A Note From Dr. Fields

This section addresses conditions such as headaches, jaw and TMJ pain, and dizziness.

While I hope this information is useful, it is not meant as a substitute for a diagnosis from a physician.

Feel free to give us a call if you have questions. You can request a free consult below.

Head and Jaw Conditions

TMJ/Jaw Pain

Temporomandibular joint syndrome, or TMJ syndrome, is a dysfunction in the jaw joint on either or both sides of the jaw up by the ear that can be associated with headache. The mandible (jaw bone) attaches to the skull at the temporal bones (cheek bones). At the junction of these two bones there is a soft fibrous disc that helps to guide movement and reduce stress. Surrounding the joint is a ligamentous capsule that helps to keep the joint in place. The muscles that move this joint include the masseter and temporalis which are the jaw closing muscles; infrahyoids and suprahyoids which are groups of muscles in the front of the neck that open the jaw; and the lateral pterygoid and medial pterygoid that are mostly responsible for side to side movement. Some of these muscles also produce protrusion and retraction of the jaw (chin forward and backward positions). In reality, it is actually the combination of all of these muscles working together in the correct firing pattern that produces all the jaw movements.

There are three basic types of dysfunctions that cause temporomandibular joint pain.

  1. Compression of the TMJ (synovitis)
  2. Stretching of the TMJ (capsulitis)
  3. Myofascial problems in the muscles around the TMJ (myofasciitis/myalgia)

It is possible for more than one of these issues to occur at a time, or even all three.

Compression of the TMJ can occur creating damage to the TMJ disc. This can cause warping, displacement, or just plain old irritation. If compression creates pain, then this is likely the problem, and the diagnosis is synovitis.

If distracting or stretching of the TMJ causes pain, then it is likely the capsule that is irritated. Remember that the capsule is a set of fibrous ligaments surrounding the joint and is important for keeping the joint in place. If stretching causes pain, the diagnosis is usually capsulitis.

Sometimes the muscles around the joint can become dysfunctional. They can become hypertonic, tight, and tender. This is usually a result of a postural abnormality that causes the muscles to have to work harder than normal. If the muscles are the cause, then the diagnosis is myofascial pathology.

When a patient presents with TMJ complaints, one of the first things I look for is whether proper occlusion occurs… that is… does the mouth shut properly. Do the teeth all fit into each other when the mouth is closed, and is the closed position in a comfortable resting position for that TM joint? If occlusion occurs in a position that protracts the jaw backwards or forwards or left or right, then this can stress the TMJ. Problems with occlusion are common, and it takes a dentist or orthodontist to tackle this part of the problem. Therefore, I feel it is important for Chiropractors to cooperate with these professionals in a team effort to treat TMJ syndrome.

Another thing I look for is the quality of motion when opening/closing the mouth. Many people with TMJ syndrome will not actually open and close in a straight path, but rather deviate left or right slightly in a C-shaped pattern. This indicates that there may be an imbalance in the musculature, specifically the pterygoids.

I also look for a combination of clicking, popping and/or locking of the jaw. Any of these can occur when opening, closing, or both and can shed some light onto the mechanism of dysfunction in TMJ syndrome. Popping in the TMJ typically indicates damage in the disc and possibly arthritic changes in the joint (synovitis).

Treatment for TMJ depends on the diagnosis. Adjustment of the TMJ may not be warranted. Correcting the posture of the head and neck is usually very helpful and therefore adjustment of the neck and upper back may actually be more beneficial than adjusting the TMJ itself. Myofascial release or trigger point therapy (soft tissue techniques) are necessary if the problem is myofascial in nature. Stretches and exercises for the jaw, head, and neck are usually a big part of treatment as well.

If you have pain in your jaw, or if your jaw clicks/pops/locks, then please reach out to us.


Headaches and Migraines

About 5 percent of all headaches are warning signals caused by physical problems that require serious medical intervention. It is important for your Chiropractor or Medical Doctor to rule out this small but potentially life threatening portion of headaches. The remaining 95 percent of headaches are primary headaches, such as tension, migraine, or cluster headaches. These types of headaches are not caused by disease; the headache itself is the primary concern.

The greatest majority of primary headaches are associated with muscle tension in the neck. Today, Americans engage in more sedentary activities than in the past, and more hours are spent in one fixed position or posture (such as sitting in front of a computer). This can increase joint irritation and muscle tension in the neck, upper back and scalp, causing your head to ache.

The American Chiropractic Association (ACA) offers the following suggestions to prevent headaches: If you spend a large amount of time in one fixed position, such as in front of a computer, on a sewing machine, typing or reading. Take a break and stretch every 30 minutes to one hour. The rule that we use at Tulsa Chiropractic Rehab is the 1 min:1sec rule. For every minute you are in a fixed position, do one second of a postural correcting exercise/stretch (namely Bruegger’s exercise). This means you could take a break every 30 minutes and do 30 seconds of exercise, or 60 seconds for every 60 minutes. Low-impact exercise may help relieve the pain associated with primary headaches. However, if you are prone to dull, throbbing headaches, avoid heavy exercise. Engage in such activities as walking and low-imp act aerobics. Avoid teeth clenching to reduce tension. Drink 64 ounces of water a day to help avoid dehydration, which can lead to headaches. Dietary changes and supplementation can also help.

With most headaches resulting from muscle tension in the neck (specifically the suboccipital muscles), simply massaging these muscles may help to relieve quite a bit of pressure and pain. This is something that you could do yourself, but Chiropractors have many highly effective soft tissue techniques to help relax overactive neck muscles and can expertly pinpoint which specific muscle fibers are involved. In combination with cervical manipulation, we can usually completely resolve a headache in a matter of minutes. Keep in mind that it is possible that the headache will eventually return. This is why correcting the postural abnormality causing the increased tension is so important. This is done with a series of stretches and exercises designed to retrain the body to function properly so that those muscles don’t become tight and tense in the first place.

If you suffer from headaches, don’t hesitate to give us a call today. We would be happy to give you a free consultation and answer any questions you might have.

Dizziness

Benign Paroxysmal Positional Vertigo (BPPV)

BPPV is characterized by dizziness with change in head position: for example, laying down or sitting up. This is a condition associated with disturbances of the inner ear. Within the inner ear lies the semi-circular canals, the organ that helps with balance and orientation. When you move your head, liquid inside these canals shifts. Tiny little hairs called cilia move with the flow of this liquid and detect changes in position. This is what gives you your sense of balance and movement in space…at least normally.

A common problem is the development of debris inside the canals called canaliths. These little chunks of calcified material can contact the cilia and send a signal to your brain that your head is moving in a direction that it isn’t. This confusing signal creates a sense of dizziness and causes the eyes to twitch rapidly to one direction. This eye movement, called nystagmus, is the source of vertigo, the sensation that the room is spinning around you.

The problem can be quite debilitating causing nausea, vomiting, disorientation, and disturbances in vision. If you have ever drank too much alcohol and got “the spins”, then you can imagine a mild case of BPPV.

The good news is that BPPV is not life threatening and usually does not worsen over time. There is a treatments for this condition known as canalith repositioning techniques that can be performed by Chiropractors. These maneuvers are performed to reposition the debris in a location that is less disturbing to the cilia and can be quite effective.

The bad news is that the position often incites an episode of vertigo and you will have to spend the next several nights sleeping at a 45 degree angle to prevent debris from displacing again. You will also need to avoid any head positions that would dislodge the debris from its corrected position. The condition may return in the future if debris is “knocked” back out of place.

Cervicocranial Syndrome & Cervicogenic Dizziness

This is a problem with the mechanics in the upper part of the neck that attaches to the base of the skull. Arthritis and degenerative changes in this area can cause irritation of the exiting branches of the spinal cord called nerveroots. You can have a variety of odd symptoms including dizziness. Cervicocranial syndrome and cervicogenic dizziness are different diagnoses technically, but lie in the same spectrum as they are characterized by disturbances in the spinal nerve roots and autonomic system that lie just outside the neck. There is typically neck pain, facial/ear pain, headaches and other sensory disturbances accompanying dizziness in these cases.

Many times manipulation of the area can help substantially. By aligning the vertebra and decreasing inflammation and irritation of the nerves, symptoms usually improve quite a bit or even disappear. I’ve actually seen several of these cases. The results range from mild improvement to immediate resolution. As long as we determine manipulation is safe, it is preferable to try conservative treatment rather than jumping straight to surgical intervention.

Vertebro-Basillar Insufficiency (VBI)

Just to be clear, this is not a condition we treat here, but is a necessary consideration of dizziness. This is a serious condition that can lead to stroke. The vertebral arteries lie inside of the neck bones and feed the back of the brain. There are cases where hardening of the arteries (atherosclerosis) or even a break in the artery wall (dissection) can cause diminished blood flow to the brain leading to numerous symptoms including dizziness/vertigo. I do a variety of tests and take a thorough history to rule out these cases. If I do find evidence of a VBI, it’s either an emergency trip to the hospital, or referral for advanced imaging like angiogram or doppler ultrasound to view the possible blockage.