What is the Temporomandibular joint?

TMJ is an acronym for “Temporo-Mandibular joint” and refers to the joint that hinges the mandible (the lower jaw) to the temporal bone of the skull in front of the ear on each side of the head. We use this joint every time we talk, bite, chew, or yawn. It is one of the most frequently used joints of the body. The temporo-mandibular joints are complex and composed of muscles, tendons, and bones. Each component contributes to smooth movement allowing the upper jaw to close on the lower jaw. This joint is a typical sliding “ball and socket” that has a disc sandwiched between it. When this joint becomes displaced or when the muscles or ligaments surrounding the joint become stretched or damaged, simple movements become painful. TMJ joint

We can locate the TMJ by putting a finger on the triangular structure in front of the ear. The finger is moved just slightly forward and pressed firmly while opening the jaw. The motion felt is from the TMJ. We can also feel the joint motion if we put a little finger against the inside front part of the ear canal. These maneuvers can cause considerable discomfort to a person who is experiencing TMJ difficulty.

What are TMJ disorders, and what are causes of TMJ disorders?

TMJ disorders are a group of complex problems of the jaw joint. This is also sometimes referred to as myofascial pain dysfunction because muscles and joints work together, a problem with either one can lead to stiffness, headaches, ear pain, bite problems (malocclusion), clicking sounds, or locked jaws. The following are behaviors or conditions that can lead to TMJ disorders.

• Teeth grinding and teeth clenching (bruxism) increase the wear on the cartilage lining of the TMJ. Those who grind or clench their teeth may be unaware of this behavior unless they are told by someone observing this pattern while sleeping or by a dental professional noticing telltale signs of wear and tear on the teeth. Many patients awaken in the morning with jaw or ear pain.
• Habitual gum chewing or fingernail biting can lead to TMJ pain.
• Dental problems and misalignment of the teeth (malocclusion). Patients may complain that it is difficult to find a comfortable bite or that the way their teeth fit together has changed. Chewing on only one side of the jaw can lead to or be a result of TMJ problems.
• Trauma to the jaws: Previous fractures in the jaw or facial bones can lead to TMJ disorders.
• Stress frequently leads to unreleased nervous energy. It is very common for people under stress to release this nervous energy by either, consciously or unconsciously grinding and clenching their teeth.
• Occupational tasks or habits such as holding the telephone between the head and shoulder may contribute to TMJ disorders.

How do we do to treat TMJ disorders?

Many TMJ related problems can often be successfully treated without surgery. Our treatment plans generally focus on calming the surrounding muscles and ligaments, relieving the pain and reducing the pressure on the joint. This can be achieved by performing chiropractic adjustments on the temporomandibular joint using a spring-loaded instrument called an Activator. We also reduce tightness in the muscles of the jaw (masseter) and neck using myofascial release muscle work.

The use of Cold Laser Therapy is also a very effective treatment we use to treat and manage temporo-mandibular joint pain. This is an FDA cleared non-thermal (non-heat producing) laser capable of penetrating deep into tissue. Laser therapy has been successfully used around the world for over 25 years, with no reported long-term or irreversible side effect. Many seek relief from TMJ jaw pain through this effective non-invasive form of therapy before resorting to surgery. We have had excellent results using the non-thermal laser to relieve pain and promote healing of this painful issue.

At times, it may be beneficial for your dentist to create a custom-fitted oral orthotic appliance. This is worn by the patient on either the upper or lower teeth and helps to relieve pressure and allows ligaments that have stretched to heal.

Stretching for Jaw Muscles and TMJ relief:

Resisted Close
1. Sit in a comfortable position with your head centered over your shoulders. Keep your chin neutral and parallel to the floor.
2. Keep your head stable, relax your jaw and let your mouth open naturally. Put your index finger against your bottom teeth.
3. Press down on your bottom teeth, gently, while trying to close your jaw. Hold for five seconds, release and repeat five times.

Resisted Open
1. Sit in a comfortable position with your head centered over your shoulders. Keep your chin neutral and parallel to the floor.
2. Keep your head stable, and rest your fist under your chin. If necessary, sit a table and rest your elbow on the table to keep your fist stable.
3. Press up, gently, with your fist while trying to open your jaw. Hold for five seconds, release and repeat five times.

Jaw Rotations
1. Sit in a comfortable position with your head centered over your shoulders. Keep your chin neutral and parallel to the floor.
2. Keep your head stable, relax your jaw and let your mouth open naturally. Slide your jaw forward and back five times. Relax then slide your jaw side to side five times.
3. Slide your jaw clockwise five times. Change direction and slide your jaw counter-clockwise five times.

Open Wide
1. Sit in a comfortable position with your head centered over your shoulders. Keep your chin neutral and parallel to the floor.
2. Keep your head stable and open your mouth as wide as comfortable and stick out your tongue as if doing a wide yawn. Hold for one second then release.
3. Repeat five times and relax.

References:
How to Exercise the Masseter Muscle, Oct 21, 2013, Max Whitmore, http://www.livestrong.com/article/454964-how-to-exercise-the-masseter-muscle
Chiropractic Treatment of Temporomandibular Disorders Using the Activator Adjusting Instrument and Protocol
November 11, 2005. James w. DeVocht, DC, PhD, James w. DeVocht, DC, PhD, Walter Schaeffer, DC, Dana J. Lawrence, DC Alternative Therapies in Health and Medicine, Volume 11, Number 6

http://www.gustrength.com/muscles:masseter-muscle-actions-and-trigger-points
http://en.wikipedia.org/wiki/Temporomandibular_joint_disorder

Inflammatory Foods

Derivation: inflame. My definition: To produce a flame inside you.

Inflammation is the new buzz word now being related to many chronic medical conditions such as: allergies, Alzheimer’s, asthma, high cholesterol and narrowing of the arteries, cancer, heart disease, celiac disease, chronic pain of muscles and joints, recurring “tendonitis”, Crohn’s disease, colitis, I.B.S. (Irritable Bowel Syndrome), dementia, diabetes, eczema and psoriasis, high blood pressure, interstitial cystitis, rheumatoid arthritis, other inflammatory arthritis; fibromyalgia, myofascial pain syndrome, Parkinson’s, slow healing response, osteoarthritis, etc and the list goes on.

So, how can we influence the amount of inflammation going on inside us? One accessible way is through manipulation of our diet. Certain foods have been shown to create inflammation in the body, whereas others can decrease the amount. The following is a list of pro-inflammatory foods: Bacon, bologna, bratwurst, brownies, (white) breads- including buns, rolls and bagels, butter, cake, candy, cereals*, cheese (American, cheddar, creamed, gouda, jack, mozzarella, provolone, swiss), cookies, corn chips, corn syrup, crackers*, cream, croissants, corn chips, danish, doughnuts, egg rolls, french fries, french toast, (deep) fried foods, fruit juices, granola*, hamburgers, hash browns, honey, hot dogs, ice cream, jam/jelly, margarine, molasses, muffins, noodles*, onion rings, pancakes, pastrami, pepperoni, pie, pickles, pita bread*, pizza, pasta*, popcorn, potato chips, pretzels, puddings, relish, ribs (beef or pork), rice (white), salami, sausage, sherbet, shortening, sodas, soft drinks, syrup, tortillas (flour), tortilla chips, waffles, whipped cream, whole dairy.

*Unless 100% whole grain and high fiber.

The following are considered anti-inflammatory foods: Acai, amaranth, anchovies, apples, arugula, artichokes, asparagus, avocado, bananas, beans (green, black, kidney, garbonzo, pinto, lima, and soy), bean sprouts, beets, berries (blackberries, blueberries, boysenberries, goji berries, gooseberries, raspberries, strawberries), bok choy, broccoli, brussel sprouts, cabbage, canola oils, cantaloupe, carrots, cauliflower, celery, cherries, cranberries, cucumbers, dairy (non-fat), eggplant, endive, gooseberries, grapes, grapefruit, herring, honeydew, kale, lemons, lentils, mackerel, mango, mangosteen, millet, mushroom, mustard greens, nectarines, noni, nuts – raw (almonds, Brazil nuts, cashews, chestnuts, filberts, hazelnuts, macadamia, peanuts, walnuts), okra, olive oil, onions, oranges, papaya, parsnips, pears, peas, peaches, peppers (bell and hot), persimmons, pineapple, pomegranate, plums, poultry (no skin), prunes, pumpkin, quinoa, rhubarb, rutabaga, salmon, sardines, scallions, seeds (flax, poppy, pumpkin, sesame, sunflower), spices (cinnamon, cayenne, garlic, ginger, green tea, parsley, pepper, nutmeg, oregano, rosemary, turmeric), spinach, squash (butternut, crook neck, summer, winter, zucchini), sweet potatoes, tomatoes, trout, tuna (water-packed), turnips, water chestnuts, watermelon, wild game, yams.

If you analyze these lists you will notice that pretty much all the fruits, vegetables, beans, nuts, seeds, spices as well as poultry (chicken, turkey, duck) and wild game are on the good list. And guess what? Processed foods, fried foods, breads (not whole grain), sweets (simple sweeteners), fruit juices, snack foods, sodas, margarine, whole dairy, many cheeses are on the “No-No” or “Here Comes the Heat” list. Does this sound all too familiar? Now we have yet another reason to try and reduce or delete from the “No-No” list. To quote Michael Pollan, “Eat food (real) and mostly vegetables”. Simple as that.

Upper Back, Lateral Chest, Posterior Shoulder Use of Foam Rollers – Tips and Techniques

Benefits of using a foam roller is comparable to a deep tissue massage, myofascial release and myofascial trigger point therapy. Myofascial trigger points are taut bands or knots in the muscle tissue that can refer pain to other areas. For example, a trigger point in a gluteal muscle may refer pain down the leg. Trigger points can also limit range-of-motion, inhibit muscle strength and cause muscle fatigue. Regular work can increase flexibility and performance while decreasing muscle tension and pain.

Maximize the effectiveness of the foam roller by incorporating it into your daily stretching routine. Use the roller before and after activity, and always roll before you stretch. This will help to warm up cold muscles and prepare them for deeper stretching.

Make sure you roll on soft tissue and not over joints, ligaments or bony protrusions. Start by placing your body on a roller and slowly roll up and down the muscle. If you find a knot or tight band, hold that spot and try to feel the tissue release and soften underneath the pressure. Take deep breaths and try to keep your body as relaxed as possible.

Use of the foam roller can be painful. If an area is too painful to roll, place your body on the roller for 15 seconds before moving on to the next spot. As the tissue starts to loosen up you should be able to roll with less pain.

For Upper Back (rhomboids, middle trapezius thoracic spine):
Lie with the foam roller under your upper back. Place your hands behind your head with your elbows drawn in slightly toward midline – this allows your shoulder blades to separate. UB1

Draw your belly button in and lift your hips up off the floor using your legs for leverage. Roll up and down on the roller from your shoulders down to the bottom of your rib cage. UB2

For Lateral Chest (latissimus dorsi, teres major)
Start lying on your left side with the foam roller below your armpit and positioned perpendicular to your body. Lean back slightly and extend your left arm out with your palm facing forward.SLDR1

Using your right arm for leverage, roll the lateral upper torso along the foam roller. Repeat on the opposite side.SLDR2

Outstretch your arms placing your palms on the foam roller. Sit back on your heels. Focus on stretching forward rather than down. A stretch should be felt along the side of your upper back.SLDR3

Posterior and Lateral Shoulder (serratus anterior, posterior capsule, lateral and posterior deltoid)
Start side-lying and extend your right arm. Place the palm of your left hand on the roller. Keeping your hips stacked and torso still, push the roller out and back extending and retracting through the shoulder and shoulder blades. SLDR4

As your shoulder muscles relax, increase the range-of-motion for a greater stretch. Repeat on the opposite side.SLDR5

Stop in the office and pick up your roller today! 802-655-0354
Reference: Foam Roller Techniques, OPTP, 2008, Michael Fredericson, MD, Terri Lyn S. Yamamoto, PhD, Mark Fadil, CMT, p. 15, 17, 23.

Dr. Kelly’s and Dr. Marion’s Suggestion for Nutrition to Support Every “Body”

039Our patients often ask us what we recommend for vitamins and supplements to support their adjustments and treatment for their musculoskeletal conditions. To this we often answer: an overall healthy body will be able to heal it’s health conditions, whether it may be a low back sprain/strain or lacerated finger, much quicker than a toxic, sluggish system that is not in balance, has inadequate immune system functioning and poor digestion.
We are aware that many feel there is a daunting amount of information, positive claims and even research for a whole host of supplements, but … we could go broke trying to take all of them. What to do?
Below is a list of the supplements that we feel most people should consider taking on a daily, regular basis to provide better health for their bodies (hopefully) in motion.

1)  A good quality multi vitamin and mineral supplement.
The supplement should be “packed” with all major vitamin, minerals and digestive enzymes with amounts far exceeding the “% daily value”. Why do we need to take such a supplement? Because our US soil content is significantly depleted of the mineral and soil microorganisms compared to the 1930’s, AND because of the creation of genetically modified plants which are commonly less nutritious than heirloom plants (Scientific America, April 27, 2011). Of major significance: when “minerals go down, disease goes up” . As an example, bone deformities are associated with calcium, copper, fluoride and magnesium deficiencies (Nutrition Security Institute, “Human Health, the Nutritional Quality of Harvested Food and Sustainable Farming Systems”).
2) Probiotic supplements – A probiotic bacteria complex of several “good flora” bacteria along with FOS (fructooligosaccharides), 3-6 capsules/day.
Probiotics (and cultured, fermented foods) help to keep our gut or GI system (our intestines) properly functioning via the good bacteria that are in probiotics helping to crowd out the bad bacteria. Food then passing through our GI system can more properly be digested and the nutritional content extracted from the food. Bacteria in the GI tract are responsible for the operation of the mucosal immune system that resides in the GI tract lining (Peyer’s Patches). They also aid in antibody production to antigens and help to differentiate between harmful vs non harmful antigens. It is said that 70-80% of our immune system stems from our GI tract. This is exactly why we need to keep our gut functioning as optimally as possible.
3) Omega 3 Fatty Acids– in particular Fish oil or krill oil – 3,000 IU/day
However this recommended amount is misleading. One must look at the label on the back of the bottle and look at how much EPA and DHA is actually in each capsule. EPA and DHA are the compounds in Omega 3 Fatty Acids which are responsible for the positive benefits of fish oil, such as: decreasing the risk of stroke, increasing LDL and lowering triglyceride levels, decreasing clot formation, prevention and improvement of coronary heart disease, improving circulation, important in infant brain and eye development, reduces risk of premature birth, may help with depression, may reduce pain and inflammation in those with rheumatoid arthritis, lupus and autoimmune diseases and decreases joint swelling and inflammation (Colorado State University Extension, No 9.382). Therefore, if the label read 1,000 IU of Omega 3 fatty acid but the back label reads 200 mg of DHA and 300 mg of EPA, one would only receive 500 mg of the active components of the capsule =the capsule is 50% bioavailable. This information along with the supplement being produced from wild caught fish, that the heavy metals have been extracted from the oil and that the capsule is enteric coated (which reduces stomach upset and fish “burping”) are other important factors in choosing the correct supplement.
4) Vitamin C – 1,000 to 3,000 mg/day
Vitamin C is one of the safest, least toxic, yet highly effective antioxidant, antinflammatory supplement. And…it is cheap! Vitamin C or ascorbic acid is a water soluble vitamin and therefore the body is unable to store it. What we are unable to use at any given time will simply be excreted in the urine. The following benefits are attributed to Vitamin C: lowered blood pressure, decrease plaque build up in arterial walls, maintain the vascular integrity of the blood vessels, provide protection against cancer, prevent oxidative damage from smoking and overall decreases inflammation in the body.
5) Vitamin D3 – 1,000-3,000 IU/day
The medical doctors are now all over this vitamin. The northern states residents (Vermont!) are especially at high risk for Vit D deficiencies because our sunlight is so weak in the winter time. Vitamin D can be found in a few foods, however approximately 80-90% comes from our skin’s absorption of vitamin D. Symptoms of vitamin D deficiency include: general tiredness, muscular and joint aches and pains and frequent illnesses or infections. Those at the highest risk for D deficiencies are: dark skinned people, the elderly, those who stay inside the house commonly and those who cover up completely or use total sunblock when outside. It’s as simple as getting a screening blood test for Vitamin D to determine if you are one of the many who are deficient.

That’s it, our list. However, if one has a particular health issue they are trying to combat, improve or change there are many wonderful supplements and herbal preparations that can help you improve your health. Please consult with your doctor, chiropractor, acupuncturist or naturopath for the best supplement for your condition and the recommended amounts.

Here’s to a healthier body for every “body” this year!

Forearm Tendonitis

ImageTendonitis is the inflammation of a tendon, the bands of strong connective tissue that attach muscle to bone, which are often due to a repetitive strain injury.  Repeated straining of a tendon can cause small tears that lead to the inflammation of the tendon.  The fibrous tissues of the tendons have a relatively poor blood supply and are therefore slow to heal compared with muscle or bone.  The pain, swelling, stiffness, and weakness caused by tendonitis can last for months or even years.  This condition is common among athletes, computer users and those engaged in strenuous manual labor involving regular lifting which tends to overuse the tendons through repetitive motions. 

Pain in the forearm area and wrist is described as “tight, achy, and burning sensation”, similar to a pulled muscle.  The swelling of the tendons from the wrist to the elbow can be extremely painful.  Swelling, at times, will make it quite stiff with limited range of motion in the wrist.  Routine activities such as turning a door knob or opening a jar can become impossible as it may be difficult to make a fist or flex the fingers. 

The pain is fairly constant but will increase with physical activity.  It is also common to experience pain in the morning and during the night, when the arm is at rest.   Some people describe hearing grinding sounds when rotating their hand or wrist. 

Treatment

RICE it!  R.I.C.E is an acronym for treatment used by people who suffer from forearm tendonitis.  ‘R’ for period of rest, during which time one should avoid lifting heavy items or straining the muscles in any way.    ‘I’ for ice.  Applying ice can be useful in reducing inflammation and pain.  Wrap an icepack in a towel and do not apply ice for more than 20 minutes at a time in order to minimize the risk of frostbite.  ‘C’ for compression.  Light pressure on the forearm has proven helpful along with keeping the arm slightly elevated (‘E’) when resting and applying ice, further helping to alleviate swelling. 

Stretching 

Gentle stretching of the forearms in wImagerist extension and flexion will help elongate the tendons of the forearm.  Hold the stretch for 20-30 seconds and repeat for 4-6 repetitions a day.

Cold Laser Therapy

We are proud to offer laser therapy for tendonitis and various other musculoskeletal conditions we treat.   Low-level laser therapy (LLLT) reduces the pain and inflammation and promotes healing by focusing infrared and visible red light on the injured tendon.  The treatment is painless and the patient may feel a warm tingling sensation as the nerves are stimulated.  Laser therapy for tendonitis may reduce the need for surgery and cut the healing time for tendonitis by as much as 50%.  It may also help replace anti-inflammatory and pain medications.   Photons (light energy) from the laser beam stimulate the cells of the damaged tissues, increasing cell division, circulation, and oxygen supply to the tissues, thereby promoting tissue regeneration.  Laser therapy for tendonitis also promotes nerve cell regeneration.

Call our office and let’s get started on your tendonitis treatment plan today!  802-655-0354.

 

References:

http://altmd.com/Articles/Laser-Therapy-for-Tendinitis

http://www.tendonitistypes.com/forearm-tendonitis.html

http://www.itendonitis.com/forearm-tendonitis.html

Kneebone WJ. (2006) Practical Applications of Low Level Laser Therapy. Practical Pain Management November/December

Eating with the Seasons

Image

There are many benefits to eating with the seasons.  In the fall and winter, foods that provide warmth and carbohydrates such as carrots, potatoes, pumpkins, cabbages, onions, and winter squash will provide vitamins to boost the body’s germ fighting ability and strengthen the immune system for the cold and flu season.  These vegetables store well in cool, dark places.  The added carbohydrates will help to insulate against the cold weather throughout the season.  Adding fish to your diet during this time of year provides beneficial calories and increased levels of vitamin D.  Vitamin D found in cold water fish is essential for maintaining mental health and a strong immune system.  Nuts, which also store well in the winter, are loaded with Omega 3 fatty acids.  This adds moisture to the body from the inside out.  Our milk can be different in the winter compared to the summer.  The nutritional content of pasteurized milk changes with the diet of the cow.  Research has shown that iodine levels of milk are higher in the winter and beta carotene higher in the summer. 

Our bodies are pretty smart and we associate certain foods during certain times of the year for good reason.  The natural cycle of produce is perfectly designed to support our health.  When we eat with the seasons, we are constantly rotating our diet so we receive an assortment of vitamins, minerals, antioxidants and phytonutrients.   Apples grow in the fall and are the perfect transition food from the warm summer to the winter cool down.  In the spring, the abundance of leafy greens helps us to alkalize, detoxify and lose some extra pounds after a long winter of heavier foods.  In the summer, we cool down and stay hydrated by eating more fruits, berries, cucumber, watermelon and the like.  Building a lifestyle around seasonal food facilitates the body’s natural healing process.

Food grown outside its season or natural environment needs a lot more human intervention in the form of pesticides, waxes, chemicals and preservatives to grow and look appealing to consumers.  The vitamins and minerals contained in produce begin to decrease the minute the food is picked.  By the time the food arrives at your local grocery store, it may be several weeks old!  By choosing local and seasonal food, you get a cleaner and healthier product.   

If you are fortunate enough to have the space to grow at least some of your own food, it can help a great deal with the food budget.  Make jam when berries are at their ripest and in the fall, can sauces from tomatoes.  When there is an abundance of a product, the prices go down.  Seasonal food is much cheaper to produce for the farmer.  Cash in on the seasonal bounty when you can.   

Hang in there, Vermonters.  It won’t be too long before we taste those first fresh greens of spring!

References:
http://www.deeprootsathome.com/
http://beforeitsnews.com/survival/2013/04/the-reasons-for-eating-by-the-seasons-2-2469614.html
Daisy Luther, http://www.theorganicprepper.ca/
Rebecca Kaplan, http://www.freenewspos.com/news/article/f/581016/today/5-reasons-to-eat-with-the-seasons

Exercise and Cognitive Function

Brain exercise
Your brain is no different than rest of the muscles in your body- you either use it or you lose it. You utilize the gym to stimulate the growth of muscle cells, just as you use a brain fitness program to increase connections in your brain. But you can actually get an additional brain boost hitting the gym. The benefits of physical exercise, especially aerobic exercise, have positive effects on brain function on multiple fronts, ranging from the molecular to behavioral level. According to a study done by the Department of Exercise Science at the University of Georgia, even briefly exercising for 20 minutes facilitates information processing and memory functions.

Exercise increases the heart rate, which pumps more oxygen to the brain. It also aids the bodily release of a plethora of hormones, all of which participate in aiding and providing a nourishing environment for the growth of brain cells. Exercise stimulates the brain plasticity by stimulating growth of new connections between cells in a wide array of important cortical areas of the brain. Recent research from UCLA demonstrated that exercise increased growth factors in the brain, making it easier for the brain to grow new neuronal connections.

From a behavioral perspective, the same antidepressant-like effects associated with “runner’s high” found in humans is associated with a drop in stress hormones. A study from Stockholm showed that the antidepressant effect of running was also associated with more cell growth in the hippocampus, an area of the brain responsible for learning and memory.

The usage of physical exercise in conjunction with brain training increases your chances of increasing cognitive functions within parameters, including time of exercise and style of exercise. Interestingly, differences between exercise styles, such as opting for cycling over running, is associated with an enhanced brain function during and after working out. Ballroom dancing, an activity with both physical and mental demands has had a higher impact on cognitive functioning over exercise or mental tasks alone, indicating that the best brain health workouts involve those that integrate different parts of the brain such as coordination, rhythm, and strategy.

Tips for choosing the right physical exercise:

• In general, anything that is good for your heart is great for your brain.
• Aerobic exercise is great for body and brain: not only does it improve brain function, but it also acts as a “first aid kit” on damaged brain cells.
• Exercising in the morning before going to work not only spikes brain activity and prepares you for mental stresses for the rest of the day, but also produces increases retention of new information, and better reaction to complex situations.
• When looking to change up your work out, look for an activity that incorporates coordination along with cardiovascular exercise, such as a dance class.
• If you work out at the gym alone, opt for circuit work outs, which both quickly spike your heart rate, but also constantly redirect your attention.
• Hitting a wall or mentally exhausted? Doing a few jumping jacks might reboot your brain.

References:
http://www.positscience.com/brain-resources/everyday-brain-fitness/physical-exercise
Clinical Research, Rehabilitation Program, Eastern Health Authority, St John’s, Newfoundland and Labrador, Canada. mploughm@mun.ca