Accidents and Injuries

Jaw pain can make chewing, yawning, and talking a painful experience. This is a syndrome known as Temporomandibular Joint syndrome or disorder or TMJ and TMD. What happens is the temporomandibular joint that connects the jaw to the skull becomes inflamed. It is part of the musculoskeletal system, which means that chiropractors can treat the syndrome with various chiropractic techniques that include soft tissue work and temporomandibular joint adjustments. Chiropractic can bring lasting relief from Temporomandibular Joint Syndrome/Disorder.

How to Tell if TMJ Is Present

Jaw pain is the most common symptom but there are other factors that can cause pain. To help determine if it is TMJ, here is a list of additional symptoms:

• Difficulty or pain moving the mouth such as when chewing
• Popping sensation sound when opening/closing the jaw
• Cracking sensation sound when opening or closing the jaw
• Headaches that radiate to the facial muscles
• Tooth pain
• Pain in the neck and shoulders
• Tightness in the jaw
• Facial muscles become fatigued
• Dizziness or ringing in the ears

Chiropractic and Dental

If it is TMJ should an individual see a dentist or a chiropractor? This depends on the situation and individual.

• If TMJ is caused by teeth grinding while sleeping, or there is pain/problems with the teeth then seeing a dentist is recommended.
• If TMJ pain is accompanied by joint or muscle pain, or there is neck and/or back pain, then chiropractic is recommended.
• Certain cases could require dental treatment and a chiropractor for the joint issues.

Chiropractic TMJ Treatment

Jaw Adjustment

One way chiropractic treats TMJ is through jaw adjustment/s. This varies from patient to patient. An example assessment and adjustment for TMJ.

• The chiropractor will utilize the most beneficial technique/s for each individual.
• The chiropractor will have the individual open and close their jaw while feeling each side.
• They will determine which side opens first and widest, and which opens last and not as wide.
• Then they will perform a jaw adjustment through gentle pressure applied to both sides of the jaw.

Soft Tissue Treatment

A contributor to jaw pain can be attributed to the muscles that are used to open and close. In this case, the chiropractor will perform soft tissue manipulation to loosen them up. This releases the jaw so it evens out. This also helps with headaches associated with TMJ. The focus is on three muscles:

• Masseter
• Pterygoid
• Temporalis

A chiropractor will mobilize these muscles applying pressure repeatedly as the individual opens and closes their mouth.

Jaw Exercise Therapy

The chiropractor will recommend exercises to help quicken the healing process and strengthen the muscles. These are simple exercises that can be done at home or work to help relieve any discomfort or pain and for prevention.

Mouth Opening

• Place one thumb under the chin
• Open the mouth and gently push against it with the thumb
• Hold for 5 to 8 seconds then close mouth
• Repeat a few times every day

Mouth Closing

• Open the mouth holding the chin with the index finger and thumb from both hands
• Close jaw with gentle resistance with the fingers
• Hold for 5 to 8 seconds
• Repeat a few times every day

A chiropractor may collaborate with a dentist to provide the best treatment plan.

Body Composition

Body Dehydration

Dehydration happens when the body loses more water than it can replace. This can come from frequent:

• Diarrhea episodes
• Vomiting episodes
• Too much alcohol the night before
• Excessive sweating
• Excessive urination

When dehydration sets in a wide range of symptoms can present. Early signs/symptoms include:

• Dizziness
• Headaches
• Dry mouth
• Cool skin

If dehydration is not addressed in the early stages, it can lead to not having the urge/need to urinate. There is potential for long-term health issues like high blood pressure. High blood pressure is common for individuals that are chronically dehydrated. When the body’s cells lack water, the brain sends a signal to secrete vasopressin, which is a chemical that constricts the blood vessels. This causes blood pressure to rise. This could eventually lead to heart failure. If the blood vessels continue to progressively narrow, oxygen, and blood circulation to the brain decreases. This results in migraine headaches and decreased ability to concentrate.

Disclaimer

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP, CIFM, CTG*
email: coach@elpasofunctionalmedicine.com
phone: 915-850-0900
Licensed in Texas & New Mexico

References

Ibi, Miho. “Inflammation and Temporomandibular Joint Derangement.” Biological & pharmaceutical bulletin vol. 42,4 (2019): 538-542. doi:10.1248/bpb.b18-00442

Blum, Charles L. “Chiropractic and dentistry in the 21st Century.” Cranio: the journal of craniomandibular practice vol. 22,1 (2004): 1-3. doi:10.1179/crn.2004.001

Brantingham, James W et al. “Manipulative and multimodal therapy for upper extremity and temporomandibular disorders: a systematic review.” Journal of manipulative and physiological therapeutics vol. 36,3 (2013): 143-201. doi:10.1016/j.jmpt.2013.04.001

https://www.nidcr.nih.gov/health-info/tmj

Chiari malformation is a condition that causes brain tissue to extend out and settle into the spinal canal. It protrudes out where the skull and neck meet. It occurs because part of the skull is too small or shaped in a unique way that allows part of the brain to settle into the foramen magnum. The foramen magnum is a large opening at the bottom of the skull. The brain's nerves go through into the spinal canal and join the spinal cord. However, only the nerves should be present. The brain should not be able to push/press/leak through. When it does this is Chiari malformation.

Causes

Chiari malformation can be caused by structural problem/s with the:

• Brain
• Skull
• Spinal canal

Structural conditions/issues can be present at birth, which are congenital defects. This is also called primary Chiari malformation and is not caused by any other condition. Secondary Chiari malformations are caused by something else, most often through surgery. This is extremely rare, but it is possible to develop after having surgery to remove a tumor in the skull or neck region. A surgeon could have removed too much bone while removing the tumor. This allowed the brain to settle into the open space.

Types

There are 4 types and are categorized by how much brain tissue protrudes into the spinal canal.

Type I

This is the adult version and is also the most common.

It is usually first noticed and discovered from an examination for something else. Most individuals don't realize that they have Chiari malformation unless the symptoms are severe. With Type I a part of the brain, specifically the cerebellar tonsils settle into the foramen magnum.

Type II

Type II is also known as Arnold-Chiari malformation. This is the pediatric version. Symptoms are more severe with Type II because more brain tissue comes through. With this type, the cerebellar tonsils and some of the brainstem protrude. With Type II myelomeningocele, which is a form of spina bifida is a concern. What happens is the vertebrae and spinal canal do not close correctly before birth, so the spinal cord has no protection.

Type III

This type also affects children and is more severe than types 1 or 2. Here a significant portion of the brain, including the cerebellum and the brainstem protrude all the way through the foramen into the spinal canal.

Type IV

Type IV is the most severe form. With this type, the brain does not develop properly.

Symptoms

The symptoms vary based on the type and severity. The most common symptom is a headache. Individuals with a Chiari malformation usually have headaches in the occipital region of the brain. This is the back of the head, right where the skull joins the cervical spine/neck. The headaches can be aggravated being in certain positions and actions, tilting the head back, and coughing. Typical symptoms include:

• Balance problems
• Dizziness
• Difficulty with fine motor skills
• Trouble swallowing
• Vision problems
• Weakness

However, Chiari malformation can interrupt the flow of cerebrospinal fluid. Cerebrospinal fluid is necessary to protect the brain and spinal cord. If the normal flow is disrupted it becomes more difficult for the brain and spinal cord to send/receive nerve messages. The pressure built up can also cause nerve issues/problems. For some individuals, symptoms can come and go. This depends on how much cerebrospinal fluid has built up. Individuals with Type I sometimes don't have any symptoms. It all depends on the severity.

Diagnosis

Diagnosis is done with a magnetic resonance imaging test or MRI. The MRI will show the various parts of the brain, skull, spinal cord, and spinal canal. They will be able to see abnormalities that could point to Chiari malformation.

Treatment

The recommended treatment depends on the severity. If pain is presenting a doctor could recommend pain medications to help manage the pain. Non-steroidal anti-inflammatory meds could also be recommended to reduce inflammation. Analgesics or pain killers can be recommended. Often both non-steroidal anti-inflammatories and analgesics are available in over-the-counter and prescription. The doctor will figure out the best medication treatment plan.

Surgery can be used to relieve symptoms and is the only way to relieve the pressure on the spinal cord and nerves. The goal is to stop the malformation from worsening. Surgeons use a posterior fossa decompression procedure. The surgeon removes part of the skull to make more room for the brain to sit in. This takes the pressure off the brain and spinal cord, and should reduce the neurological symptoms and problems. The surgeon may increase the size of the dura or the sac around the brain.

Laminectomies at C1 and C2, which are the first and second levels of the neck and are utilized to make more room for the brain. The surgeon will place a patch that is made from animal or synthetic tissue that will grow into the dura. The patch makes the dura bigger, which allows more room for the brain. Not all surgeries involve the dural patch.

Neck Pain Chiropractic Care

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*