TMJ Disorder And Neck Pain

Chronic neck pain is a common health issue that can be challenging to treat. Most doctors do little to address the origins of neck pain, opting instead to prescribe pain relievers, anti-inflammatory drugs and muscle relaxants. While these medicines may offer temporary relief from neck pain, they do not provide a lasting solution. One common underlying cause of chronic neck pain is temporomandibular joint disorder (TMD).

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Temporomandibular Joint Disorder Symptoms

TMD is a fairly common condition that can develop at any point in your lifespan. TMD primarily affects the position and function of your jaw. People who suffer from this disorder often experience the following symptoms:

  • Jaw stiffness and discomfort
  • Cracking and clicking sounds when moving the jaw
  • Facial pain
  • Frequent headaches
  • Dizziness
  • Ringing in the ear

The majority of people with TMD also experience chronic neck pain. Studies of the neck and jaw region reveal that the jaw muscles do not work independently of the neck. In fact, any movement of the jaw also recruits muscles in the neck, and misalignment of the temporomandibular joint can affect posture and movement in the neck and upper back. The close interaction of the two regions explains why TMD is often a common root cause of chronic neck pain.

Causes of TMD

TMD can develop suddenly after trauma, or it may have a delayed onset after an injury.
Some common causes of TMD include:

  • Injury to the teeth or mouth, such as a sudden impact
  • Whiplash
  • Grinding or clenching the teeth
  • Stress and anxiety
  • Poor posture
  • Orthodontic interventions, such as braces
  • Faulty breathing patterns
  • Habits like gum chewing, nut cracking or chewing ice

The majority of patients with TMD are female, leading researchers to question if there is a hormonal component to explain the gender disparity. Since many of the causes of TMD are also symptoms of the disorder, such as teeth grinding and poor posture, effective treatment of TMD requires a comprehensive and integrative course of intervention.

Diagnosis of TMD

TMD diagnosis is based primarily on the patient’s medical history and physical examination. As a patient, you will be asked to move your jaw by opening and closing your mouth and chewing. The doctor will observe your jaw range of motion, listen to and feel your jaw as you move it, and apply pressure to your jaw region to identify painful areas, especially in the preauricular, masseter and temporal regions.

In addition to the health history and physical exam, your doctor may request:

  • Dental Xrays
  • CT scan
  • MRI
  • TMJ arthroscopy

At NYDNRehab, we use dynamic diagnostic ultrasonography to view the jaw and neck in motion. Ultrasound gives us the opportunity to assess the structures of the patient’s jaw and neck in real time, with the patient providing useful feedback. The ability to clearly see how the muscles of the neck and jaw interact removes the guesswork and enables us to make an accurate diagnosis of TMD. Diagnostic ultrasound is safe, easy and painless, and gives us immediate results, so we can begin treatment right away to relieve your pain.

Conventional TMD Treatment Options

Among many traditional practitioners, the first course of action for TMD involves medications, including pain relievers, anti-inflammatory drugs, antidepressants and muscle relaxants. However, drugs merely mask the symptoms of the condition without getting at its roots.

In addition to medications, other conventional treatment approaches may include:

  • Oral splints or mouth guards (occlusal devices)
  • Education and counseling
  • Corticosteroid injections
  • Arthrocentesis to irrigate the jaw
  • TMJ arthroscopic surgery
  • Open-joint surgery

Sadly, conventional approaches often fail to alleviate pain in the long run because they do not address the true underlying causes of TMD. In fact, many traditional approaches may exacerbate the patient’s pain and discomfort while costing massive amounts of time and money.

Specialized Chiropractic and Physical Therapy Care – Treating Neck Pain by Addressing TMD

TMD sufferers often habitually clench their jaws in an effort to realign them, to relieve pressure and reduce obstruction to the structures of the mouth. Clenching causes persistent muscle tension in the jaw, neck and shoulders, creating postural imbalance.

Chiropractic care addresses misalignment by encouraging proper posture through treatments such as:

  • Vertebral readjustments
  • Physical therapy to improve muscle tone and function
  • Release of soft tissue fascia, to decrease muscle tension
  • Ergonomic counseling to foster proper posture
  • Cranial osteopathy to realign the cranium, mobilize the sutures of the skull, and restore cranio-sacral synchronicity
  • Dry needling to release trigger points in the neck and masticatory (chewing) muscles

Sadly, conventional approaches often fail to alleviate pain in the long run because they do not address the true underlying causes of TMD. In fact, many traditional approaches may exacerbate the patient’s pain and discomfort while costing massive amounts of time and money.

TMD Treatment at NYDNRehab

Patients who suffer from chronic neck pain are often unaware that their pain is directly related to TMD. Many people find great relief after just their first treatment. Ongoing therapy promotes healthy functional posture and harmonious muscle function. Many patients who receive chiropractic care to address TMD enjoy:

  • Decreased fatigue
  • Increased ability to concentrate
  • Improved mental and emotional health
  • Increased ability to exercise
  • Improved sleep quality
  • Pain-free chewing
  • Decreased muscle tension

Chiropractic and physical therapy address the underlying origins of your neck pain without resorting to harmful pharmaceuticals, painful injections, uncomfortable dental appliances or invasive surgery. By approaching the human body as an interconnected system, physical therapy and chiropractic care offer evidence-based and effective treatments to help eradicate the underlying causes of chronic neck pain.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

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Complete tear of rectus femoris
with large hematoma (blood)

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Separation of muscle ends due to tear elicited
on dynamic sonography examination

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