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Choosing the right medical professional to assist you in getting better is obviously of the highest importance, to your head, neck or facial pain recovery. Here are the next 2 most important things to do to recover from your headaches, neck and facial pain as soon as possible...
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When patients enter my office, I know that this question is probably the first that they'd like to ask me.  So two things that I find very interesting about these statistics...
So you want to be rid of your pain?
It's been bothering you for over a month and just doesn't seem to be getting better. What should you do? Will anything help? With over 20+ years of experience, I can confidently say that it is a very rare occurrence when I'm not able to help my patients. Having said that, I will say that the amount of improvement and the speed at which it happens almost invariably comes down to this. (*Note- if there's one take home lesson that I would have for my patients when they first come see me- this would be it) How Important is it to you to get better? "What?" you might exclaim. Why else would I be here!! But you really should stop to really consider this question. If I've learned one thing about my patients in all these years, it's that some people say that they want to get better- but as a priority this falls way down their list. And truthfully, I have no issues with people having other priorities- family, work, vacations, etc. Heck, our lives can get busy! However if getting better isn't one of your top 5 priorities in life when you come to see me- it's very likely not the right time for you to start orofacial physical therapy. I hate to see people disappointed and waste their time if they're not truly committed. That means on average seeing me for 5 treatment visits and doing your exercises daily for about 15 min/day. Could it be less than that? Yes. Could it be more? Yes. But I think this is a pretty good baseline expectation for people who don't know what to expect. What I've found is that if patients that see me don't devote some time at home to addressing their problems, then in most cases their problems can persist... especially as it relates to orofacial problems, neck pain & headaches. If the cause isn't addressed, symptoms will still often improve with my help. But if the cause isn't addressed, it will likely cause symptoms to merely reoccur or at the very least take longer to resolve. If your schedule is too busy to make the commitment, maybe there's other options. Maybe you & your doctor have found that pain meds are acceptable to help take some of the edge off for awhile. And when you're ready to consider Orofacial Physical Therapy, you might again ask yourself the question... How important is it to you to get better? I look forward to helping you. Respectfully, -JONATHAN For all of you that were able to attend the Dentist Health & Ergonomics presentation last month at the Englewood Henry Schein office, it was great catching up again. Just a quick follow up on what we discussed- Most of you were already well aware that your ergonomics in the operatory could certainly improve. By it quickly became apparent that it seemed the biggest issue was how to implement the suggested ergonomic changes- without in turn affecting your patient’s overall comfort. So in this article there are some follow up thoughts on that very topic... The biggest challenge discussed was certainly- How to tilt the chair back for healthier dentist positioning- without making the patient uncomfortable & unhappy? Well often times, especially with older patients, these patients don’t tolerate neck and spinal extension as comfortably as they did when they were younger. Time and gravity has tended to lock their bodies into more kyphotic or rounded postures. So how to best respect their bodies and yours while treating their teeth. One of the best ways of ensuring that the patient is comfortable, even when tilting them back, is to support their spine with supportive cushions. As you can see from the picture, the supportive cushions will often allow the patient to be much more comfortable while also allowing a more horizontal posture.   When placing a supportive cushion under your patient's neck to clean the upper arch, prepare them for their new more extended neck position You might say something like- “I’m just going to help support your head with this cushion and tilt your head back for a few minutes so that I can reach that decay and really clean these top teeth thoroughly. And then I’ll we’ll come right back to this position again.” Just a few words like this to reassure them can help reduce any additional anxiety and tension that might arise from being in the position. Similarly, here is another strategy to reduce any prolonged patient tension or anxiety. As busy as things get throughout your day, An occasional patient “mini-break” helps to reassure the patient The biggest disappointment I think I’ve ever had at my dentist’s office was… the day he got rid of his “sippy cup and spit” beside the chair! I was admittedly in love with that contraption! Whenever things got a little too intense, I could always look forward to that little break and sip of water that I knew was just a few moments of displeasure away. Ok, the sip cup and spit fountain beside the patient chair may be gone forever. But the occasional promised patient mini-break doesn’t have to be. You’d be surprised at how much even just a few brief mini-breaks during a treatment would decrease patient tension and anxiety. And by helping to reduce any sustained emotional tension, you’ll quickly discover that it will likely also reduce most complaints of physical tension and discomfort as well. And as an aside- it would also reduce the likelihood of patient TMJ issues. Trismus and other jaw pain issues that arise occasionally in the dental office most often occur with prolonged patient TMJ opening in the presence of higher amounts of jaw tension/anxiety. Many of these might be avoided by decreasing prolonged jaw opening and measures of reassurance to reduce their anxiety and tension. If there is an area of the upper arch that requires prolonged work, remember that the patient’s head is in an extended position that for many can be slightly more uncomfortable. Perhaps after working on that area for a while you might consider giving the patient a mini-break from that neck position to work on another area of the mouth. Then, of course after a respite come back to the upper arch again later and continue. One of the endodontists at the presentation has an excellent ergonomic set-up in his office and he offered this strategy. To ensure that he remains in a comfortable and healthy posture throughout the day, he will Very gradually tilt the patient’s chair backwards throughout the treatment. By gradually lowering the patient, the patient typically isn’t even aware that their position has changed. And finally, just a reminder, even if you still struggle to lower your patient as they just don’t seem to tolerate lowering the tilt of the chair... You can still focus on 2 other things to improve your daily body mechanics and long-term health. 1. Your elbows, which should be located along side of your body with your arms relaxed, should be at the same level of your patient’s mouth. When in this correct position, your forearms will be parallel to the floor. As a reminder, keep in mind that ideally your dental stool should be at a height where your hips are higher than your knees. 2. You should also consider a stool which allows you to be closer to your patient. A saddle stool will allow you to open your legs to position yourself closer to your patient. This will allow you to see in the mouth without hunching your spine and allows less strain and reaching toward the patient. Best of luck with all these tips! And I'm sure many of you have suggestions of your own. Please feel free to help others by sharing them in the comments below. I see many patients with chronic neck issues. They might have been going to a chiropractor for years to help regularly resolve their pain. These are patients who could really use my help, because although the chiropractor is certainly helping them- there's certainly more that can and likely should be done. Here's one example- Although there's a lot more to stabilizing a neck than this, this is often a good start. Place your fingers against your temple and turn your head. Neither your head nor your hand will actually move, just provide the mild resistance. On a scale of 0-10, start by providing 2/10 intensity resistance. Hold for 3 seconds. Relax. Repeat. Repeat until your neck starts to feel some fatigue and then stop. Repeat on the other side. As you continue this exercise daily, your repititions will improve before fatigue sets in. Here is a picture to help-  Although chiropractic and physical therapy can be very helpful in reducing pain and allowing the neck to move again, without improved neck stabilization, invariably the neck will lock up again causing pain and stiffness to return.
These simple stabilization exercises are a great way to get a head start (-no pun intended) on having a flexible and stable neck again! Tinnitus, commonly known as- ringing in the ears. I've had people ask me- "What can you do for tinnitus". Well, certainly there isn't just one single cause. But there is often a link between tinnitus, the jaw and muscle tension. William Teachey, an ENT physician that specializes in the area of otolaryngic pain syndrome found that 41% of new patients in medical clinic where being seen for myofascial problems. This means that roughly 41 % of new patients being seen by him for tinnitus had a cause attributable to muscle tension/irritation. I also often see muscle tension around the ear- to the neck and jaw causing tinnitus. When I have treated patients in the past, it has been obvious that increased muscle stretch to the neck has increased their ear ringing. This makes it very obvious that the muscle tension in the neck and tinnitus are related. Some simple exercises and manual treatment can quickly reduce the neck muscle tension. If you look at the anatomy, the temporomandibular joint lies just beside… the eustachian tube aka the ear canal. It's not uncommon to have jaw dysfunction or tension, however one of the side-effects of tension in the jaw is often tension to the ear region. With a history of poor posture, I often see patients that have their jaw compressed towards area behind the jaw- the ear. This can bring on tinnitus. So the next time you have ringing in the ear, I would suggest you see your ENT physician. However, if after seeing him it still remains unresolved- and especially if you have a history of neck pain, jaw pain or headaches- then come see me.  Here's an entertaining post from Erson Religiouso III, a physical therapist that works a great deal with TMD.
A couple of points on his post... 1. As I've discussed before, he demonstrates nicely just one of the relationships that should become obvious to you between your neck and how your teeth touch (aka your occlusion). As you pull your chin backwards and nod you will feel your teeth touch in a different spot then when you crane your neck forward. 2. When you utilize poor posture, it causes excessive tension in your face (from the tension of the tissue under your jaw). And it's none too flattering, as he clearly demonstrates! Thanks Erson! Pain, especially unresolving chronic pain, is a problem that I see many, if not most, of my patients for. The National Institute of Health defines chronic pain as any pain lasting more than 12 weeks.
Few would argue that “pain” is a message from our brains meant to alert us that there’s a potential injury. Within that statement are some very important points that are quite often lost on individuals suffering from chronically painful experiences. -You send the message of pain to yourself. Under that assumption, then you also control the amount or volume of that message. Yes, it’s very easy to get caught in the trap, that our pain is separate from ourselves. Or that the area of our body that seems to hurt is separate from us. But it isn’t. It’s not uncommon to hear a patient say something like- “It throbs, whenever I move it.” Which is much different than... “I’m hurting, whenever I move. In the second statement, there’s ownership of the pain. ...Or control of pain. I’m hurting me. My head is opting to interpret this as strong pain. From there it’s a small step to realize that “I” am in control of “myself”. So when I’m hurting, I am sending a signal to myself to hurt, specifically my brain receives messages from my arm somethings going on. Then my brain says that whatever’s going on should be recognized as pain. But it’s a self-choice nonetheless. Do you remember when you experienced your a tickle. Have you ever tried to resist it? It’s difficult at first, but with focus and concentration you can just become able to change your response to the sensations you’ve attached to each. We can learn to turn down the volume on the incoming signal with practice. Again it’s our message to ourselves, so we control this message and how/how much the message is delivered. A good way to decrease the volume of the message is to attach a different meaning or emotion to each. Let’s say that your brother is tickling you. Have you ever tried to not laugh. You probably thought about relaxing and settling into it more. You are effectively down-regulating or dampening your nervous systems response to the tickle. And- it works! Here’s another instance- let’s say you were injured when you fell off a bike. The fall injured your shoulder. Initially the first few days, you didn’t move the shoulder because it was hurting. After a few days it hurts less. In fact, it really doesn’t hurt nearly as much unless you raise it. So maybe your therapist starts helping you raise it during therapy. It hurts as he does this too. Now you could have your inner voice telling you possibly one of two things.
Same pain. Two different stories attached to the pain. The first story is a story of fear. The second story is a story of reassurance, faith and certainty. Now let me tell you what’s happening with each story. When your brain receives a message from your shoulder as its moving, it must decide how to interpret each message. As this message is moving up your sensory nerves from your shoulder it receives input from your body before it reaches your brain. This input can be inhibitory (decrease the strength of the message) or excitatory (increase the strength). If it decreases the messages strength it will send hormones and pain-reducing molecules to the nerve to lessen its strength. If it’s excitatory then it will enhance the message through pain-provoking molecules and hormones increasing their input to the nerve before it travels to our brain. Fear will excite and increase the strength of the pain being interpreted by the brain. If we’re reassured and unconcerned the message will rapidly lose it strength and it may not even be strong enough to be considered pain. Perhaps merely discomfort- like a stubbed toe or a small paper cut. The point is, you control how the message will be felt by you. Are you afraid the injury could require surgery? Are you afraid that the shoulder is permanently injured with a rotator cuff tear? Or are you relieved and encouraged that it continues to slowly get better with time? The important thing to remember here is that I’m not suggesting that you ignore your pain because you’re “imagining” it. Just be really self-aware of your pain and the emotion or story you attach to it. Because invariably, the story you’ve attached to it, becomes true for you. The nervous systems in our bodies can be taught to go into a mode that maximizes the body's recovery. The easiest way, and likely the most effective, is to utilize our breath. Resonant frequency breathing (slower pacing of the breath) can be beneficial with as little as 15 min of daily practice. I find that I don't even need to set aside a special time for this- I just do this in my car while driving. Here's the instructional in how to perform this breathing pattern:
DIAPHRAGMATIC BREATHING: Volitional Diaphragmatic Control (VDC) In a posturally relaxed, neutral position, breathe slowly and regularly with your diaphragm with “lips relaxed, tongue relaxed, teeth slightly apart” a. Place your palm on the center of your stomach between your belly button and ribs.
The pause allows carbon dioxide, the byproduct of burning glucose and oxygen, to increase. During the pause after exhaling, the heart is still distributing the products of metabolism and respiration. About 80% of the blood goes to our muscles and in the pause you are learning to let the carbon dioxide increase. Carbon dioxide rise provides the key signal that tell your brain when to breathe in again. If you are exercising, the big muscles make carbon dioxide fast and the diaphragm needs the chest and neck muscles to exhale the excess. However, when we are just thinking or doing activities that do not use big muscles, breathing only with the diaphragm, and allowing the pause, is the best way to get oxygen and glucose into our brain and sore muscles, and lower stress hormones. If you begin to feel lightheaded or dizzy, you are trying too hard and exchanging too much air. Return to your normal breathing pattern, or wait longer between breaths breathe less deeply. Utilizing this breathing pattern will improve the effectiveness of the treatments you receive from me even more! If you have any questions, please let me know so I can help. FYI: Research has shown that it typically will take 8 days of daily practice to start engaging this breathing strategy correctly. Here's a nice article about unilateral headaches & facial pain-
It discusses the upper cervical spine of the neck, specifically C2/3, as the segment of the spine responsible for unilateral headache/facial pain which swaps sides. Also, it is very clear to say that even if it does not swap sides- C2/3 could still be responsible. Treatment of C2/3 for resolution of headaches is best performed with a combination of joint stretching/mobilization AND exercise to STABILIZE the segment afterwards. |
AuthorJay Schaefer, Owner hANS Physical Therapy group, CCTT, CODN, COMT Archives
November 2024
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