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PrintArm pain or neck pain…Where is the source?
Have you ever experienced pain in the arm, but the movements of the shoulder and elbow do not seem to aggravate the pain? Or found pain on the side of your thigh or knee, but there is nothing wrong with your knee? Are you imagining the pain? Where is the pain coming from?
These pains are real. Pain in the arm can be referred from the neck and similarly the source of pain in the leg can be from the lower back.
Types of referred pain from the spine
- The most common is a deep dull ache in certain parts of the affected limb. See image below. These areas of pain correspond to where the nerves in the spine supply sensation to. There are 7 vertebrae in the neck. Depending on the level, nerves exit from the vertebra and travel to specific areas of the scalp, shoulder, arm, forearm and hand. Similarly nerves exiting between the 5 vertebra of the lower back travel to the bottom, thighs, legs and feet. These nerves supply sensation to these particular areas and are called dermatomes. So if the exiting nerves are mildly irritated, it can refer pain to its specific dermatome. Therefore, if the structures surrounding the nerves are inflamed, immobile, strained or somehow affect the exiting nerves, pain can develop in the extremities.
- The second type of referred pain is sharper, more acute and often described as pulling, stabbing and severe pain. However, the site of pain remains the same. In these cases, the nerves exiting the vertebra are not only irritated but usually impinged or compressed. The cause of the impingement is usually severe degeneration in the vertebrae, disc prolapse and swelling which reduces the canal space, for which the nerves to exit. These types of pain can be accompanied by loss of strength of muscles in the arm and leg as well as decrease sensation as the compression affects the conduction within the nerve fibres. The impinged nerve essentially is less able to send its usual amount stimuli to the muscles it excites.
Treatment of referred pain
The treatment for referred pain is simple. Find the cause of the irritation or compression and remove or reduce the cause as much as possible within the realm of physiotherapy.
- Type 1 Dull achy pain is usually due to poor posture, excessive mechanical loading on the spine, i.e. tight muscles, stiff and or mal-positioned facet joints.Once the mechanical fault is corrected, the structures offloaded, through manual therapy, the symptoms tend to promptly reduce.
- Type 2 Pain which is more acute, it is more difficult to treat. As the source of pain is from the compression /impingement of the nerve, the cause of the impingement is usually structural. This means that the existing degeneration of the spine and the significant disc protrusion are the main reasons for the impingement. Therefore unless that is addressed, often the pain is not completely resolved.
The role of physiotherapy in this intance is to reduce the non structural causes such as excessive vertical loading, the narrowing of the canal and pain reduction. These non structural causes could be the result of swelling, poor posture, muscle spasm. Traction and specific exercises are therefore taught to open the canal space and reduce disc protrusion and impingement.
Pilates and Physiotherapy
What is Pilates?
Pilates is a unique body conditioning exercise designed to rebalance the body, bringing it, into its correct neutral alignment whilst targeting the deep postural muscles (Transverse abdominals and muscles of the pelvic diaphragm). In essence pilates challenges the core muscles and builds strength from the inside out, helping a person to reshape their body, adding to a leaner and more toned figure. It boasts of a perfect balance between strength and flexibility, whilst relieving unwanted stress and tension. The phenomena of pilates is a popular and growing trend in western countries amongst athletes and celebrities, as well as in the treatment of peripheral and spinal musculoskeletal dysfunction. Today pilates is evolving and is taught worldwide in gyms and hospital, benefiting millions of people. The aim of this article is a brief introduction to pilates and its clinical benefits in physiotherapy.
Background
Pilates was first discovered in Germany in the early 20th century by a keen diver, gymnast and boxer by the name of Joseph Pilates. Joseph Pilates had spent the majority of his childhood fighting rickets, asthma and rheumatic fever and this fuelled his desire to become physically immune to these ailments. Through studying a variety of different disciplines (yoga, Zen) he brought about this new notion of exercise. During the war he practised his theory of exercise, and became involved in the rehabilitation of war victims. Once the war ended, Joseph Pilates relocated to New York and soon went on to open the first pilates studio attracting elite actors, dancers and athletes.
Clinical Pilates vs Pilates
Clinical pilates is used to treat people with musculoskeletal injuries and is conducted by a physiotherapist certified with Clinical pilates certification. If a person experiences an injury or repetitive injuries, they may have joint stiffness, muscle spasms, poor posture or abnormal movement patterns as a cause or a result of the injury. It is therefore important to first treat the above complaints before commencing pilates.
In addition certain pilates exercises may aggravate the symptoms. An example is someone who may experience a back strain, due to too much extension in the lower back. Such individuals may have an exaggerated lordotic postures and therefore extension pilates exercises may not be advisable. This is something that would not be picked up if a person was to attend a routine pilates class, which does a combination of both flexion and extension exercises.
Not only is it important to select the right type of pilates exercise, it is also necessary to ensure that the correct and appropriate level is prescribed. Routine pilates may be too challenging for a person with back pain. This will cause the individual to compensate and utilise stronger global muscles as opposed to the core muscles, therefore negating the benefits of the pilates exercise. As a secondary result, a person may start to experience muscle spasm in the global muscles due to the increased exertion. The physiotherapist having tested your muscle strength and range of movement, will be able to ensure that the exercises are appropriate and although challenging not detrimental to recovery.
The added benefit of clinical pilates to routine pilates is not only is it more individualised to the person and their problem, it can also be more functional. If the person for example is keen to return to an activity or a sport (swimmer, footballer, dancer) the standard exercises can be modified by the physiotherapist to strengthen the core muscles whilst carrying out the aggravating movement. This could mean that the core muscles of a footballer is challenged as he kicks, dribbles a football and not just in static postures.
Peripheral injuries
When dealing with peripheral joint/ muscular injuries e.g. ankle instabilities the ankle is the main focus of the treatment. This makes sense and is always a good place to start to strengthen and rehabilitate local structures. However the research is beginning to move towards looking at the whole picture. Improving an individual dynamic control of their movements, will mean that person is less likely to sustain injuries. There is a growing trend to rehabilitate athletes whilst incorporating Pilates based exercises to teach a person to move more efficiently. Pilates can be used to treat hip, shoulder, knee and ankle injuries.
Spinal Injuries
Pilates in conjunction with manual joint mobilisations and soft tissue release is an effective way to treat back pain.
Time and time again the research has shown that any form of back pain leads to a loss of function of the deep muscles (multifidus) of the spine at that level. Unfortunately these muscles do not have the capacity to turn back on again, once the initial episode of back pain has resolved, and therefore these muscles require specific training to reactivate and stabilise the spine. In the long term these muscles without exercise will continue to waste further and subsequent muscle spasm in the global and more superficial muscles is experienced. This predominately occurs as a mean to stabilise the back in the absence of the deep muscle activity. Such individuals will report recurrent flare ups of back pain in the year due to the ongoing weakness of the spine.
In addition to weakness, back injuries usually occur after an extended period of time, in a bad posture, excessively loading the joint.
Clinical pilates is a form of exercise that both facilitates the strengthening of these deep muscles whilst educating a person where a neutral spine lies. In time a person will feel that there back is stronger, as they become more aware of what sitting or standing in a good posture entails.
In the long term they will also have the endurance to sustain these better postures for longer periods, through conducting the exercises.
If a person is new to pilates one- to one sessions with a physiotherapist or very small classes is initially strongly recommended, this is to ensure a person can be taught the correct techniques and the 5 concepts of pilates accurately (breathing, neck, rib pelvis position and stabilizing). Pilates can be a little tricky and can easily be done incorrectly and therefore close supervision is required to prevent faulty patterns learnt.
The benefits of Pilates
• General fitness and body awareness greater strength and muscle tone
• Improved flexibility
• A flatter stomach
• Improved efficiency of the respiratory, lymphatic and circulatory systems
• Better posture and awareness
• Less incidence of back pain
• Increased joint mobility
• Lower stress level
Which clients would benefit from Pilates?
• Males and females
• Pregnant: Pre and post natal
• Athletes and dancers
• Amputee and stroke rehabilitation clients
• Elderly
• Children 12 years-old +
Clinical pilates therefore targets the musculoskeletal injury more specifically. The physiotherapist is able to identify your posture type, establish the mechanism of injury, understand what the peron is aiming to return to and work out which exercises would be of more benefit to the individual. Clinical pilates therefore looks at treating the cause as well as selecting the appropriate repertoire of exercises to strengthen the injured areas and even be done for injury prevention.
If your suffering from recurrent episodes of back pain or peripheral injuries – Clinical Pilates may be just what you need!
Yearning for a Good ‘Neck’ Sleep?
Have you ever woken up with a stiff and/or painful neck or shoulder, and wonder if it is because of the pillow that is causing the problem?
If the answer is most likely a yes, continue to read on.
A pillow that fails to support the neck probably will cause the neck to end up in a wrong position for a long period of time, which inevitably causes excessive stress to the neck and leads to pain. The question here is, how do we choose a good pillow?
A GOOD pillow is one that could help preserve the natural curvature of the neck, and the position in which the neck has its normal curvature is called the neutral position of the neck. This is important because the muscles at the neck can be supported so that they can relax and not overwork throughout the night. Just like a good back support could help us maintain a good back posture and prevent overworking of the back muscles, a good pillow could help us maintain a good neck posture at night.
Before we talk about how to choose the most suitable pillow for yourself, we must look at the sleeping positions. The reason is that with different sleeping positions, different support is required to maintain a neutral neck postion.
Back sleeper
When someone lies on his/ her back without a pillow, the head usually falls downwards and the chin tilts upwards. This puts a lot of stress on the neck as it aggravates the reversed “C-shape” of the neck. The situation would be worse if he / she has a stiff / hunched upper back.
A good pillow for back sleeper is one that could fill the gap between the back of the head and the upper back, so the natural curve of the neck can be maintained. There are many contour pillows that could help achieve this.
When using a contour pillow, the higher end should be inserted underneath the hollow of the neck closer to your shoulder.
What to look out for:
- Place your hands around your neck to feel for any muscle tightness/tension. If you are in the correct position, your neck muscles will be relaxed.
- Get someone to take a look at your neck posture from the side view. He/she should be able to draw a straight line from the ear lobe to the shoulder joint and the hip joint.
Modification:
If your pillow is too low for you, you could use towels and pile them on top of a regular pillow (the towel is the modified higher end of the contour pillow, and works to fill the gap between the back of the head and the upper back). Do not use a regular pillow that is too high or too low, which either bends the neck too much forward or allow too much backward arching of the neck.
Side sleeper
A contour pillow may best serve the purpose of maintaining a neutral neck.
The higher end of the pillow again needs to be underneath the hollow of the neck. It is also important to pull the pillow as close as possible to the top of your shoulder. The height of the contour is usually equal to the width measured from the base of the neck to the tip of the shoulder of the same side.
What to look out for:
- As shown in the picture above, the spine should form a straight horizontal line, parallel to the floor.
Modifiation:
Again, an extra pile of towels on top of a regular pillow may be used as a modification of a contour pillow.
Tummy sleeper
Though this is not a sleeping position recommended as it forces the neck to be turned to one side and also arch backwards excessively, some people do sleep this way. For people who sleep on their tummies, it is the best to choose a regular pillow that is soft and low.
The pillow also needs to be pulled lower so that it supports the top part of the chest. Those could help prevent excessive neck rotation and backward arching.
Idiopathic scoliosis- The importance of Classification
This article is a follow up article on the series of idiopathic scoliosis published previously. In this article, we will talk about the different types of classification and the importance of it.
One of the main differences between the traditional treatment of scoliosis and that of SpineCor system for physiotherapy and bracing is the use of curve classification in the latter system. The use of a classification system enables a more precise treatment intervention.
How are the scoliotic curves classified?
The curves are classified according to the direction of the curve, the location of the curve and the number of curves presented. The direction of the curve is either to the left or the right. The location of the curve can occur in the thorax, which is anywhere from the base of the neck to the level of the last ribcage, the lumbar, which is the lower back, or in between these two regions- the thoracolumbar region.
Why is classification important?
Scoliotic curves that occur in thorax, thoracolumbar and the lumbar region will all have different effect in the 3D presentation of how the spine will rotate, tilt and compensate inside the body, which ultimately result in a different postural presentation for each type of curve.
For example, when a right curve is present in the thoracic spine, although from the xray it looks as if the trunk should follow the direction of the scoliosis, i.e bends to the left, it does more than that. The lower trunk is also rotated to the right which causes compensation in the upper trunk to rotate left, so that the resultant effect is that the head is facing forward. However, if a scoliotic curve is present in the lumbar spine, the trunk does follow the direction of the curve.
This means that being able to diagnose the type of curve present will mean that a predictable spinal orientation can be determined. With this knowledge, exercises can be prescribed specifically to counter this movement pattern, ensuring maximum mobility and strength in the affected joint and muscles respectively.
A similar principle is used when bracing with the SpineCor system. Prior to bracing, once the curve classification is determined, the corrective movement for that specific curve is taught to the client (see fig1). Bracing is done in the corrective movement position (See fig2). This corrective movement is essentially a movement direction opposite to the orientation of the scoliotic spine. This specificity allows the collapsed side of the curve to be open and provides a real opportunity for curve reduction.
Treatment Options for Chronic Pain- What Does the Research say?
As discussed in the previous article, chronic pain can manifest through very complex thought processes, as result of a wide variety of factors stemming from physical, psychological and cultural influences.
For this reason, there is not one single fix for chronic pain, but its treatment is very much defendant on a combined approach.
This article will focus on the conservative management of chronic back pain whilst not negating the importance of appropriate pharmaceutical and other interventions.
So what does the research say?
- Exercise therapy -the first line treatment
The current evidence suggests exercise is more effective than “GP care” for the reduction of pain, disability and return to work . No one form of exercise (e.g. Aerobic, Mckenzie, conditioning exercise) appears to be superior to the other, although an supervised and individualised exercise programme is recommended over general exercise conducted individually. This is something that can be discussed and provided by a qualified physiotherapist following a thorough assessment of your back.
Studies comparing the effect of pilates based exercises and usual back care, has shown pilates to significantly reduce low back symptoms and disability over long term basis.
There is strong evidence showing that exercise therapy alone is not more effective than conventional physiotherapeutic techniques (e.g joint mobilisations) and therefore exercise therapy must be prescribed along side other treatment adjuncts.
- Cognitive behavioral therapy
This form of psychosocial therapy assumes that maladaptive, or faulty, thinking patterns cause maladaptive behavior and “negative” emotions (Maladaptive behavior is behavior that is counter – productive or interferes with everyday living).This treatment focuses on changing an individual's thoughts (cognitive patterns) in order to change his or her behavior and emotional state, allowing them to partake in exercise and all activities of daily living.
- Manual therapy
Joint mobilizations should be considered as treatment in the short term management for chronic pain sufferers to increase function and decrease pain.
The research shows that joint mobilizations carried out in physiotherapy treatments is of equal effectiveness to analgesia, normal "GP care" and physiotherapy exercises in reducing symptoms.
- Massage
Massage is not considered as an effective treatment option for chronic pain sufferers, but may be useful to treat the symptoms of muscle tightness post exercise.
- Education
This is vital in in helping people understand that beliefs can alter and affect their recovery from pain. Pain should not been taken for granted, and a person should seek medical advice to decrease the amount of pain as soon as possible.
Education regarding pain, and understanding that pain is an unpleasant but subjective emotional experience, and therefore should not be used as a tool to measure the amount of tissue damage is vital.
Having less fear and anxiety will make a person more willing to return to functional activities and exercise allowing for recovery.
References:
O. Airaksinen, J. I. Brox, C. Cedraschi, J. Hildebrandt, J. Klaber-Moffett, F. Kovacs, A. F. Mannion, S. Reis, J. B. Staal and H. Ursin, et al (2006) European guidelines for the management of chronic nonspecific low back pain, European spine journal, vol 15: 193-300
Rydeard,R., Legar, A., Smith, D (2006) Pilates-based therapeutic exercise: effect on subjects with nonspecific chronic low back pain and functional disability : A randomized controlled trial, The Journal of orthopaedic and sports physical therapy, vol 36:474-484
Anti-Aging Exercise for your Lower Back – Good Nourishment is the Key
The discs in the spine age and degenerate just like all of the other structures in the body. However, today’s sedentary lifestyles often speeds up this process. We cannot apply anti-aging creams or lotions to our discs, but certain exercises can help to maximize the discs nourishment.
The Theory: Disc Nutrition
The discs are fluid filled gel like structures that act as shock absorbers in the spine. They are found between each segment of bone throughout the spine. The discs slowly lose some of this fluid through the daytime under the effects of gravity. The fluid is then drawn back into the disc when we sleep at night in an unloaded position. This movement of fluid is critical for disc health as discs nutrition is provided from this exchange, and the volume exchanged must remian balanced. Unfortunately, sedentary individuals may be encouraging a negative fluid balance. It has been shown that sitting or standing statically for as little as 1 to 2 hours significantly increases the outflow of fluid. This process leads to the first step in disc degeneration. The disc becomes ‘dehydrated’ and mechanically ineffective when it tries to distribute the body’s load. This initial change often presents as the mild ache you feel when sitting for long periods.
The Degeneration Cycle
Over time the disc reduces in height and becomes less compliant. Globally the spine loses flexibility and therefore cannot create enough pressure on the disc to effectively and sufficiently move the fluid in and out. The disc receives less nutrition and has difficulty removing waste products. The cycle continues and may cause a break down of the structure of the disc. This stage relates to when back pain becomes more chronic in nature, and additional disc damage and pain can occur from minor activities.
The good news
Traction exercise completed on a daily basis can halt and even reverse this process. The overall aim is to improve the fluid flow mechanism in the disc and ultimately increase disc height and health as it rehydrates.
Where to start?
Any exercise to ‘traction’ or ‘decompress’ the lumbar spine can help. An example is shown below using a yoga block (approx. 7cm height), placed below the belt line
- Spend 1 minute relaxing in this position
- Remove the block and rest for 30 seconds
- Repeat this process 3 times in 1 session
- 1 session should be completed around midday, and a further session prior to sleeping.
Other Important Factors
- The exercise should be carried out in the evening. This is when the disc has been maximally compressed from daytime activity. Traction allows the discs to take in fluid more efficiently during the night hours when the spine is unweighted.
- If you normally exercise immediately after working at the office all day, use the traction exercise as part of your warm up to ‘decompress’ the discs. This will reduce the stress on the disc during your exercise routine.
- Added benefits This position stretches the muscles and other soft tissues at the front of the spine and hips, which are often tight from many hours spent in working postures.
- The stretch can create better alignment of the upper body making you stand straighter, which is important for maximum recovery following a lower back injury.
Caution Assessment by a Physiotherapist is strongly recommended prior to starting the above exercise. If you already have lower back pain you may also require hands-on treatment from a therapist to physically mobilise a particularly stiff spinal segment for the above exercise to be more effective.
Non-golfer with golfer’s elbow
Golfer’s elbow refers to a painful condition of the inner side of the elbow. Cause of the pain is usually overuse of the forearm muscles attached to the elbow. These muscles work to bend the wrist and rotate the forearm. Despite the name, it also afflicts non-golfers.
Any repetitive wrist flexion activity (bending towards the palm side your hand) can lead to the development of Golfer’s elbow; activities such as golf, tennis, badminton, or games that involve repetitive throwing such as cricket and netball.
Symptoms
The main symptom for Golfer’s elbow is pain at the inside of the elbow. In addition,
- The pain is felt either on or around the bony part, and sometimes spreads down the forearm.
- The pain is usually worse with wrist bending or grasping/lifting activities. Sometimes fully straightening the elbow is difficult because of pain.
- There may be tingling sensation, or numbness on the inside of the forearm and the last 2 fingers, and is usually worse with or after activities.
- Over time, grip strength weakens.
Treatment
The management of Golfer’s elbow starts with pain control, followed by soft tissue therapy, and conditioning of the affected muscles and followed by the correction of technical faults.
Pain control & soft tissue therapy
This is the first stage. Before we proceed with the other stages of treatment, the pain needs to be under control. Initial pain and inflammation control is usually achieved by rest, icing, and use of anti-inflammatory medication (see RICER). This happens within the first 1-2 weeks. Physiotherapy treatments such as ultrasound, myofacial release & taping are helpful too.
Conditioning of the affected muscles
When pain and inflammation is under control, the stiff muscles need to be released by heat treatment, massage, and stretching exercises. (pictures) Strengthening exercises should start with pain-free movements. Important movements are gripping, bending of the wrist, and turning of the forearm. Good posture of the body and shoulders is important during exercises. For those who experience tingling or numbness of the forearm and fingers, it is because the nerve passing through the affected muscles is irritated, either by direct compression of the muscles or by the chemicals released from the inflammation of the muscles. In this case, it is necessary to gently mobilize the nerve to assist with better healing (see picture).
Functional Recovery
Technical fault in movements varies depending on the different requirements of the individuals. For example, those who play racquet sports, good wrist control during strokes are crucial to prevent overuse injury. A good technique is one in which the wrist stays neutral (bent neither to the palm nor the opposite) during strokes. Return to sports should be paced to the tolerance of the muscles, and improvement of techniques and fitness.
Distinguishing Types of Headaches
We have often talked about headaches in the past and how it is linked to issues arising from the neck (Neck-Related Headaches and Causing Most of the World’s Pain, Anonymously). The type of headaches that we talk is called "Cervicogenic Headaches". But often readers ask us how do we distinguish cervicogenic headaches from other types of headaches, so we described here some of the most common types.
Flickr: TrevinC
So figure out, the most common types of headaches are tension, sinus and migraines. How they feel like is described below:
Common types of headaches | |||
Type | What it feels like | Who gets it | How often and for how long |
Tension | Mild to moderate steady pain throughout the head, but commonly felt across the forehead or in the back of the head. Generally not accompanied by other symptoms. | Can affect children, but is most common in adults. | Frequency varies. Generally hours in length. |
Sinus | Mild to moderate steady pain that typically occurs in the face, at the bridge of the nose, or in the cheeks. May be accompanied by nasal congestion and postnasal drip. | Affects people of all ages. People with allergies seem most vulnerable. | Frequency varies. Generally hours in length. Often seasonal. |
Migraine | Moderate to severe throbbing pain, often accompanied by nausea and sensitivity to light and sound. The pain may be localized to the temple, eye, or back of the head, often on one side only. In migraine with aura, visual disturbance precedes the pain. | Typically occurs from childhood to middle age. In children, migraine is slightly more common among males, but after puberty, it’s much more common in females. | Attacks last a day or longer. They tend to occur less often during pregnancy and with advancing age. |
Reference:
- The International Classification of Headache Disorders, Cephalalgia, Volume 24 Supplement 1 2004 2nd Ed.
- Headaches: Relieving and preventing migraine and other headaches, Harvard Medical School Special Report
Neckache from Deskbound work. Can Physiotherapy help?
"Dear Sir / Madam,
My neck has been aching on and off when I am working at my desk. Recently, I started to experience heavy headedness and I tend to lose concentration due to that. I have gone through an X-ray and I was told that I have cervical Spondylosis with a bone spur pressing onto the nerve. Are my heavy headedness and neck ache due to spondylosis? Can physiotherapy help me in my condition?" – Josh
Dear Josh,
Thank you for your enquiry.
Spondylosis is a medical term for signs of degeneration or wear and tear to the structures around the spinal bones. It is a problem faced by many people especially deskbound office workers.
There are many other underlying factor and one of them is the bone spurs which can pinch a nerve causing symptoms like pain and numbness. This may cause by excessive mechanical pressure from a poor sitting posture. According to your description, it seems like your heavy headedness is likely linked to excessive physical stress to the neck causing Spondylosis.
In a poor sitting posture, the neck is poked forward from the shoulders and the shoulders are rounded with the lower back in a slouched position. As the neck is hanging away from the shoulders, the muscles in the neck and shoulders will have to work harder to pull the neck back in order to support it. This increases the mechanical pressure on the joints which further aggravates the degenerative process. The muscles will also get fatigued and overworked, giving you the achy sensation to the neck and shoulders.
When your muscle tension becomes bad, it potentially can radiate pain up to the base of the skull. This is because there are sensitive nerves that supply to the head, eye, ear and the joints near the base of the skull . Excessive pressure over these areas can give rise to tension headache, stabbing pain behind the eye, ringing in the ears, jaw pain. The heaviness you felt from the head is most likely from the same upper neck joints at the base of the skull.
To solve your problem, our physiotherapists will
- Mobilise the neck joints to give it flexibility and reduce the mechanical pressure over the joints.
- Some soft tissue work on the muscles may need to be done to reduce your muscle tension.
- Regular stretching or range of movement exercises to reduce muscle fatigue and maintain flexibility.
- Ergonomic advise will be given on how to sit properly at work and there will be some training exercises to increase your awareness of your sitting posture so that you can decelerate the degenerative process and prevent the problem from returning.
It will usually take about 6-8 sessions to have significant improvement on such a case. You can refer to this link for more information on neck related headaches.
Regards,
Chye Tuan
TMJ dysfunction- The possible origin of severe referred pain
The temporomandibular joint (TMJ) refers to the jaw joint. When dysfunction occurs in the jaw joint, it may cause symptoms that people could not associate to the jaw. This is because the pain caused by the TMJ dysfunction may refer pain to the other structures surrounding or away from the TMJ. However, early diagnosis with physiotherapy will prevent TMJ dysfunction from becoming chronic.
TMJ is the most frequently used joint in our body as it allows us to open and close the mouth at least 2000 times a day. Therefore, a dysfunction in the TMJ can cause pain that can debilitate our daily activities.
So what the common symptoms from TMJ?
- Severe headaches
- Dizziness
- Pain in the eyes or in the back of the eyes
- Earaches
- Ringing in the ears
- Pressure in the ears
- Hearing problems
- Stiff shoulder and neck muscles
- Tooth ache
- Difficultly swallowing
- Frequent sore throats
When the TMJ is injured, muscles, ligaments, tendons, nerves and blood vessels can get injured simultaneously. The nerves send out and receive information from these structures. Irritation of the nerve can cause pain felt far from the originating problem. This phenomenon is also known as “referred pain”.
Another cause of referred pain from the jaw is the “trigger point”. A trigger point is an irritable spot in a muscle that is locked into a painful spasm. Normally, when a muscle is working, its fibers act like little pumps, contracting and relaxing to circulate blood through the muscle. In a trigger point, the muscle fibers hold their contraction, which leads to blood flow decrease. This causes the tissue to have lesser oxygen intake and more accumulation of muscle waste products. The trigger point responds to this, sending out more pain signals in the affected area and connected areas leading to a no ending cycle of continuous muscle contraction and lack of blood flow.
The main goal of the physiotherapy is to identify the source of the symptoms, aiming to reduce the pain and regaining normal function of the TMJ with manual therapy and exercises.
