Temporomandibular Joint Dysfunction

Temporomandibular joint dysfunction (“TMD”) is a musculoskeletal problem of the jaw generally characterized by jaw pain and clicking and often accompanied by headaches, tinnitus (ringing in the ears), and neck pain. It can be worsened by poor postural habits, grinding/clenching teeth while sleeping or awake, sleep apnea, dental conditions, chewing gum, ice or other dense items, eating foods that require wide jaw opening, stress or psychological trauma, and others. Common treatment options include a bite or night guard, dental care, psychotherapy, physical therapy, and surgery.

Physical therapists evaluate and treat both the temporomandibular joint (TMJ) and the cervical spine (neck). Clinicians begin a course of care by evaluating the neck and jaw to identify patients’ unique presentation and develop customized treatment plans accordingly. During the evaluation process, neck and jaw mobility, strength, jaw opening and closing, airway clearance, surrounding tissue tenderness, muscle and ligament tightness, disc and retrodiscal tissue mechanics, signs of grinding/clenching and posture are assessed.

Physical therapy treatment often involves a combination of manual therapy, exercise, postural training, eating and chewing education, dry needling, and other modalities to address both jaw and neck pain and dysfunction. Physical Therapy is often provided in conjunction with medical management, dental care, and psychotherapy as appropriate. Treatment for TMD can range from weeks to months and is often related to complexity and chronicity of condition.

Patients who are compliant with care including self-management typically appreciate the greatest success. Your dentist, physician, nurse practitioner or physician assistant can refer you to physical therapy.

 

Dr. Mike Winebrenner is a 1999 graduate of the Bachelor of Science program in Physical Therapy at Daemen College and a 2008 graduate of the Master of Business Administration program from Loyola College in Maryland.  He earned his Doctor of Physical Therapy from Widener University in 2009.  Mike is Dry Needling, LSVT BIG and Bike Fit certified. Additionally, he has advanced training in temporomandibular joint dysfunction (TMD). With a strong background in spine care, his focus is on long term prevention and wellness.  Mike’s commitment to exercise and wellness is evident by his active lifestyle, including cycling, fishing, kayaking, hiking and health club exercise.

Ask an Expert: Do I Need to Stop Running?

I have been diagnosed with Osteoarthritis (OA). Do I need to stop running or participating in sports?

This is a question that we are asked regularly during physical therapy sessions! A recent 2020 meta-analysis by Zampogna et al on of the effects of activity in people with OA concluded that, “compared to controls, aquatic exercise, land-based exercise, tai chi, and yoga showed a small to high effect for improving pain, physical function, quality of life, and stiffness. Active exercise and sport are effective to improve pain and physical function in elderly people with osteoarthritis.”

Furthermore, a 2018 study by Lo et al. in The Journal of Clinical Rheumatology concluded that, “among individuals over 50 years old with knee OA, self-selected running is associated with improved knee pain and not with worsening knee pain or radiographically defined structural progression.”

That being said, I recommend avoiding contact sports which have a higher risk of orthopedic injury, such as tackle football and rugby. I also recommend a well-rounded exercise program which incorporates mobility, balance and strengthening exercises into your regular routine.

When progressing activity, it’s a good idea to gradually increase intensity or duration of activities by no more than 10% per week. For example, if you normally run for 20 minutes on the treadmill at 7 mph and you want to progress this activity, you can either increase the time to 22 minutes or increase the speed to 7.1 mph.

If you are limited in your daily life and recreational activities due to pain, stiffness or weakness then consider making an appointment with a physical therapist to help you get moving again!

Ask an Expert: I Was Diagnosed with Moderate Hip Arthritis, Can PT Help?

I recently got diagnosed with moderate hip arthritis, but the Doctor does not recommend a hip replacement yet. Can Physical Therapy help?  

Physical therapy is a form of treatment that helps to alleviate pain and improve movement in those who have mild to moderate hip arthritis. It is a non-invasive and drug-free approach that can be very effective in managing the symptoms of this and other arthritic conditions.  Physical therapists are trained to work with people who have arthritis and can develop a personalized plan of care to help alleviate your pain and improve your mobility. They may use a combination of techniques, such as exercises, stretches, and hands-on therapy, to help you regain strength and flexibility in your hip joint.

Exercises are an important part of physical therapy for hip arthritis. Your therapist may prescribe exercises that are specifically designed to help improve the strength and flexibility of the muscles around your hip joint. These exercises may include range of motion exercises, leg strengthening exercises and balance exercises.  Stretching is also an important component of physical therapy for hip arthritis. Stretching can help to increase the flexibility and range of motion in the hip joint, which can help to reduce pain and improve your ability to move around.  Hands-on therapy, such as massage and manual therapy, can also be used to help alleviate pain and improve mobility in people with hip arthritis.

Physical therapy can also help you learn how to move and do everyday activities in a way that puts less stress on your hip joint. This can help you to reduce your risk of injury and further damage to your hip joint.   It is important to note that physical therapy can be an effective treatment option for hip arthritis, but it is not a cure. However, it can help to alleviate symptoms, improve mobility, and reduce the risk of further injury. It is always best to consult with a physical therapist to discuss if physical therapy is right for you.

Jeremy Dunker, PT, DPT, OCS

How Can OT Help with Low Vision

What is low vision?

Low vision is permanent vision loss from an eye disease or condition that cannot be corrected by standard treatments like glasses or contacts, medications, or surgery. With impaired vision, it becomes very difficult to complete tasks such as reading, navigating home and community environments, managing medications, managing calendars and appointments, managing finances, preparing meals and snacks, driving, recognizing faces for social participation, using household appliances like dishwashers, washing machines, and microwaves, and so much more.

What can one do to prevent low vision?

The best way to prevent low vision is to have routine checkups with an optometrist or ophthalmologist and, if diagnosed with an eye condition, adhere to the prescribed care plan laid out by the doctor. The three most prevalent conditions resulting in low vision are macular degeneration, glaucoma, and diabetic retinopathy. If one has a family history of eye conditions, it is crucial to have routine eye exams. It is also important to manage your health conditions, for example, controlling blood sugar is extremely important in preventing diabetic retinopathy. Once these eye conditions are present, they cannot be reversed, but further impairment can be prevented. This is why it is so important to follow the doctor’s instructions once diagnosed with an eye disease.

How can therapy help?

Since low vision is permanent, occupational therapists are not able to restore lost vision, but we can help those with low vision best utilize their remaining vision to be as successful and independent as possible. Occupational therapists perform home assessments to identify potential hazards and make appropriate modifications for safety and success. Some examples include adjusting lighting, removing clutter, and adding a contrasting color to doorways, steps, or thresholds. Occupational therapists may also modify the task, teach new skills, and utilize technology to improve daily function. Visual scanning and tracking techniques may be taught to better utilize remaining vision or, one may be introduced to adaptive tools and technology.

Each condition resulting in low vision impacts the visual field differently and have their own unique set of challenges. Occupational Therapists understand these conditions and how they impact the visual field. Occupational Therapists combine this knowledge with an individualized approach in order to provide training and modification in the client’s home and immediate surrounding community for optimal performance of the activities that are meaningful to the client.

Anna Pung, OTR is an Occupational Therapist in the Senior Living setting.  She has a Master of Science in Occupational Therapy from the University of Alabama at Birmingham (UAB) and Bachelor of Science in Psychology from Mississippi State University.  Shespecializes in low vision, dementia, fall prevention, orthopedics, and neuro rehab. Anna is very passionate about working with individuals throughout the aging process to maintain independence and high quality of life.

Ask an Expert: Should I Stretch Before a Workout?

Question: Should I stretch before a workout?  

Yes, but not in the way you probably think! Let’s look at the goals of stretching before a workout- to warm up the muscles and to prevent injury.

To warm up the muscles we need to increase blood flow, which comes from movement. While stretching is technically moving, there are far more effective options, such as walking. A five-minute walk or light cardiovascular exercise (jogging, biking, elliptical) will warm up your muscles much more than stretching will.

Does stretching prevent injury?  

Laursen, et al in 2014 found strength training and proprioception (balance) training both decreased risk of injury but stretching did not have any effect on injury risk. Swing and a miss there. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials – PubMed (nih.gov)

Is there any benefit to stretching? 

Yes, yes there is! We do not need to stretch all our muscles, but if we have limited range of motion, then we should be stretching those involved muscles. A few movements we should be able to do- look up, down, left, right. When we raise our hand, our arm should be in line with our ear. While sitting with our feet in front and legs straight, we should be able to touch our toes.

When we do not have proper mobility, our body will compensate; this can cause overuse or long-term injuries. So, while stretching does not reduce injury risk for your workout, it is still beneficial to our bodies.

Warm-up Routine:  

  • 5-10 minutes of light cardio
  • Targeted stretching for flexibility deficit
  • Exercise!

Alex Strahle, PT, DPT, CSCS is a Physical Therapist in the Employer Based Clinic setting in Indianapolis, IN.  Alex enjoys seeing patients return to an active lifestyle after treatment for their pain and dysfunction. He takes into consideration the psychosocial and physical requirements in treatment and believes in creating a positive and healing environment for his patients.