Learning with Laughter

In non-technical terms, the fascial system is the body stocking under the skin or straight jacket holding us together.

The fascia of the body is the tough connective tissue orientated in longitudinal and transverse tubes which holds us together. It stops the heart and liver descending downwards into the pelvis and also prevents uncontrolled lateral expansion of the torso. The fascia envelopes every structure of the body. Even the tiniest nerve or a taste bud has its own fascial sheath or envelope. About half of the muscular attachments of the body are to fascia so that muscle tone or the state of contraction, have a lot to do with how tight or loose the fascial sheaths and envelopes are, in certain areas of the body.

An example of this fact was solving a patient’s back pain. I believe one must “think global and act local”.

Any one had their Jaw, neck and back treated for back pain? Probably not!

A patient came in with acute lower back pain. He had no history of any recent injury however he mentioned that his bite was “off”. I noticed the spine had a visible “s” curve sideways which was caused by muscle spasm and his head and neck had done a compensatory rotation so he could see where he was walking! Next day he visited the dentist who had fixed his high filling! Within 10 minutes he walked out pain free with a straight spine. Clinically I find treating a short leg, pelvis misalignment and body fascia helps the jaw.

Did you know that there is continuous line of fascia connecting the inside of your head to your big toe? Starting inside the head the fascia exits and forms the carotid sheath then the Pericardium in the chest ie: thorax. This in turn connects to the Respiratory diaphragm, Psoas or hip flexor and then down leg into bottom of the foot

 

“You are only as young as your spine”

A healthy flexible spine and Dural Tube is critical in treating TMD, headaches and back pain. This is because that Dural Tube connects the head to your upper neck and pelvis.

Anatomy: The Dural Tube situated within the spinal Vertebral canal is made of fascia and must have a reasonable degree of movement in relationship to the arachnoid membrane. According to Wikipedia this is “A delicate fibrous membrane forming the middle of the three coverings of the brain and spinal cord, closely attached to the dura mater, from which it is separated only by the subdural cleft, but separated from the pia mater by the subarachnoid space.

I found this article interesting from the CranioSacral Therapy by John Upledger and Jon.D. Vredevoogd:

“THE DURA MATER forms a tube which runs downwards through the vertebral canal. Within the canal its only bony attachments are to the posterior bodies of the second and third cervical (neck) vertebrae and to the posterior body of the second sacral segment. It exits the vertebral canal through the Sacral hiatus and blends with the periosteum of the coccyx (tailbone). The Dural Tube within the vertebral canal is also firmly attached to the Foramen Magnum of the Occiput. This dura mater connects with membranes inside the skull which line and form partitions in the skull cavity.”

I find, clinically, that stretching the fascial system together with mobilising joints in the neck and back makes a huge difference to help relieve headaches, TMD and improving flexibility.

1. Physiotherapy to mobilize fascial restrictions

2. Exercises to stretch out this structure

Video and pictures to follow every month: 1st tip Seated roll down  (as seen on YouTube) 

 

The arachnoid mater is one of the three meninges, the membranes that cover the brain and spinal cord (To read more follow the links).

Using the occiput (base of skull) to evaluate and mobilize the Dural tube.

I ask the client to lie on their back and place hands on the occiput and apply a very light traction towards the top of the head.

 

This is a picture of the 2nd Vault Hold

  

and the Occipital Base Release

 

Pictures reprinted from CranioSacral Therapy by John Upledger and Jon D. Vreevoogd with permission of Eastland Press.

TMD – Who to refer

• Key point “ TMD patients treated with conservative and reversible modalities on the whole responded as well as patients treated with more aggressive regimens, both short terms and long term assessment of outcomes”.

Reference: Greene CS p224 Chap14 “concepts of TMD etoliogy. Effects on Diagnosis and Treatment” in TMD’s an evidence-based Approach to Diagnosis and Treatment, Laskin, Green, and Hylander, eds Quitnessence 2006

• Early intervention is Key as passage of time is a major factor in development of chronic pain problems: any pain that lasts longer than 3-6 months is considered chronic. Patients tend to treat their symptoms after 6 months as if acute and this can lead to escalating psychosocial issues, for example (frustration, anxiety, depression, relationship conflicts),

 

TMD and occlusion

“…there is a relatively low association of occlusal factors in characterizing TMD. Skeletal anterior open bite, overjets greater than 6 to 7 mm, retruded cuspal position/intercuspal position slides greater than 4mm, unilateral lingual crossbite, and five or more missing posterior teeth are the five occlusal features that have been associated with specific diagnostic groups of TMD conditions.

Reference: Occlusion, Orthodontic treatment and TMJ disorders: a review. McNamara JA Jr, Seligman DA Okeson JP. J Orofac Pain 1995 Winter;9 (1) ; 73-90

• 70% of patients with TMD present with neck pain, more prevalent with myogenous than arthrogenous TMD 

• All patients with neck pain, headaches, ear aches, sinusitis and facial pain because with TMD often a central pain phenomenon-region of primary lesion excites neighbouring areas in Central Nervous System to produce heightened sensitivity

 

• Referred pain-pain arising from a trigger point, which refers pain to another area. Most common example would be when patient comes in complaining of upper tooth pain. This could be from a trigger points in Temporalis muscle.

Other contributing factors are behavioural, (forward head posture, parafunctional habits, muscle tension), and widespread pain like fibromyalgia. All these factors aggravate symptoms.

• All patients who have been in car accidents, any presumed innocuous hit on the head. Recent one I had patient had hit head on car roof /boom of a boat etc.

TMD SELF CARE

In our fast paced lifestyles and communications it is hard to make time for self. Meditate –take time for your self

 

Try to something you love every day –aim for greater heights, because time spent now will ensure healthy retirement

After 100 who cares!

Make time to have fun and be able to laugh at your self!

Laughter is best medicine and can improve perspectives of challenging situations in every day life

BASIC SELF CARE FOR PATIENTS

Awareness of habits or jaw use patterns

• Teeth should only make contact during eating and swallowing, otherwise they should be apart

- Bite… Restful jaw position is when tongue tip is behind the maxillary central incisors, lips together and the teeth slightly apart

DIET MODIFICATIONS

 Softer foods place less stress on the jaw muscles

   Cut foods into small bites-

 No hard food like nuts/carrots or chewy food

Do NOT chew gum

 

 Avoid wide jaw opening

 Support your jaw with your hand when yawning

 Do not sleep on your stomach or with your jaw resting on your hand or arm

 Avoid leaning on your chin or jaw

Apply moist heat on muscles for 15-20 minutes

 Apply “ice cube’ massage to joint /muscles for 5 minutes

-  Do not test jaw

 Jaw movement that elicits pain may prolong recovery

- Exercise to maintain good health –best exercise is one you love. Do 4 times a week for at least half hour.

- Mindful breath based exercise like Yoga

Pilates, tai chi, Qi gong are excellent for chronic pain sufferers

- Yoga Stretching Whatever works for you!

Why is it important? With aging and a sedentary lifestyle muscles lose their flexibility. This leads to muscle imbalances and adaptations causing some muscles to become strong and short and others muscles to become weak. These imbalances place abnormal forces around joints and can lead to common overuse injuries such as tendonitis, plantar fasciitis, jaw, neck and back pain.

Overtime tight muscles can compress nerves, resulting in tingling and numbness; muscle weakness and pain. When you improve your flexibility you improve posture, decrease tension and increase circulation in the muscles.

Alternate nostril breathing (see December newsletter)