TMJ And Neck Pain, Need Help With San Leandro Chiropractic Care

March 2, 2011 by drburt

This blog post is based via interaction on the AskDrBurt a Question Blog. This is a real case, real patient who is searching for a solution to his never ending pain. It is a very long post and if you are a health care practitioner feel free to add your professional advice in a comment area. If you are a reader, and also have health related problems without a solution from your current medical practitioner please contact me via AskDrBurt a Question?

Thanks for the very concise and informative blogs Dr. Burt! I would like to ask for advice on presenting my symptoms to health care providers. I have been suffering TMJ symptoms for at least two decades if not more, but none of my health care providers wanted to consider TMJ disorder as a cause. Instead they seem to dismiss the idea and only treat symptoms when they’ve become severe and pretty blatantly obvious. Background/History:

1. Had a fall at age 10 (I’ll be 40 this year) that fractured/dislocated my jaw. No treatment at the time, as it appeared the injury would self heal and any manipulation might affect growth. Since that fall my jaw has always locked, popped,and grinded. It is also very small and my lower teeth have always been crowded.

2. Had ‘braces’ from age 12-14, doc seemed to push my lower jaw back when fitting a bite position for me, and it was always uncomfortable. My lower teeth are extremely crowded and within 2 months after removal of braces/retainer several of the teeth moved back again due to crowding, affecting any hope of a normal bite.

3. Have had significant tinnitus and frequent unexplained ear aches and jaw pains for years. Was told in early 2000’s that I grind my teeth very loudly at night.

4. In 2005 I cracked a 2nd to back/upper molar by night grinding. Began wearing a ‘boil and bite’ mouth guard’ (haven’t had dental insurance, didn’t prioritize or couldn’t afford a custom guard).

5. In 2006, I cracked a lower 2nd/back molar, and had to have it crowned. Still wearing a mouth guard, I cracked both the temp crown and the permanent crown through night grinding.

6. Bought a tempurpedic matress topper and tempurpedic cervical pillow in hopes the highly recommended product/brand would alleviate some of the grinding. It has helped and improved sleep quality too!

6. After that experience, I gave up caffeine, stopped any gum chewing (never was much for it anyhow), began eating organics, regular yoga and massage, and between 06 and present consulted with a family therapist for work stresses as needed. I do regular cervical stretches (provided by physical therapist) get massages and do TMJ self-massages. Life is very low stress right now (got my masters in 2010 and it’s my only debt, woohoo!) but my symptoms continue to worsen, which is pretty stressful as now I’m in constant pain. I am very fit and active, but very gentle on my neck/head with any activities. Unfortunately I’ve had to eliminate all but gentle stretching over the last 6 months due to neck/jaw/upper trap muscle spasms.

7. In 2008, after suffering pain, burning and numbness in my face, neck, shoulder, arms and hands, with loss of fine motor skills in my hands/fingers, I was diagnosed with a completely dessicated C-6/7 and a nerve-compressing herniation at 5/6. Orthopod performed dual discectomy and fusion with plate and screws. He informed me my pain tolerance was very high and I should be cautious of anything ‘uncomfortable’ vs. letting things become painful before seeking medical care. He tried Flexeril (and then Amrix), Mobic, and Vicodin as needed for 3 months before surgery. I asked if I would participate in physical therapy after surgery, but he said no the surgery should fix everything. There was no trauma, no accident, no specific injury that lead to this situation. Doc even diagnosed ‘undetermined’ for the cause. Seems a bit unusual to do that much damage and not want to find or diagnose a cause?!?

8. About 6 months later I began noticing the return of the hypertonacity in my SCM, levators,UT, and rhomboids. Last summer I gave up working out all together (other than stretches), my doctor put me on flexeril, which did very little for 6 months. In December she sent me to physical therapy (severe loss of range of motion in side to side neck movements, and severe loss of motor functioning in my hands with new burning/numbness). PT performed chiropractic manipulations from the thoracic region up to my c-spine, a minimal (maybe 2-3 minutes max) amount of muscle manipulation (the area directly to either side of my spine, thoracic up to c-spine), and traction 3x a week for 6 weeks. He also gave me some shoulder stabilizing exercises which did provide great and quick relief to a quickly rounding posture. I continue those at home. The PT provided temporary relief of the symptoms in my hands/arms but the neck/jaw/upper back symptoms remained, and any week that I was not able to get

all 3 sessions (Christmas and New Years the office closed), my symptoms came back within 3-4 days. 2 weeks after the end of PT, I was back to my original limitations and pain.

Last week my primary sent me for X-ray (TMJ specific) and a new C-spine MRI. She also ordered a TMJ specific MRI but that has not yet been scheduled. Waiting for the doc to call for my follow up post radiologist report. A good friend of mine is a radiologist in CA, so I sent him a copy of my films, and anecdotally (as a friend and I realize it’s not considered the best practice) he noted what appears to be a significant herniation at C-3/4 on the MRI. The x-rays were not of very good quality and he suggested I may need new films, but he said it was clear that my disc is no longer recognizable in the TMJ joints, there is significant condyle (sp) degredation and evidence of adhesions.

In addition, I have been treated at the same dentist office by 2 dentists since 2008 and have always asked about my jaw issues, and noted that the only way the dentist could even work on my back teeth was for me to manually dislocate my jaw to open it wide enough. My dentist has been replacing amalgam fillings with composite to ensure better strength of those teeth that formed cavities in my childhood (havent’ had a cavity since 1982). At one point, my original dentist stated she wanted me to see a maxillo facial surgeon before completing my work, the last of which was to replace the crown I destroyed in 06 (yes, I dealt with the searing sensitivity of a ‘nub’ for 5 years..I can tolerate a significant amount of pain, and I have always been VERY particular with my dental care). She left the practice before finishing the work, and my new dentist avoided the subject on several occasions when I mentioned the referral. He said ‘we don’t refer unless things are bad’…to which I let him know my history of symptoms, self treatment, and injury from ‘unknown cause’. His reaction ‘yeah, wow that IS kind of bad”. End of discussion. He encouraged me to have the last crown placed, despite my voicing concerns that it would increase TMJ grinding, but he said it wouldn’t be a problem if he gave the crown a low profile. He was absolutely wrong. I have had to go back for 2 sessions of dental work where the crown surface was lowered, and the two teeth surrounding the crown, and one on the top jaw have also needed reduced as they are not under greater pressure with the new crown placement.

The only consistency in 30 years has been the night bruxism. The rest of my spine is happy and healthy, and symptoms have progressively radiated from the TMJ area down my head, neck and arms.

I apologize for the mini-novel, and if you can give any guidance I will be extremely grateful. I’m at the end of my wits as to why practitioners continually ignored that something was at the root of my symptoms as the symptoms have been significant. I now am wondering what can possibly be done if 3/4 is severely herniated as I already have 3 vertabra fused in my C spine?!? I don’t want to become disabled or severely limited, and if that’s the case I’m beyond frustrated that none of my practitioners ‘stepped up’ to give this proper attention. Any suggestion made by a practitioner has been followed to a T, but those have been rare. As of late, I started seeing a new primary and she is very interested in helping me come to the root of my symptoms, thank goodness.

I feel I am articulate (sorry, I know verbose fits this note as well) intelligent, patient, motivated, very healthy, active, self-aware, avoid any and all medications unless necessary, and find preventative care (such as healthful living, stress reduction, massage, chiropractic, etc) to be the best way to lead a healthy life.

So, how can I share this succinctly with practitioners as we go forward in the process of discovering a cause and hopefully finding solutions for the cause vs. remedying damaging and continual symptoms? I don’t want to sound whiny or self-involved, but after 30 years of this, and at least 10 years of being handed off to someone else or some other practitioner….only to utilize their every resource and still have issues (hello, TMJ disorder anyone?) I’ve lived through more pain, limitation and frustration than a person should expect in this day and age with our advanced medical system.

Thank you so very much for your time. I appreciate any advice. Confidentiality and discretion is also appreciated 🙂

Dr. Burt’s Answer:

Got your message via AskDrBurt a question. Long history of problems that have been avoided, ignored or misdiagnosed in the past. My main concern is the surgery that was performed on your cervical spine. Post surgical scar tissue formation is the main cause of excessive pain in your cervical spine. No Post Surgical rehabilitation was performed, such s physical therapy. I do not understand how come your surgeon said:”The surgery will fix the problem.” WOW. Limited ROM is making things even worse in your neck. Intervertebral discs stop getting their nutrition the moment the two adjacent vertebraes stop moving – process called imbibition. Solution – life long manual cervical distraction and maintaining whatever is left of a cervical lordosis. I have couple of products on my blog that would be of a great benefit to you. If you are interested I could send you direct links and you can evaluate them.

TMJ – TMJ is very closely related to a cervical spine. There is a close neurological relationship between TMJ and Cervical Vertebral Joints. The question is – did your jaw healed properly after it was fractured? If yes, then there is still some hope in correcting by special cranial work (S.O.T. technique – Sacro Occipital Technique) It is very hard for me to provide more recommendations as I would actually need to see, examine, evaluate and make my own diagnosis with areas of concern. Doctors of Chiropractic look at the health related problems from the causation point of view and not symptoms point of view. Find the cause and the problem will be fixed. Feel free to ask any additional questions. Perhaps by helping to find the proper solution to your problem is going to be the first step, second would be to find the proper health care practitioners.

PS: Would you like me to post your health history and the problems that you had with previous doctors on my blog? can keep your name confidential if you like, so no one will know who you are. This will open a door to many other health care providers reading your story and possibly commenting and adding valuable advice to your health related problem.

Talk to you later

Reader’s Response:

Wow, thank you so much for your prompt response! I couldn’t agree more with your statement that fixing the cause usually resolves the symptoms, and that is my main mission now.

Unfortunately, the jaw was never re-evaluated after the initial fracture/dislocation at age 10. If I had to estimate, I would say ‘no’ as that’s precisely when the popping, locking, grinding sounds upon movement began.

Considering I only have the axis, atlas, 3 and 4 discs left in my c-spine (not sure I got the anatomy properly identified with those terms) I have always done as much to keep range of motion functional post surgery. 2×3 times a day I use a heat pack (dry rice wrapped in flannel) stretching under warm shower, and PT generated cervical stretches (I also use a stretching strap, theracane, pro-stretch for calves and mini-tough tennis ball to roll the balls of my feet, and a foam roller for myofascia release), and now spend most of my time at a standing desk, as only standing and flat supine laying down do not cause significant pain/numbness….if it can help, and it’s not surgical or drugs, I’m willing to try it. Please do send me links to the products you mentioned and I will determine if they are within my budget. Unfortunately I’ve not been able to work much due to the pain and the limited amount of time I can spend seated during travel, ugh!

Another concern….should I be wary of the x-rays recently taken…as the tech had me lie in a prone position and placed my head on what was like a slightly inclined podium on the x-ray table? How could joint position possibly be properly evaluated since I have a hard time with ROM on rotation, and the pressure point ended up right ON the TMJ area? Tech had to take 5 attempts on the left side, 8 on the right. In addition the MRI tech decided against the deliberately ordered contrast for the MRI, and there appears to be a black blurred area around my fusion and above due to the titanium. I would certainly have traveled to a larger metropolitan area if I had the funds available, but as an entrepreneur I’m without health insurance at present. I KNOW things will get better, I KNOW this will pass.

I suppose it can’t be too terribly invasive to post my information after removing identity…please feel free to edit anything as you see fit if it will make it more relevant to other practitioners.

I understand you cannot evaluate beyond the anecdotal information but I cannot tell you how absolutely grateful I am for your consideration and suggestions.

Again, thank you from the bottom of my heart for your reply, suggestions and care. If there is anything I can do to promote your business, your blog (through my blog) or your products please do not hesitate to share that process with me. I will oblige and remain extremely grateful.

Attached the x-ray taken a few weeks after the fusion 09 June 2008. What lordosis, ha!?! Sorry that IS humor albeit sarcasm…if we can’t laugh at ourselves…… ;0)

Very Gratefully,

Reader wished to keep his identity anonymous.

Dr. Burt’s Answer:

Hello again,

I agree with you 100% that your X-Ray tech just radiated you for nothing. Spine is a weight bearing structure and responds to weight bearing stresses. You could see better what is going with the spine when you shoot X-Rays in a standing position. Full spine X-Ray is an optimal if possible. Lower back problems are related to your neck problems. Every single subluxation and curve in a cervical, thoracic and lumbar spine must be taken into consideration in order to achieve the best results possible. I would not expose myself a second time to an additional dose of radiation at this point and time. The is still a small presence of cervical lordosis which is a positive sign. There is nothing that can be done at this point and time with your lower cervical spine. Sorry to say, but too much damage has been done by your orthopedic surgeon. The goal at this point is to keep the vertebraes and IVD (Intervertebral discs) from degenerating farther. If I would be you I would get these two products: #1. Bodyline BDL127 The Neck Decompressor and #2 Posture Pro Corp. POS107 Deluxe Full Spine Posture Pump Model 4100

Neck Decompressor will keep your IVD healthy and Posture Pump will help to keep cervical and lumbar lordosis in order. I use these products on myself and the members of family.

When the blog post will go live you can continue the conversation via DISQUS, thus many other doctors can add value to your condition.

PS: If you are a health care practitioner and got to the end of this blog post feel free to add any recommendations for this patient. Thank you.

7 Major Causes of Lower Back Pain?

January 5, 2011 by drburt

Millions of people are affected with lower back pain all over the world. It could be a minor and temporary pain and it could be as extensive as referring pain into upper and lower extremities. There are different factors and causes of lower back pain. Below is the list of 7 major causes of lower back pain.

SPRAIN AND STRAIN:

A deconditioned lower back and the one with previous injuries is more prone to soft tissue injuries like sprains and strains. An overstretched muscle is a definition of a sprain injury. An overstretched tendon is definition of a strain injury. Both injuries result in fibrotic tissue which is extremely painful if not properly and timely rehabilitated.

DISC PROBLEMS:

The IVD or intervertebral discs (look at the main picture) are serving a function in our spine as shocks or struts in a vehicle. Their job is to prevent the vertebral bodies of the spine from degeneration which in medical term is called osteoarthritis. Lack of mobility between vertebral bodies will cause the IVD to dehydrate and eventually shrink in height. IVD does not have any blood supply and the only way it gets the nutrients is by the process called imbibition. In plain English – when two adjacent vertebras move they help to pump liquids with nutrients into the IVD. Common disc complaints involve the disc protrusion or bulging (which can be prolapsed or sequestrated) the later is a very bad one. Make sure that you schedule your appointment with your local chiropractor at least once a month. Our body just like the vehicle we drive, it requires maintenance.

MUSCLE IMBALANCE:

Muscle imbalance is the cause of a poor posture. Over the time certain muscles loose their function under overworking conditions or when they are under utilized. If this happens the inevitable result will lead to problems such as neck pain, shoulder pain, and lower back pain or even frozen shoulder.

EMOTIONAL:

Emotional problems linked together with neuromuscular system. Stress or emotional trauma would lead to muscular tension. Muscles such Upper Trapezius and SCM (Sternocleidomastoid) are innervated by cranial nerves (which are the nerves that are connected directly to the brain).

STRACTUAL PROBLEMS:

Scoliosis – an excessive sideways curve of either the upper or lower regions of the spine. Kyphosis – sometimes referred to as “hunchback”, this is an excessive outward curve of the upper back.

DISEASE:

Ankylosing spondylitis – a disease that causes inflammation in spinal joints and limb joints potentially leading to fusion of vertebrae Arthritis – especially osteoarthritis, involves cartilage that normally cushions joints breaking down. Osteoporosis – is a condition involving thinning of the bones. It commonly occurs in women after the menopause but can also affect men.

SCIATICA:

Sciatica is a nerve pain from the sciatic nerve, a nerve that runs from the spine through the buttock and down the back of the leg. Sciatica is often caused by a disc bulge or prolapse pressing on the spinal nerve. Other causes can include a narrowing of the nerve tunnel between the discs as a result of osteoarthritis. If you would like to discover how to completely cure sciatica naturally without drugs, surgery, physical therapy, exercise, or change of diet you might want to take a look at this report “Stop Sciatica.” (affiliate link)

Please Post a comment below or share your thoughts through Facebook, Twitter or comment section below to join the conversation. Feel free to add any additional tips.

Lower Back Pain and Seven Herbal Remedies

December 6, 2010 by drburt

Billions of dollars spent every year in U.S. alone on a treatment of lower back. Even more money lost on a productivity. Elderly people are more prone to have lower back pain due to the loss of elasticity of soft tissue surrounding the spine. Younger generation is too busy at work and often times experience lower back pain as well due to prolonged sitting at their desks. There many different pills, supplements, pain relievers, and many other substances that can help relief the pain.

However, many people choose not to take pain relief medicine that contains chemicals and artificial ingredients. Instead, lower back sufferers choose herbal and home remedies. From doctor’s point of view it is not a solution to a sprain/strain injury, or overuse injury. However, these remedies can provide some temporary relief and there are no side effects, unlike NSAIDs. Below is the list of some herbal treatments that can provide lower back pain relief.

1. Combination of concoction of turmeric, some ginger and garlic in a small amount warm water can be used for massaging the painful area. Ginger’s aroma will penetrate a skin layer and will help to relax the muscles of the effected area. This method can be used every day, and it is totally safe without any side effects.

2. Boiling ginger and drinking its juice is a good relief for back pain and sore throat. Keeping it hot and steaming will both help. The warm water that goes to your body helps alleviate lower back pain.

3. Vegetables must be an important part of your diet. Sulty and fatty foods must be avoided at all times. Lower back pain relief can only be achieved by proper monitoring of your diet and daily activities. When in pain, it is always recommended to first try home remedies before taking all sorts of pain killers. If both failed, contact your local Chiropractor.

4. Get into soft diet. Constipation can contribute to lower back pain. Make sure you detoxify daily by eating food rich in fiber. It is one good treatment for lower back pain relief. Here is a list:

Legumes & Lentils: Dried beans, peas and other legumes including baked beans, kidney beans, split peas, dried limas, garbanzos, lentils, pinto beans and black beans. Green beans, snap beans, pole beans, lima beans and broad beans. Dried fruit such as figs, apricots and dates. Fruits like raspberries, blackberries and strawberries, cherries, plums, pears, apples, kiwi fruit, guava, banana. Pears contain more fiber than prunes.Vegetables like Fresh or frozen green peas, broccoli, Brussels sprouts, Sweet corn, beet root, baked potato with the skin, carrot. Greens vegetables including spinach, beet greens, kale, collards, Swiss chard and turnip greens. Nuts such as almonds, Brazil nuts, peanuts, pistachios, and walnuts (Nuts are also high in fat content, read calories in nuts.). But pistachios are the lowest in calories and fat of all nuts, and a one-ounce serving has three grams of fiber. Whole wheat and barley products Rye, oats, buckwheat and cornmeal. Coconut (this is also high in saturated fat).

5. Chamomile and licorice can be boiled together to make tea. You can drink it while it’s still hot. The warm water and the natural scent these herbs produce can help tired and painful muscles to relax and be re-energized.

6. Red pepper is often avoided due to its flavor. However, if you can help it, include red pepper especially cayenne to your diet. It has an ingredient called capsaicin that is best to relax muscles. Meanwhile, there are creams that include this kind of ingredient for lower back pain relief.

7. Another effective lower back pain relief is to hydrate yourself. Make sure you drink 8 to 10 glasses of pure water everyday. Herbs like mint cool the body. You may also drink fresh fruit and vegetable juices.

Unless you have been involved in an accident or strenuous workout, common lower back pain can be treated with warm water and herbal treatments. Stress related back pain only needs to be relaxed and you will feel results in a few minutes.

If pains persist, make sure to make an appointment with your doctor. For herbal lower back pain relief also, you need not be consulted with a doctor, however, if you choose to take over the counter medicines, make sure you check with your medical doctor on what is best in relieving the pain.

Will this article make you reconsider your own health choices? Post a comment below or share your thoughts through Facebook, Twitter or comment section below to join the conversation.

Chronic Lower Back Pain and 6 Natural Ways to Fix It

November 22, 2010 by drburt

Millions of people suffer from excruciating and immobilizing lower back pain form all over the world. It almost seems like world wide epidemic. A large percentage of these people have to go to work every day and concentrate on their tasks with agonizing and boring back ache. There are many different treatments available for lower back pain varying from modern medicine to great alternative therapies.

Chronic lower back pain causes:

Cancer, Osteoarthritis, Osteoporosis, Fibromyalgia, Biomechanical Misalignments, Unbalanced Musculature are the main reasons for lower back pain. Work or sport related injuries or automobile accidents could be the serious cause of lower back pain through out people lives. It can debilitate them for a very prolonged period of time. Sometimes even minor postural abnormalities, sudden jerks or movements, improper exercises and minor falls can be the result of chronic lower back pain

Natural Ways to Counter Severe Chronic Lower Back Pain:

Change Your Posture:

The spine, same as our feet, gets the hardest job in our body as it is used in practically every movement we make and it takes pressure from other body parts such as from the neck, shoulders, head and our arms. As we walk, stand, sit, carry a heavy object or dance, our spine takes the pressure to keep our body erect but at the same time it also has to have the flexibility to make other kinds of movements while keeping our balance.One of the following can be noticed when one has a bad posture: high shoulder, a forward stooping head, a rotated trunk (torso), a hunch back, a high hip, and a side-bent neck and one of the feet will be externally or internally rotated. Abnormal posture can result from trauma (like a car accident or fall), repetitive movements (turning your neck towards the monitor), and certain bad postural habits (sleeping on your stomach). READ MORE …

Get a Good Mattress:

Many patients have been asking my professional advice on which mattress they should buy. There is not a definite answer for every patient. Every single one is going to need a different one in order to get a good night sleep for years to come. Below are some tips and tricks that you can use when buying a new mattress.A mattress should provide uniform support from head to toe. If there are gaps between your body and your mattress (such as at the waist), you’re not getting the necessary support that your body requires. READ AND WATCH MORE …

Get Good Pillows:

When we expect a good night sleep, the majority of us consider mattress characteristic and features, room temperature, room illumination, and noise. Hardly ever we will think about our pillows. There are a lot of options available nowadays. It is important to know that our cervical spine alignment is an important feature of our general well being. Selecting a head support which is equally comfortable to sleep with as well as be able to improve the quality of good night sleep, has to be a necessary foundation for a good nigh sleep. READ AND WATCH MORE …

Use Legs Not Back:

Normally when we lift a weight we put great pressure on our back. Instead, keep your lower back in arched position and lift the load. Bend the knees and put the pressure on your leg muscles. An upright torso while lifting weights can always avoid the risk of chronic lower back pain. READ MORE …

Exercise Routines:

Inclusion of a strict exercise regime for 30 minutes to one hour, everyday can alleviate chronic pain and prevent the occurrence of the same. If you are suffering from chronic lower back and hip pain, it is imperative that you take the advice of a fitness expert. Only a fitness expert can help you with an exercise routine, according to your body condition and physical ability. Body alignment exercises, Bowen therapy and exclusive exercises for the lower back can strengthen the back and abdominal muscles. MORE ABOUT EXERECISES …

Choose Comfort Over Style:

Ladies today choose stylish footwear that are high-heeled like stilettos. They can definitely accentuate your presence but they can damage your back, irreparably. A sturdy shoe and flat footwear can definitely look good on you and save you from many an endless chronic lower back pain treatment. You can stop chronic lower back pain by being cautious and rational. READ MORE …