What is my TMJ?

Pain with chewing can be caused by dysfunction of the temporomandibular joint (TMJ). The TMJ is formed by the mandible (highlighted in blue in the picture below) and the mandibular fossa. The mandibular fossa is a depression in the temporal bone of the skull in which the jaw bone inserts (circled in red below). If there is a dysfunction of this joint, it can lead to a plethora of symptoms including ringing or fullness in the ears, headaches, neck pain, and pain with chewing. 

Pain from the joint 

If there is dysfunction inside the TMJ itself, this can cause pain with chewing. When you open your mouth, the portion of your jaw that inserts into your skull must roll and glide forward. There is a disc inside the joint to lubricate this motion. Sometimes the jaw will slip forward too much in the joint when you open your mouth and slide right off the disc. This causes a popping or clunking sound and is often painful. 

Pain from the muscles 

The muscles of mastication (the muscles you use to chew) can also cause pain when chewing or eating. There are four muscles of mastication: the temporalis, masseter, lateral pterygoid, and medial pterygoid. All these muscles help to either open or close your mouth. These muscles can become painful with TMJ dysfunction or if they are overused such as when grinding your teeth at night. If these muscles are overused they can cause joint restrictions and headaches. 

How can physical therapy help?

Physical therapy can help TMJ pain by addressing both the muscular and internal joint components of this problem through joint mobilizations and soft tissue work. 

This may be the most frequently asked question I get: My low back hurts, what should I do about it? The answer is clear: it depends! There are any number of different anatomical structures and disease processes in the low back that can be the cause of your pain. And sometimes there are no clear causes from any particular structures! We call this non-specific low back pain, and it occurs quite frequently.

However for our purposes we will group back pain into 3 categories:

1. The Annoying Ache

2. The Sharp, Stabbing “I Can Barely Get Out of Bed” Pain

3. The Serious “I Need To Go To The Hospital” Pain

We will deal with number 2 and 3 today. The first thing to cover is the red flags, meaning warning signs that you should head to the ER. Here is a basic list of the most important:

1) Bowel and Bladder Changes: meaning either urinary retention (being unable to urinate), or bowel incontinence (being unable to hold back a bowel movement), although any changes in your bathroom habits should prompt a discussion with your doctor.

2) Saddle Sign: If you have numbness or tingling in the area between your legs or buttocks (anywhere that would be covered by a bicycle seat) then you should also skip straight to the ER. If you want a picture of what this means, find the Wikipedia page for Cauda Equina Syndrome.

3) Significant Neurological Signs: If you are noticing significant weakness, your foot is dropping, your legs are collapsing under you, or both legs are painful, numb, or tingling then you should seek direct attention.

Obviously if your pain is so great that you cannot stand it, then by all means go to the ER. But just pain is likely not indicative of something that needs urgent surgical treatment.

So with those exceptions out of the way, what do I do when I have sharp, stabbing back pain that is keeping me from moving? Here are 3 principles:

1. Total Bed Rest is NOT best: You likely will have to take it easier and modify or stop many of your normal activities that cause an aggravation of your symptoms, but you should not just lay in bed and not move at all.

2. Pay attention to what aggravates your pain: If you know what brought the pain on, that is great. But whether you do or not you should try to take note of things that make the back feel better or worse so you can share this with your PT. For example, “I tend to notice that my pain increases with sitting for a long time or with bending down to tie my shoes, but it feels better when I stand and walk around.”

3. Gentle movements that reduce pain are beneficial. Try things like lying on your back and bringing one, or both knees up to your chest. You can also try lying on your back with your knees bent up, then letting your knees and legs rock back and forth gently from side to side. If you are able to, you can assume a cat/cow or Child’s pose position, or even try a Cobra. All of these depend on if you are able to tolerate the position and movement without aggravation of your pain. Again, gentle movement helps calm the back down, too aggressive and you can re-irritate the back. Your therapist will help you find this balance when you are able to come to your session, in the meantime, try your best and err on the side of caution.

Make sure to check back next time for what to do with that annoying aching pain!

If you are having achy pain in your knees or specifically around your patella (kneecap) with prolonged running, sitting, or with stairs and squatting you may have a condition called Patellofemoral Pain Syndrome (PFPS). This syndrome is caused by irritation and inflammation of the articular cartilage on the underside of the patella (Chondromalacia Patellae) and can be due to various anatomical or biomechanical faults. This does not, however, have to be a lifelong struggle with pain as there are many ways to address the improper movement patterns around the knee that be used to return you to your optimal function. 

 

So what is PFPS? 

When the knee is working properly, the patella will glide smoothly between the femoral condyles in the trochlear groove (see image) during knee flexion and extension. With PFPS, this is not the case and can be due to multiple factors. If you have decreased mobility and/or muscular control at the hip and ankle, this will lead to an improper positioning and tracking of the patellofemoral joint especially during weightbearing activities. This causes an increase in the irritation of the cartilage beneath the patella. Weakness in the quadriceps muscle can also affect the pulley-like mechanics of the patella and play a direct role in patellar movement. Tightness of the connective tissue surrounding the patella (retinaculum) can be another big factor in improper patellar positioning. If the lateral retinaculum is too tight, it can pull the patella out of alignment during knee movements. When someone is suffering from PFPS, they may have one, two, or all of these impairments that contribute to their knee pain. 

What is the treatment for PFPS?

Physical Therapy can be used to alleviate the symptoms of PFPS by addressing the improper biomechanics at not only the knee, but also at the hip and ankle. A Physical Therapist will utilize various tests and measures in their examination to determine the cause of your specific knee pain and the impairments that need to be addressed. These impairments may be limitations in joint mobility, problems with muscular control around the hip knee and ankle, or simply weakness surrounding the joints of your involved leg. While PFPS is not limited to runners, a majority of knee pain with running can be attributed to the patellofemoral joint. If you are a runner, your Physical Therapist can utilize a running gait analysis to better understand what increased stresses are being put on your patellofemoral joint, and at what portion of your gait cycle they are occurring. Regardless of your activity level, your physical therapy treatment will be specifically tailored to your needs in order to get you back to an active lifestyle without being limited by knee pain. 

 

What contributes to my balance?

Balance is essentially made up of three components: your vision, vestibular system, and proprioception. We will break these down further! 

 

Vision and balance:

Vision is one of the major contributors to balance. Looking at your surroundings provides input as to where your body is in relation to the wall, the floor, etc. For example, your brain registers that the wall is vertical in front of you and that keeps your balance in check. If vision is impaired or eliminated it will have significant effects, try to stand on one leg with your eyes closed! 

 

Proprioception and balance: 

Proprioception is knowing where your body is in space. Proprioception is accomplished through the joint receptors in your muscles, tendons, and ligaments. For example, this is how you would know if your finger is bent or straight while closing your eyes. If the muscle, ligaments, and tendons are not doing a proper job with this task, then the input to your brain will be decreased and balance will subsequently be decreased. Ways to challenge proprioception are standing on foam or an uneven surface. 

 

Vestibular system and balance: 

The vestibular system is housed in the inner ear inside your head. This system provides input to your brain about which way your head is turned and if your head is accelerating or decelerating. If the vestibular system lags behind, it can affect your balance during quick movements of the head. Examples are turning your head when you hear an unexpected noise while walking, or looking up to see an airplane. If the vestibular system is lagging, it can also affect eye movement which crosses over into the “vision and balance” portion of this blog. Lagging of eye movement when quickly moving your head can cause imbalance.

 

Other things that might affect balance:

One other thing that may affect your balance is medications. If you have had a recent medication change or change in dosage that could likely be causing light-headedness. This can especially happen with medications for high blood pressure.

Orthostatic hypotension is another condition that can cause light-headedness when going from laying down to sitting/standing, or from sitting to standing. During these positional changes, your blood pressure drops then has to rise back up to where it was. If the blood pressure takes too long to return to normal you will feel light-headed. Those high blood pressure medications are one of the things that can cause this process as they decrease the amount of fluid in your blood. The solution to this problem is to stay hydrated and move slowly when getting up! 

We can help!

If you are experiencing any or all of these conditions, we can help! Same-day/Next-day Appointments are available. Please visit www.frederickpt.com or call (301) 663-7898 for more information.