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Episode Number: 013
Host: Dr. Thomas Lamar
Show Date: 05/28/2010
Run Time: 24:21
Description: If you’ve ever experienced pain in the jaw with popping and clicking, you’ll want to tune your ear to this episode as Dr. Lamar explains why a chiropractor just might be the provider of choice.
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Dr. Lamar’s article: TMJ and the Chiropractor
SpinalColumnRadio — Torticollis Episode
Dynamic Chiropractic Article on new chiropractic college in Malaysia
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Does your podcast listening schedule need a little backbone? If so, it’s time to schedule an appointment with your podcast chiropractor, Dr. Thomas Lamar.
Spinal Column Radio, episode number thirteen.
Coming up next on Spinal Column Radio — TMJ and the Chiropractor
[intro theme music]
And welcome back to another exciting and information packed episode of Spinal Column Radio. My name is Dr. Thomas Lamar, chiropractor and Dad of 6. And this is the podcast that gets you to think. To think about your health in a whole new way. We’re the podcast for your backbone… the podcast with backbone. Who knew that spinal education could be this much fun?
We’d like to invite you to visit our podcast website at spinalcolumnradio.com where you can learn more about us, check out our world-renown “What’s a Podcast?” page, and can access the show notes for this episode. Also, we encourage you to leave comments and ask questions through our website, or, if you prefer, you can email me using DrLamar AT spinalcolumnradio DOT com.
[transitional sound effect]
Well, have you ever had a jaw that would pop or click every time you opened it, causing intense pain? Maybe the jaw would even “lock” sometimes, making it next to impossible to fully close or open your mouth. Perhaps, the pain was also accompanied by headaches, neck pain or ear pain… Maybe even dizziness or ringing in your ears. Well if you have, you definitely are not alone. It’s called TMJ, and your first inclination might be to rush off to the dentist, but a little later on in the show I’m going to tell why a chiropractor… that’s right a chiropractor… just might be the provider of choice in this situation.
[transitional sound effect]
But first, I have an email I want to share with you from a podcast we did back in February of this year on Torticollis (which was episode 007)… I encourage you to go check it out… but just as a quick background, Torticollis is neck condition in which the neck twists and flexes to the the side uncontrollably and is usually locked in that position. It can be very painful and unsightly… not to mention scary for the patient. The red herring, or distractor, in all of this is the tight spastic muscle on the side of the neck. It just won’t let go. Consequently, many treatment approaches out there focus on this tight muscle… and find ways to relax it with things like medication, heat, ice, massage, stretching… or in more difficult, persistent situations, find ways to shut it down by employing more invasive measures such as injecting it with botulism bacteria, snipping the nerves that go to that muscle, or by cutting the muscle itself.
What we chiropractors find is that the muscle is not the problem… but rather a reaction to the problem. You see most cases of torticollis — although not all — are from a mechanical derangement of the joints in the neck … To the point where the pain from the stretch of the joint capsule is so much that it causes the muscle in the neck to go into this uncontrollable, relentless, spastic lock-down.
Okay… now the email. And I want to share this email because not only does it demonstrate the power of the Internet, but — perhaps more so — it underscores the potential power behind a show like ours.
It’s from a concerned mother who literally lives on the other side of the globe from my small town office in Kingston, WA. And it reads:
hi…my name is siti from malaysia. my son is diagnosed with mild torticollis since 3mths old when we went to see the paed for jab. [Jab must be the little boy’s name]. i said mild because in my son case he still can turn his head right n left. it just that his head is titled to right and his chin to left. the paed asked us to wait till 5mths to confirm it and if the neck still tilt then we go to physio. and at 5mths we went to physio. the physio session took twice only and the rest we have to do it at home. first few mths its ok but then we had difficulty when my son shows resistance. now he is 12mths and he still has the tilt head. what i don’t understand it only comes once in a while when he enters new month age. and it will takes like few days for his head to tilt then back to straight again perfect. seems that on and off….i don’t know what to do know. i feel bad as a mom as i don’t do nothing and i feel sorry for my son im afraid it gonna be permanent. hope u can advice me.
Wow…. well my first thought was… only the Internet — and I could argue a podcast, because of the personal connection you feel with the host — could bring people together like this. How totally cool to know that a small town chiropractor, like myself, can make an impact outside of his geographical reach. Now… outside of me actually hopping on a plane to go adjust young Jab… (which would be really neat, by the way, but probably not very practical), what advice can I give to Siti?
Well’s here’s my response:
Hello Siti –
Thanks for writing. I’m so sorry to hear about your son. You must be very frustrated and concerned. My best advice to you is to find a chiropractor. I was unsure if you had chiropractors in Malaysia, but a quick Google search shows that you do. As my podcast on Torticollis explains, the treatment that you are getting through the physical therapy is focusing on the muscle… not the underlying structure. And certainly the “wait and see” approach offered by your doctor did not help.
A chiropractor should be able to help get to the root of the problem…. and it shouldn’t take that long either. Try to find one that is comfortable working with children. I’m able to help infants with torticollis in just a handful of visits. It certainly is worth trying. Let me know how it goes and keep listening to SpinalColumnRadio.
Folks, Chiropractic is the only treatment that I am aware of that gets to the core of this problem. Why chiropractic is not offered up as a viable option when a medical professional diagnoses this condition is beyond me. And apparently this is a global problem.
I pray that she is able to find a Malaysian Chiropractor.
And, really, she should be able to… there are definitely chiropractors down there…. and, as a matter of fact, I just ran across this article — I wasn’t necessarily searching for it — but there on the front page of the May 20th Dynamic Chiropractic (one of our widely-read trade publications) was the headline: “Degree Program in Malaysia Off to a Great Start — Inaugural class is more than halfway through first semester.” That’s right Malaysia has started a chiropractic school. I’ll put the link to this article — if you’re interested — in the show notes. And now… on with the show.
[transitional Muzak sound effect: Song — King Zaya Zaya at the Shopping Mall / Artist: by Balinese Dog / Album: Muzak for Sixteen Downloaders / Released May 10, 2010 / http://www.jamendo.com/en/album/66406 — licensed under Creative Commons Attribution-NonCommercial-ShareAlike]
There I sat in the dental waiting room, flipping through a magazine as my toe kept time to the Muzak.
…Suddenly, the young dentist poked his head out from behind the door and called my name. He looked worried. And to tell you the truth, I began to feel the same way — because I wasn’t there to be seen. It was my wife’s turn in the chair, and I was only waiting.
The year was 1996, and I had freshly graduated chiropractic college six months prior. My wife was finishing up her year as an elementary school teacher in California before we packed up and made the big move to where we now reside in Washington State. So, in an effort to complete as much of her needed dental work as possible, with insurance paying the tab, we opted for the “open-mouth-marathon.”
The dentist told me that my wife was in pain and was calling for me. You see, in the middle of her “marathon” she was struck with piercing pain in her right jaw that was accompanied by intense popping every time she opened her mouth. When I arrived at her side I could see that she was in distress. Standing behind the reclined dental chair, I placed my hands on her on the side of her face and proceed to release the tension in her jaw musculature and then gave her some swift adjustments to the upper neck as the dentist and his two assistants looked on. Moments later my wife looked up at me with a sigh. The pain had dissipated and the popping had ceased. I looked up at my dental audience. Their mouths were agape.
The dentist pulled me into his private office and started paging through his anatomy books. “What is it that you just did?” he asked in amazement. “Because we certainly didn’t learn about it in dental school.”
I’m certain, had I stayed in the area, we would have enjoyed a good working relationship.
[transitional Muzak sound effect]
Well today, we’re talking about TMJ. Now for some, they know exactly what I’m talking about… but for others, I just rattled off three random letters. TMJ stands for Temporomandibular Joint, which is “doctor speak” for the jaw. And it is often used to describe a variety of painful and dysfunctional jaw disorders. It also goes by other three letter acronyms: TMD — which is probably a bit more accurate. That stands for Temporomandibular Disorder. And then there’s the less commonly used CMD — Craniomandibular Disorder. Actually, there are a bunch of acronyms out there, and they’re all somewhat related. And it can get a bit confusing. If you’re interested, I’m putting a link in the show notes to an article that I found that does a pretty good job of organizing it all.
Well, the general consensus among TMJ professionals is that most of us will experience some degree of TMJ symptoms at one time or another. That’s the bad news. The good news, however, is that most of us will not require any type of formal treatment. And here’s why….
The TMJ is a highly adaptive joint. It is constantly remodeling itself to adapt to the pressures and demands that we place upon it. We run into problems,however, when those demands get out of proportion… when those demands become so great — so overpowering — that the joint simply cannot keep up. Consequently, its adaptive processes… they fail and the onslaught of TMJ symptoms emerge.
Symptoms such as jaw pain, jaw popping or clicking, a jaw that locks open or closed, ear pain, dizziness, face pain, headaches, neck pain, teeth pain, ringing in the ears, teeth grinding…. it really varies depending on the situation and the unique characteristics of the patient.
Also, there is whole host of secondary symptoms that can come on as a result of the tension in the neighboring musculature due to the TMJ dysfunction:
things like voice fluctuations; sore throat without infection; swallowing difficulties, bloodshot eyes; tongue pain; balance problems such as “vertigo”, dizziness, or disequilibrium; feelings of like a foreign object in your throat; clogged, stuffy, “itchy” ears… a feeling of fullness in the ears; watering of the eyes …plus a bunch of others.
Regardless of what the symptoms are, a key point that I want to make here is that because the TMJ has the unique characteristic of adapting to the demands and stresses that are placed upon it, the goal of treatment — whatever that treatment may be, whether its from a dentist, a chiropractor, or some other health care provider…. the goal of the treatment is not necessarily to “fix” the problem, but rather to enhance the TMJ’s ability to adapt. So, it may be that just doing something relatively conservative, relatively simple, will be enough for the TMJ to regain is adaptive abilities.
So what are these demands that are placed on the TMJ that have the potential to cause it to fall into a state of dysfunction? Everything from dental bite problems to poor posture… bruxism to bar room fights… whiplash to spinal misalignments.
Interestingly on a website I saw, they talked about how women tend to report TMJ pain more than men. Something like 80-90% more. And of the men that have TMJ problems, they typically have had some sort obvious trauma involved, such as a blow to the jaw.
Apparently Burt Reynolds had a nasty bout of TMJ when he was hit in the jaw with a chair during the filming of a movie. This accident initiated two years of pain, vertigo, nausea and substantial weight loss.
When it comes to TMJ disorders, many dental professionals look to the teeth as the source of the problem — or more specifically — the occlusion (basically how the teeth meet). But malocclusion issues aren’t always to blame with TMJ problems, but rather might be a resultant, or an obvious outcropping, of another more extrinsic factor.
While in chiropractic college I had the opportunity to have as one of my instructors, Dr. Darryl Curl. Now, Dr. Curl was no ordinary chiropractor, because he was also a dentist. That’s right he had both degrees. Not something you see every day.
Now, the story, as I remember it, was that he received his dentistry degree in the early 70’s. As he went on with his practice of dentistry over the years a patient came into his office with popping and clicking in his jaw. Now, as luck would have it, Dr. Curl had been doing a lot of self-study on this topic, as it was not something that was taught in dental school, but something that he had recently taken an interest in. So, he went ahead and made this patient a custom dental mouth piece to take the pressure off the TMJ to bring about healing. Well, the patient returned about six weeks later with a great big smile and proudly demonstrated to Dr. Curl how he could now open and close his mouth pain-free and without popping or clicking. Well, Dr. Curl was rather pleased and announced that he was glad that the mouth piece had been so successful. Well, the patient looked at Dr. Curl and said, somewhat reluctantly, “Well, to tell you the truth Doc, I threw that mouth piece away and went and saw my chiropractor. He found that I had an anatomically short leg. He fit me with a heel lift and then started adjusting my neck and back. I feel great now and my jaw has never been better!”
Well, Dr. Curl just stood there in shock. Because what this man had just said made absolutely no sense whatsoever to him. But, realizing that there was more to learn with regards to the TMJ, Dr. Curl — with an open mind — took this chiropractor to lunch.
What he learned — and what Dr. Curl teaches — is that the skeleton is a “kinematic chain.” This is just a fancy way of saying that the joints below have an influence on the joints above.
[transitional music: Song — Dem Dry Bones / Artist: Delta Rhythm Boys / 1930’s / http://www.archive.org/details/DeltaRhythmBoys-DemDryBones — licensed under Creative Commons Public Domain]
So, in this gentleman’s case — and granted it is a bit of an extreme case, but it serves our point well — the short leg, caused an unleveling of the pelvis, causing the lower back to compensate in the opposite direction, which made the mid back compensate the other way, which made the neck compensate the opposite of that, which ultimately threw off the upper most joint of this kinematic chain — you guessed it — the TMJ.
And so, when the chiropractor, set out to bring about balance to the pelvis and the spine, the TMJ was able to come back into order. In other words, the extrinsic demands that were being placed on the TMJ lessened it to such a degree, that the adaptive qualities that the TMJ is known for were able to function once again.
Well, this impressed Dr. Curl so much that he enrolled in chiropractic college and became a chiropractor himself. Combining his knowledge of both disciplines put him in a unique position, and he soon became an international authority on TMJ disorders. (And just as an aside, I tried to hunt down Dr. Curl to have him on our show, but unfortunately couldn’t locate him…. so Dr. Curl if your listening or if you know where he might be… drop me a line, I’d love to chat with you).
You, know, the TMJ is one remarkable joint. It’s estimated that it moves over 2000 times per day — making it one of the most used joints of the body. And its movement is so complex. I mean, what other joint do we have in our body that, under normal movement, practically “dislocates” itself every time it moves. Let me explain….
On either side of the jaw bone (the mandible) we have two rounded “knobs”, called condyles, that fit into recesses that are in the skull. Situated between these condyles and the skull is a cartilage pad, or disc, …. one for each side. This basically forms the TMJ that we’ve been talking about. When you open your mouth, yawn, chew, or speak… during the first few degrees of opening, these “knobs” (or condyles) basically rotate, or hinge, in their sockets. But then — and this is what makes the TMJ look like it’s dislocating — the jaw translates, or moves forward as it continues to rotate open. Remember the disc I was speaking of? … Well, during the forward translation, the condyles of the mandible basically ride this disc like a sled. In other words, the disc must move, in order for proper opening to occur.
So let me explain why a jaw might “pop” or “click.” Like two synchronized swimmers going for the gold, the left and right TMJ must work in perfect unison to pull off a properly functioning jaw. It’s when they get out of synch (for any number of reasons) that we start to run into problems. Basically one of the TMJ’s continues to move as normal and the other one gets “hung up.” As one opens their mouth, with the normal moving TMJ going through its motion of rotating in its socket and then sliding forward on the sled-like disc, pressure in the dysfunctional joint — on the other side- — builds up until the leverage from the normal moving side literally pries it free causing the classic, and disconcerting, “pop.”
The chiropractic approach to this problem, as I’ve alluded, is to look at the mechanical demands that are playing on this upper most joint in the kinematic chain. By offering mechanical balance, through chiropractic adjustments, to the foundational joints below the TMJ, jaw stress can be alleviated. We also look to the muscles that affect the jaw — either directly or indirectly. The chewing muscles, for example — also called the muscles of mastication — literally form a “hammock” that support the jaw. If one side of the hammock is tighter than the other because of accumulated stress, the jaw begins to deviate and problems have a tendency to ensue. Manual trigger point therapy to these muscles can be extremely effective. Also, sometimes the jaw itself needs to be adjusted. Chronic inflammation in the TMJ has a tendency to breed adhesions which literally “cement” the movable disc in the joint… creating all sorts of problems. The jaw adjustment is able to get this moving again… bringing about proper function.
Once again…. the treatment as I said before — regardless of what it is or who is doing it — is really all about enhancing, or resurrecting, the TMJ’s adaptive abilities. Not necessarily “fixing” the problem. Sometimes the conservative efforts of chiropractic are enough for the patient. Other times they do not advance the patient adequately and more invasive procedures focused on the jaw and the teeth are needed by a Dental TMJ specialist.
But the appeal of chiropractic is that oftentimes it is enough. And it can be considerably more cost effective. And plus we’re not taking a patient through procedures that are irreversible — that may not be needed… like filing down teeth.
Take for example this analogy. Now, I hope that the practice of filing down teeth in an effort to improve one’s bite because of TMJ problems is only reserved for the most extreme of cases, but this is kind of like a door that drags across the carpet every time you open it. One approach to fix it would be to trim off the bottom portion of the door to provide additional clearance — allowing it to swing freely. Another approach would be to look beyond the obvious and to check the hinges. By adjusting the hinges, the door can once again regain its normal function as it used to without reshaping the door.
Of course a little WD-40 wouldn’t hurt either.
[outro theme music]
Dr. Lamar: Well, that about fulfills my TMJ’s quota of 2000 times a day. Logan, why don’t you finish up the show.
Logan: No problem. Hey, we want to remind you to tell your friends and family about our show. Let’s make this thing go viral.
Spinal Column Radio would like to remind you that true health comes from the inside out — not outside in. As such, the content of this podcast, along with the show notes and related links, is not intended to cure, diagnose, treat, or prevent any disease. But, instead, is meant to inform and inspire you in asking better questions regarding your health. Since the circumstances surrounding your particular situation are unique, you are encouraged to consult with a Doctor of Chiropractic — or other health care practitioner of your choosing.
Next time on Spinal Column Radio, Dad’s going to take you to the other end of the spine — when he talks about a Pain in the Butt. So, until then, for my Dad, who’s resting his well-used TMJ, this is Logan Lamar, the son of your podcast chiropractor.
Spinal Column Radio is a production of Spinal Column Communications in conjunction with AnchorChiropractic.net. Copyright 2010.
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