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Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) is the most expensive of all work-related injuries. Over his or her lifetime, a carpal tunnel patient loses about $30,000 in medical bills and time absent from work.
CTS typically occurs in adults, with women 3 times more likely to develop it than men. The dominant hand is usually affected first, and the pain is typically severe. CTS is especially common in assembly-line workers in manufacturing, sewing, finishing, cleaning, meatpacking, and similar industries. Contrary to the conventional wisdom, according to recent research, people who perform data entry at a computer (up to 7 hours a day) are not at increased risk of developing CTS.
What Is CTS?
CTS is a problem of the median nerve, which runs from the forearm into the hand. CTS occurs when the median nerve gets compressed in the carpal tunnel—a narrow tunnel at the wrist—made up of bones and soft tissues, such as nerves, tendons, ligaments, and blood vessels. The compression may result in pain, weakness, and/or numbness in the hand and wrist, which radiates up into the forearm. CTS is the most common of the “entrapment neuropathies”—compression or trauma of the body’s nerves in the hands or feet.
What Are the Symptoms?
Burning, tingling, itching, and/or numbness in the palm of the hand and thumb, index, and middle fingers are most common. Some people with CTS say that their fingers feel useless and swollen, even though little or no swelling is apparent. Since many people sleep with flexed wrists, the symptoms often first appear while sleeping. As symptoms worsen, they may feel tingling during the day. In addition, weakened grip strength may make it difficult to form a fist or grasp small objects. Some people develop wasting of the muscles at the base of the thumb. Some are unable to distinguish hot from cold by touch.
Why Does CTS Develop?
Some people have smaller carpal tunnels than others, which makes the median nerve compression more likely. In others, CTS can develop because of an injury to the wrist that causes swelling, over-activity of the pituitary gland, hypothyroidism, diabetes, inflammatory arthritis, mechanical problems in the wrist joint, poor work ergonomics, repeated use of vibrating hand tools, and fluid retention during pregnancy or menopause.
How Is It Diagnosed?
CTS should be diagnosed and treated early. A standard physical examination of the hands, arms, shoulders, and neck can help determine if your symptoms are related to daily activities or to an underlying disorder.
Chiropractor's can use other specific tests to try to produce the symptoms of carpal tunnel syndrome. The most common are:
Pressure-provocative test. A cuff placed at the front of the carpal tunnel is inflated, followed by direct pressure on the median nerve.
Carpal compression test. Moderate pressure is applied with both thumbs directly on the carpal tunnel and underlying median nerve at the transverse carpal ligament. The test is relatively new.
Laboratory tests and x-rays can reveal diabetes, arthritis, fractures, and other common causes of wrist and hand pain. Sometimes electrodiagnostic tests, such as nerveconduction velocity testing, are used to help confirm the diagnosis. With these tests, small electrodes, placed on your skin, measure the speed at which electrical impulses travel across your wrist. CTS will slow the speed of the impulses and will point your doctor of chiropractic to this diagnosis.
What Is the CTS Treatment?
Initial therapy includes:
Resting the affected hand and wrist
Avoiding activities that may worsen symptoms
Immobilizing the wrist in a splint to avoid further damage from twisting or bending
Applying cool packs to help reduce swelling from inflammations
Some medications can help with pain control and inflammation. Studies have shown that vitamin B6 supplements may relieve CTS symptoms.
Chiropractic joint manipulation and mobilization of the wrist and hand, stretching and strengthening exercises, soft-tissue mobilization techniques, and even yoga can be helpful. Scientists are also investigating other therapies, such as acupuncture, that may help prevent and treat this disorder.
Occasionally, patients whose symptoms fail to respond to conservative care may require surgery. The surgeon releases the ligament covering the carpal tunnel. The majority of patients recover completely after treatment, and the recurrence rate is low. Proper posture and movement as instructed by your doctor of chiropractic can help prevent CTS recurrences.
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Disc Bulges & Herniations
Do I Have A Slipped Disc?
The intervertebral disc is a special type of cartilage that connects and cushions the 24 bones of your spinal column. Each disc attaches to the vertebra above and below it. This provides the proper spacing for pairs of nerve roots to exit the spine from between each joint. A disc can thin, wedge, bulge, protrude, tear or herniate, but it doesn’t slip!
Each spinal disc has a jelly-like "ball bearing" core that is contained by bands of fibrous tissue. Healthy discs give you flexibility, allowing normal turning and bending. This movement produces a pumping action that supplies proper disc nutrition and waste removal.
Trauma produces the most common form of disc injury.
Spinal misalignments can cause disc tissue to adapt into a wedge-like shape. This is the earliest stage of disc damage. While this position can encroach upon adjacent nerve tissue, pain or other obvious symptoms may not be present. Even before symptoms appear, chiropractic care can be helpful.
Like a blister, disc tissue can bulge. As the soft nucleus of the disc is compressed, it pushes outward where the disc wall is weakest. This distortion can produce obvious symptoms (sciatica) as it affects nearby nerves. Muscles tighten to protect and splint the joint. Chiropractic care has been known to help.
The most extreme form of disc damage is when the disc ruptures, leaking its contents into surrounding tissues. With its cushioning and separating functions gone, movement is painful and surgical intervention is often involved.
Uncorrected, long-standing vertebral subluxations can make discs susceptible to damage. "I didn’t do a thing" or "I just bent over to tie my shoes" are comments we often hear.
How does chiropractic care help disc problems?
The purpose of chiropractic care is to locate and correct areas of the spine that interfere with the proper nervous system control of your body. Because the intervertebral discs are so close to the spinal cord and nerve roots, disc involvement is quite common in chiropractic cases. Chiropractic adjustments help restore proper motion and position of malfunctioning spinal bones, reducing nervous system involvement. If caught before permanent damage occurs, disc tissue often returns to a more normal size and shape.
Aren't disc problems simply part of the normal aging process?
No. However, many disc problems are the result of years of neglect. Many spinal problems are nonsymptomatic until the advanced stages of degeneration. Many elderly patients who have maintained their spines throughout their lives continue to enjoy excellent spinal health and function.
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Fibromyalgia
If you or your loved ones have been diagnosed with fibromyalgia, you may be wondering what the disorder means for you. The condition still remains a mystery, although an estimated 3 to 6 percent of Americans, predominantly women, have fibromyalgia syndrome. Even diagnosing the condition can be complex: according to the National Fibromyalgia Association, it can take a patient up to 4 years to be accurately diagnosed.
Fibromyalgia is typically diagnosed in patients with:
Widespread pain in all 4 quadrants of the body for a minimum of 3 months; and
Tenderness or pain in at least 11 tender points when pressure is applied.
These tender points cluster around the neck, shoulder, chest, hip, knee, and elbow regions.
Some fibromyalgia experts say, however, that many people may still have fibromyalgia with fewer than 11 tender points if they have widespread pain and several other common symptoms, including:
- Fatigue
- Sleep disorders
- Chronic headaches
- Dizziness or lightheadedness
- Cognitive or memory impairment
- Malaise and muscle pain after exertion
- Jaw pain
- Morning stiffness
- Menstrual cramping
- Irritable bowels
- Numbness and tingling sensations
- Skin and chemical sensitivities
Correct Diagnosis Is Key
Correct diagnosis of fibromyalgia is very elusive, so if you are diagnosed with the disorder—or suspect that you have it—seek the opinion of more than 1 health care provider. Other conditions may create fibromyalgia—like pain, fatigue, and other symptoms. Ruling other conditions out first is very important.
In addition to clinical evaluation that will assess possible causes of your pain, your doctor may need to order blood work to determine if you have:
- Anemia
- Hypothyroidism
- Lyme disease
- Other rheumatic diseases
- Hormonal imbalances
- Allergies and nutritional deficiencies
Disorders that cause pain, fatigue, and other fibromyalgia-like symptoms.
If the tests show that you have 1 of these conditions, treatment will focus on addressing that problem first. If your pain is caused by a muscle or joint condition, chiropractic care may help relieve it more effectively than other therapies.
Treatment Alternatives
If no underlying cause for your symptoms can be identified, you may have classic fibromyalgia. The traditional allopathic approach includes a prescription of prednisone, anti-inflammatory agents, antidepressants, sleep medications, and muscle relaxants.
These temporarily relieve the symptoms, but they do produce side effects. If you prefer a natural approach, the following suggestions may be helpful:
Studies have shown that a combination of 300 to 600 mg of magnesium per day, along with malic acid, may significantly reduce may significantly reduce the number of tender points and the pain felt at those that remain. B vitamins may also be helpful.
Eating more omega-3 fatty acids and fewer saturated fats has shown promise in fibromyalgia patients. Limit red meat and saturated fats and increase the amounts of omega-3 fatty acids by including fish, flax, and walnut oils in your diet. Fatty acid deficiencies can interfere with the nervous system and brain function, resulting in depression and poor memory and concentration.
Improving the quality of sleep can help reduce fatigue. Watch your caffeine intake, especially before going to bed. Reduce TV and computer time. If you watch TV in the evening, choose relaxing, funny programs instead of programs with violent or disturbing content. Ask your doctor of chiropractic for other natural ways to help you sleep better.
Stress-managing strategies can also help address anxiety or depression issues. Cognitive therapy has been shown helpful in relieving fibromyalgia patients’ negative emotions and depression by changing their perception of themselves and attitudes toward others.
A traditional gym-based or aerobic exercise program may exacerbate fibromyalgia symptoms and is not recommended. Instead, yoga, Pilates, or tai chi—which offer mild stretching, relaxation, and breathing techniques—may work better than vigorous exercise.
Chiropractic care has consistently ranked as one of the therapeutic approaches that offer the most relief for the fibromyalgia patient. Your doctor of chiropractic can also include massage therapy, ultrasound, and electrical stimulation in the treatment program, which may help relieve stress, pain, and other symptoms.
Your doctor of chiropractic has the knowledge, training, and expertise to help you understand your problem and, in many cases, to manage it successfully.
Remember, however, that the treatment program can be successful only with your active participation. If your doctor of chiropractic feels that he or she cannot help you, you will be directed to another health care provider.
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Headaches
There are many types and causes of headaches. Regardless of the cause, if you have a headache, you want it to end. Fast!
This has produced a huge market for medications that cover up the symptoms of headaches. Powerful drugs can numb your nervous system so the pain doesn't register. While these approaches may be convenient, they can cause adverse effects and kidney or liver damage. Worse, they don't correct the underlying cause of the headache.
A cause of headaches can be from spinal bones in the neck that aren't supporting your head properly. They're not moving right. This can affect nerves, muscles and even the blood supply to your head.
Chiropractic doctors locate areas of the spine that aren't moving properly. They notice if proper spinal curves are present. They look at your posture and your ability to turn and bend. These and many other examinations can help determine if you are likely to benefit from chiropractic care.
If you're a good chiropractic candidate, your care will consist of a schedule of chiropractic adjustments. These help normalize spinal function, help restore essential spinal curves, improve circulation and reduce nerve irritation. Many patients report fewer and less severe headaches.
While we can't guarantee results, our office has a high success rate with patients who get headaches.
What causes headaches?
The most common causes are physical trauma, emotional stress, nutritional deficiencies or chemical toxins. Sometimes there may be a combination of these and other factors. Our examination process helps identify the most likely cause.
How long will it take?
Some patients enjoy results quickly. Others notice a slow decline in their symptoms after several weeks or longer of chiropractic care. It's impossible to predict. If you've had chronic headaches for many years, improvement can take time.
What if I don't have a headache when I come in?
Chiropractic isn't an aspirin! Repeated visits, even when you're feeling better, can help retrain and strengthen the muscles that support your spine. Just as it takes more than one or two workouts at the gym to get in shape, it takes time for your spine to heal.
What if chiropractic doesn't work?
Headaches may be common, but they're not normal. Every headache has a cause. If we're unable to find and correct the cause of your headaches, we can refer to other specialists who may be able to help. Your health is our only goal.
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Neck Pain
What Causes Neck Pain?
Your neck is the most vulnerable part of your spine. Not only does it support your 10- to12-pound head, maintain a gentle forward curve, and permit head rotation, but it must also allow the free flow of nerve impulses to the head, face, hands and the rest of your body. Besides discomfort and annoyance, chronic neck pain is a sign that something is wrong.
Many everyday things can cause neck pain, such as watching TV, using your computer, reading a book or falling asleep in a chair or on an airplane. The temporary pain that results can resolve on its own, especially when the offending activity is discontinued. When it doesn’t, a more serious underlying problem may be indicated.
A thorough examination can determine if you’re a good candidate for chiropractic care. These tests may involve your ability to turn and bend. Muscle tone of the supporting muscles in the neck may be tested. Diagnostic imaging to reveal the underlying structure of the spine may be requested. These and other tests are designed to identify the cause and location of your neck pain.
The most common cause of neck pain is functional distortions in the spine resulting from vertebral subluxations. These subluxations are seen in cases of reverse cervical curve, whiplash and joint instability. The body responds by tightening muscles in the neck, "splinting" the joint to protect it from further insult. Chiropractic care can help
Most of the pain-sensing nerves in the neck are located in the pairs of facet joints on the back side of each vertebra. These smooth, interlocking surfaces allow you to rotate your head and bend your head up and down. If these joints become locked or fixated, neck pain can result. Chiropractic care can help restore proper joint motion.
A more difficult problem to correct is the degenerative changes that result from neglect. Years of uncorrected spinal problems can cause bone spurs, disc thinning and other forms of spinal decay. These types of problems respond more slowly, and some type of on-going supportive chiropractic care may be necessary.
Our response to stress is another common cause of neck pain. Deadlines. Rush-hour traffic. Overcommitments. Work pressures. Family obligations. . .
Ever meet someone who was a "pain in the neck"? Each of us is susceptible to our body’s unconscious response to people and circumstances. These perceptions can show up as episodes of neck pain.
If the weakest link in our bodies is our neck, stress shows up there. While chiropractic care cannot reduce the stress of your busy life, it can help improve your ability to handle and tolerate it. Without drugs or surgery!
Why did the chiropractor take pictures of my lower back?
Many patients are surprised when their chiropractic examination involves other areas of their body besides the local site of their symptom(s). Some neck pain cases can be a compensation to problems in the feet, knees, hips and lower back. Your chiropractor sees you as a whole person, not just a collection of "parts."
Will I have to have neck adjustments?
If your problem is the result of abnormal motion or position of spinal bones in the neck, cervical adjustments can be effective. There are many ways to adjust the neck, and your chiropractor has become an experienced master. Years of practice make these spinal adjustments safe and effective. Much safer than common aspirin or muscle relaxers!
How long will I need chiropractic care?
Some patients see quick improvement and then immediately discontinue their care. They often suffer a relapse since muscles and soft tissues have not had time to fully heal. Others discover that degenerative changes to their spines make periodic checkups a worthwhile investment. We‘ll make recommendations, but how long you benefit from chiropractic care is up to you.
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Sciatica
Sciatica can be a distracting pain that starts in the lower back and extends down into one or both legs. Chiropractic care has proven to be quite helpful.
Those suffering from sciatica are often in their 40s and 50s. It usually begins as an acute pain in the lower back and then extends down the back of either leg. The pain usually worsens with long periods of sitting or standing.
Like a large river created by smaller streams, five pairs of nerves exit the spine in the lower back to form the two sciatic nerves. The soft, pulpy disc between each spinal bone is often involved. While a disc can't "slip," it can bulge, herniate or rupture. This can put direct pressure on the nearby nerves. The result? Swelling. Inflammation. Pain when coughing, sneezing or with others kinds of movement.
Sciatica often worsens with extended bed rest. Pain pills or muscle relaxers are unable to correct the nerve compression caused by the bulging disc. Physical therapy merely works the area to increase your tolerance to pain. Surgery often involves cutting away disc tissue or removing bone to make room for the nerve.
Fortunately, sciatica often responds to safe, natural chiropractic care.
Improving joint motion with a series of chiropractic adjustments has produced results for millions. "Before" and "after" images of the lower back often show improved disc height and spacing. Many patients report that they can resume their lives and that their symptoms disappear. Without resorting to drugs or surgery.
Your chiropractic doctor is uniquely skilled to evaluate and reduce the most common cause of sciatica nerve pain. It's the natural approach to relief and better health. There is hope!
How do you get sciatica?
It's easy to trace some spinal problems to an event, such as a car accident. Yet, sciatica is often the result of cumulative damage. Years of bad posture, poor muscle tone, excess weight or countless other causes set the stage. Then, something simple like bending over to tie your shoes can trigger an episode.
Can anything else cause sciatica?
Spinal decay can be another culprit. Instead of disc thinning that puts pressure on the sciatic nerve roots, arthritic bone spurs can intrude into the space normally reserved for the nerve.
Can chiropractic cure sciatica?
Actually, chiropractic doesn't cure anything! Only your body can do that. The chiropractic approach to sciatica (and other health problems) is to help restore the way your spine works, reducing nerve irritation and revitalizing your own healing ability.
How long will I need chiropractic care?
Most sciatica patients are delighted with the results they get after weeks or months of care. Naturally, this varies from patient to patient. After a relapse or two, many discover that years of neglect have produced spinal instabilities that never fully heal. These patients elect to continue with periodic chiropractic checkups. It's up to you.
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Scoliosis
Scoliosis affects 5 to 7 million people in the United States. More than a half million visits are made to doctors’ offices each year for evaluation and treatment of scoliosis. Although scoliosis can begin at any age, it most often develops in adolescents between the ages of 10 and 15. Girls are more commonly affected than boys. Because scoliosis can be inherited, children whose parents or siblings are affected by it should definitely be evaluated by a trained professional.
What is scoliosis?
Because we walk on 2 feet, the human nervous system constantly works through reflexes and postural control to keep our spine in a straight line from side to side. Occasionally, a lateral (sideways) curvature develops. If the curvature is larger than 10 degrees, it is called scoliosis. Curves less than 10 degrees are often just postural changes. Scoliosis can also be accompanied by lordosis (abnormal curvature toward the front) or kyphosis (abnormal curvature toward the back). In most cases, the vertebrae are also rotated.
In more than 80% of cases, the cause of scoliotic curvatures is unknown; we call this condition idiopathic scoliosis. In other cases, trauma, neurological disease, tumors, and the like are responsible. Functional scoliosis is often caused by some postural problem, muscle spasm, or leg-length inequality, which can often be addressed. Structural scoliosis does not reduce with postural maneuvers. Either type can be idiopathic or have an underlying cause.
What are the symptoms of scoliosis?
Scoliosis can significantly affect the quality of life by limiting activity, causing pain, reducing lung function, or affecting heart function. Diminished self-esteem and other psychological problems are also seen. Because scoliosis occurs most commonly during adolescence, teens with extreme spinal deviations from the norm are often teased by their peers.
Fortunately, 4 out of 5 people with scoliosis have curves of less than 20 degrees, which are usually not detectable to the untrained eye. These small curves are typically no cause for great concern, provided there are no signs of further progression. In growing children and adolescents, however, mild curvatures can worsen quite rapidly—by 10 degrees or more—in a few months. Therefore, frequent checkups are often necessary for this age group.
How is scoliosis evaluated?
Evaluation begins with a thorough history and physical examination, including postural analysis. If a scoliotic curvature is discovered, a more in-depth evaluation is needed. This might include a search for birth defects, trauma, and other factors that can cause structural curves.
Patients with substantial spinal curvatures very often require an x-ray evaluation of the spine. The procedure helps determine the location and magnitude of the scoliosis, along with an underlying cause not evident on physical examination, other associated curvatures, and the health of other organ systems that might be affected by the scoliosis. In addition, x-rays of the wrist are often performed. These films help determine the skeletal age of the person, to see if it matches an accepted standard, which helps the doctor determine the likelihood of progression. Depending on the scoliosis severity, x-rays may need to be repeated as often as every 3 to 4 months to as little as once every few years.
Other tests, including evaluation by a Scoliometer™, might also be ordered by the doctor. This device measures the size, by angle, of the rib hump associated with the scoliosis. It is non-invasive, painless, and requires no special procedures. A Scoliometer™ is best used as a guide concerning progression in a person with a known scoliosis—not as a screening device.
Is scoliosis always progressive?
Generally, it is not. In fact, the vast majority of scolioses remains mild, is not progressive, and requires little treatment, if any.
In one group of patients, however, scoliosis is often more progressive. This group is made up of young girls who have scolioses of 25 degrees or larger, but who have not yet had their first menstrual period. Girls generally grow quite quickly during the 12 months before their first period and if they have scolioses, the curvatures tend to progress rapidly. In girls who have already had their first periods, the rate of growth is slower, so their curves tend to progress more slowly.
What is the treatment for scoliosis?
There are generally three treatment options for scoliosis—careful observation, bracing, and surgery. Careful observation is the most common “treatment,” as most mild scolioses do not progress and cause few, if any, physical problems. Bracing is generally reserved for children who have not reached skeletal maturity (the time when the skeleton stops growing), and who have curves between 25 and 45 degrees. Surgery is generally used in the few cases where the curves are greater than 45 degrees and progressive, and/or when the scoliosis may affect the function of the heart, lungs, or other vital organs.
Spinal manipulation, therapeutic exercise, and electrical muscle stimulation have also been advocated in the treatment of scoliosis. None of these therapies alone has been shown to consistently reduce scoliosis or to make the curvatures worse. For patients with back pain along with the scoliosis, manipulation and exercise may be of help.
Most people with scoliosis lead normal, happy, and productive lives. Physical activity including exercise is generally well-tolerated and should be encouraged in most cases.
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Stress
Not all stress is bad. A 20-minute workout for a fit and trim 65-year old is good stress. The same workout for an out-of-shape 35-year old would likely be bad stress!
Whether your body considers stress good or bad is largely a function of how well it can accommodate it. Ultimately, this capacity is based on the condition of your nervous system.
Stress is part of everyday living. In fact, a stress-free life would be boring! Life is enjoyable when we have ample resources to experience and overcome the stresses we face.
Physical Stress
A whiplash injury from a car accident is an obvious source of physical stress. As is repetitive motions, a slip and fall, lack of sleep or overdoing it in the garden. Early on, learning to walk, ride a bike and the birth process itself are sources of physical stress.
It’s not the stress—it’s your reaction to it that matters!
Accumulated stress exhausts our reserves. Then, something as simple as mowing the lawn can put us over the edge. Chiropractic care helps restore your adaptive capacity.
Emotional Stress
Fear, grief, anger and other emotions affect our entire body. Notice the posture of someone who is sad or depressed. Frustration, or a sense of powerlessness at work, is a common form of emotional stress.
Clearly, it’s not the stress, but our response to it that is critical. Chiropractic care, because its focus is to reduce tension to your nervous system, can help you respond more resourcefully.
Chemical Stress
Common sources of chemical stress include poor nutrition, sugar, refined carbohydrates and unhealthy fats. Drugs, preservatives, tobacco, alcohol, vaccinations, pollen and a host of other substances also affect our nervous systems, muscle tone and our spine.
The problem isn’t the pollen or chemical. Because not everyone reacts. Symptoms can appear when you lose your ability to adapt. Chiropractic care has helped millions reduce or eliminate reactions to many types of chemical stress.
If you lack the reserves to adapt to stress in a healthy way, it takes a toll. If your body reacts by “tripping a circuit breaker,” causing vertebral subluxation, chiropractic care is likely to help.
How can stress affect my spine?
Think of your spinal cord as a guitar string. The greater the tension, the higher the note. Your nervous system has “tone” as well. With each stressor, your body tightens up, like bracing yourself for a tight curve on a roller coaster. The weakest joints of your spine are forced out of their normal position. Like the shrill notes from an over-tightened string, your body loses its capacity to respond to the full range of human experience. And ill health can result.
Can chiropractic care solve all my stress?
Of course not. Much of the emotional stress we experience is largely self-induced. Imagine how much pain and suffering result from attaching inappropriate meanings to events in our lives. Or the constant burden we experience by not forgiving others. Stress is a natural part of life. Chiropractic care can’t eliminate stress, but it can help increase your capacity to accommodate it.
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Temporomandibular Joint Disorder (TMJ)
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:
1. Myofascial pain—discomfort or pain in the muscles of the jaw, neck, and shoulders;
A dislocated jaw or displaced disc;
2. 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.
3. 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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Whiplash
You're in your car, relaxed, waiting at a stoplight. Suddenly you hear a screeching of tires behind you and the harsh sound of metal hitting metal. Before you can brace yourself, you feel your car moving forward from some unseen force! You've been rear-ended.
What happens in these few seconds can have tragic consequences. And what you do about it in the next hours, days and weeks can forever affect your health.
Upon impact, your body pushes deeply into your seat. Your head, momentarily isolated by your neck, delays its reaction while your body quickly reaches the limits of your seat.
Then, your body instantly changes directions, moving forward to the limits of your seat belt. Now, your head starts moving backward in the opposite direction! Unrestrained by a seat belt your head is jerked back and then forward beyond its normal limits. Everything seems to be happening in slow motion, yet you are unable to stop your head from whipping backward and then forward.
First surprise. Then anger. Then pain.
Don't minimize your own injuries because your car has sustained little or no damage. An immediate chiropractic examination is essential. Pain pills won't heal inflamed tendons and ligaments. Muscle relaxers won't heal torn muscles. A cervical collar won't restore a graceful forward spinal curve.
Specific chiropractic spinal adjustments, because they can help restore proper motion and position of individual spinal bones, can help assure proper healing. Chiropractic doctors can help you get well and stay well after the trauma of a whiplash injury.
Why do I have pain in my arms and hands?
Because the nerves to the arms and hands exit the spine through the injured area of the neck, numbness and tingling are common. Even lower back pain can result directly from the trauma or as a reaction to the loss of proper spinal curves.
Why did my headaches start more than a week after my accident?
Whether you've been in an accident, stressed at work or overexerted yourself in the garden, your body is constantly adapting to the environment. When your capacity to adapt is exhausted, symptoms can appear. This can take days, weeks, months or years to occur.
Will I ever be normal again?
Many chiropractic patients report restored spinal curves and an end to their symptoms. Those who delay seeking appropriate care often discover that scar tissue and spinal instability require periodic chiropractic checkups.
How can I prevent whiplash injuries?
Since car accidents are the major cause of acceleration/deceleration injuries, defensive driving skills can help. Be sure your taillights and turn signals are properly working. Allow enough stopping distance in front of you. When you slow down or stop, always check your rear view mirror to see if the driver behind you is paying attention.
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