetitive motion. Research shows, for example, that pain in adolescents is associated with depression and stress, but not with computer use or physical activity.

Stress is highly individual and depends on our circumstances. For example, we react to stress better if we can vent our frustrations, feel in control, hope that things will change for the better, and get social support.

Gender also determines how we handle stress. Women are easily stressed by household problems, conflicts with people, or illness in people they know. Men get more significantly affected by job loss, legal problems, and work-related issues. Men are also more likely to get depressed over divorce or separation and work problems. Depression in women, however, is more likely to spring from interpersonal conflicts or low social support, particularly from family.

Stress on the Job

The workplace has become a major stressor, contributing to the risk of hypertension and heart disease. Recent studies have shown, however, that what stresses us out is not so much the job demands, but our attitude toward them. For example, people who react with anger to their high job strain or who are worried about their chronic work overload have much higher morning corsisol levels. Lack of a sense of control over a job is also associated with higher blood pressure, especially in women and in people with higher socioeconomic status.

Stress Relief Is Important

No matter what stresses you out, consider taking active steps to change your attitude toward stress and to reduce stress in your life. For suggestions on stress relief, please call Chiropractic Care

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Stress Relief

Stress Relief

Stress has become a fact of life, and for some, the daily norm. Although occasional stress can help improve our focus and performance, living with chronic stress can backfire by causing anxiety, depression, and serious health problems.

Understanding who we are, knowing our major struggles, putting them in perspective, and taking action can help us deal with stress. The following strategies can also improve stress tolerance and help lessen the effects of stress on our health.

Think Positively

“Adopting the right attitude can convert a negative stress into positive,” said Hans Selye, author of the groundbreaking work around stress theory. When optimism is hard to muster, cognitive-behavioral therapy, which trains people to recognize negative thinking patterns and replace them with more constructive ones, can also help reduce the risk of chronic stress and depression.

Get Out and Enjoy Nature

While modern civilization has made our lives more convenient, it has deprived us of an essential source of stress relief—connection with nature. Studies show that interacting with nature can help lessen the effects of stress on the nervous system, reduce attention deficits, decrease aggression, and enhance spiritual well-being.

“Smell the Roses” for Better Mood

Aromatherapy, or smelling essential plant oils, recognized worldwide as a complementary therapy for managing chronic pain, depression, anxiety, insomnia, and stress-related disorders, can help you unwind. Orange and lavender scents, in particular, have been shown to enhance relaxation and reduce anxiety.

Relax with a Cup of Tea

During stressful times, coffee helps us keep going. To give yourself a break, however, consider drinking tea. Research shows that drinking tea for 6 weeks helps lower post-stress cortisol and increase relaxation. Habitual tea drinking may also reduce inflammation, potentially benefiting your heart health.

Laugh It Off

Humor relieves stress and anxiety and prevents depression, helping put our troubles in perspective. Laughter can help boost the immune system, increase pain tolerance, enhance mood and creativity, and lower blood pressure, potentially improving treatment outcomes for many health problems, including cancer and HIV. Humor may also be related to happiness, which has been linked to high self-esteem, extroversion, and feeling in control.

Build a Support System

Relationships are also key to health and happiness, especially for women. Women with low social support, for example, are more likely to increase blood pressure under stress. Loneliness may also contribute to stress in both men and women, also leading to poorer outcomes after a stroke or congestive heart failure. On the other hand, active and socially involved seniors are at lower risk for dementia and Alzheimer’s disease. Social support also helps cancer patients to boost the immune system and maintain a higher quality of life.

Employ the Relaxing Power of Music

Music, especially classical, can also serve as a powerful stress-relief tool. Listening to Pachelbel’s famous Canon in D major while preparing a public speech helps avoid anxiety, heart rate, and blood pressure, which usually accompany public speaking.

Singing and listening to music can also relieve pain and reduce anxiety and depression caused by lowback pain. Group drumming also showed positive effects on stress relief and the immune system. Music therapy can also elevate mood and positively affect the immune system in cancer patients and reduce fatigue and improve self-acceptance in people with multiple sclerosis.

To help people deal with stressful medical procedures, music can help reduce anxiety before surgery. When played during surgery, it can decrease the patient’s post-operative pain. Aiding recovery, a dose of calming music may lower anxiety, pain, and the need for painkillers.

Calm Your Mind

In recent decades, many forms of meditation have gained popularity as relaxation and pain relief tools. Focusing on our breath, looking at a candle, or practicing a non-judgmental awareness of our thoughts and actions can help tune out distractions, reduce anxiety and depression, and accept our circumstances. In cancer patients, meditation-based stress reduction enhances quality of life, lowers stress symptoms, and potentially benefits the immune system.

Guided imagery, such as visualizing pictures prompted by an audiotape recording, also shows promise in stress relief and pain reduction. Based on the idea that the mind can affect the body, guided imagery can be a useful adjunct to cancer therapy, focusing patients on positive images to help heal their bodies.

Enjoy the Warmth of Human Touch

Just as the mind can affect the body, the body can influence the mind. Virginia Satir, a famous American psychotherapist, once said that people need 4 hugs a day to help prevent depression, 8 for psychological stability, and 12 for growth. While asking for hugs may not work for some, massage can help us relieve stress and reduce anxiety and depression. Massage has also been shown to reduce aggression and hostility in violent adolescents, to improve mood and behavior in students with ADHD, and to lead to better sleep and behavior in children with autism.

Massage has other therapeutic properties, as well. Regular massage may reduce blood pressure in people with hypertension and may lead to less pain, depression, and anxiety and better sleep in patients with chronic low-back pain. Compared to relaxation, massage therapy also causes greater reduction in depression and anger, and more significant effects on the immune system in breast cancer patients.

Give Exercise a Shot

To get the best of both worlds, affecting the mind through the body while getting into good physical shape, try exercise. In one study, a group of lung cancer patients increased their hope due to exercise. Exercise can also reduce depression and improve wound healing in the elderly. Tai chi, which works for people of all ages, may enhance heart and lung function, improve balance and posture, and prevent falls, while reducing stress.

No matter what stress-relief methods you choose, make it a habit to use them—especially if you feel too stressed out to do it. As someone once said, the time to relax is when you don’t have time for it.

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Chronic Pain and Depression

Pain serves an important function in our lives. When you suffer an acute injury, pain warns you to stop the activity that is causing the injury and tells you to take care of the affected body part.

Chronic pain, on the other hand, persists for weeks, months, or even years. Some people, often older adults, suffer from chronic pain without any definable past injury or signs of body damage. Common chronic pain can be caused by headaches, the low back, and arthritis. Unfortunately, there is scant objective evidence or physical findings to explain such pain.

Until recently, some doctors who could not find a physical cause for a person’s pain simply suggested that it was imaginary— “all in your head.” This is unfortunate because we know that all pain is real and not imagined, except in the most extreme cases of psychosis. Emerging scientific evidence is demonstrating that the nerves in the spinal cord of patients with chronic pain undergo structural changes.

Psychological and social issues often amplify the effects of chronic pain. For example, people with chronic pain frequently report a wide range of limitations in family and social roles, such as the inability to perform household or workplace chores, take care of children, or engage in leisure activities. In turn, spouses, children, and co-workers often have to take over these responsibilities. Such changes often lead to depression, agitation, resentment, and anger for the pain patient and to stress and strain in family and other social relationships.

How is depression involved with chronic pain?

Depression is the most common emotion associated with chronic pain. It is thought to be 3 to 4 times more common in people with chronic pain than in the general population. In addition, 30 to 80% of people with chronic pain will have some type of depression. The combination of chronic pain and depression is often associated with greater disability than either depression or chronic pain alone.
People with chronic pain and depression suffer dramatic changes in their physical, mental, and social well-being—and in their quality of life. Such people often find it difficult to sleep, are easily agitated, cannot perform their normal activities of daily living, cannot concentrate, and are often unable to perform their duties at work. This constellation of disabilities starts a vicious cycle—pain leads to more depression, which leads to more chronic pain. In some cases, the depression occurs before the pain.
Until recently, we believed that bed rest after an injury was important for recovery. This has likely resulted in many chronic pain syndromes. Avoiding performing activities that a person believes will cause pain only makes his or her condition worse in many cases.

Signs and Symptoms

Some of the common signs and symptoms of chronic pain include:
• Pain beyond 6 months after an injury
• Allodynia—pain from stimuli which are not normally painful and/or pain that occurs other than in the stimulated area
• Hyperpathia—increased pain from stimuli that are normally painful
• Hypersensation—being overly sensitive to pain
Signs of major clinical depression will occur daily for 2 weeks or more, and often include many of the following:
• A predominant feeling of sadness; feeling blue, hopeless, or irritable, often with crying spells
• Changes in appetite or weight (loss or gain) and/or sleep (too much or too little
• Poor concentration or memory
• Feeling restless or fatigued
• Loss of interest or pleasure in usual activities, including sex
• Feeling of worthlessness and/or guilt

What is the treatment for chronic pain and depression?

The first step in coping with chronic pain is to determine its cause, if possible. Addressing the problem will help the pain subside. In other cases, especially when the pain is chronic, you should try to keep the chronic pain from being the entire focus of your life.
• Stay active and do not avoid activities that cause pain simply because they cause pain. The amount and type of activity should be directed by your doctor, so that activities that might actually cause more harm are avoided.
• Relaxation training, hypnosis, biofeedback, and guided imagery, can help you cope with chronic pain. Cognitive therapy can also help patients recognize destructive patterns of emotion and behavior and help them modify or replace such behaviors and thoughts with more reasonable or supportive ones.
• Distraction (redirecting your attention away from chronic pain), imagery (going to your “happy place”), and dissociation (detaching yourself from the chronic pain) can be useful.
• Involving your family with your recovery may be quite helpful, according to recent scientific evidence.

Feel free to discuss these or other techniques with your doctor of chiropractic. He or she may suggest some simple techniques that may work for you or may refer you to another health care provider for more in-depth training in these techniques.

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Please visit our website for more information - click here -
or call our Chicago office: 312-269-5556
or our Homewood office 708.798.5556