Clicking jaw in my opinion ……

Have you every heard some unusual nosies coming from your jaw like clicking, popping or clunking sounds?  Perhaps it’s happened when you yawned or eaten a nice chewy steak. Sometimes you might even feel like you have a entire rhythm section playing some loud beats in your jaw when you are chewing or even talking.

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The TMJ (temporomandibular joint) aka jaw joint is made up of 2 bones, the temporal bone and mandibular bone (hence the name). Between these 2 bones there is a disc that is not dissimilar to the discs between your vertebrae in your spine and cartilage in your knee. In a perfect world the disc glides together with the mandible bone always staying snug and centred on top of the condyle (round protuberance on top of the bone). When this doesn’t happen the disc moves in and out within the joint and this is the noise that you hear.

Watch a video of a clicking disc

There are many reasons why this happens and the clicking can come with or without pain, here are just a few reasons why clicking may occur:

  • Excessive forces in the joint that come from oral habits such as clenching, grinding, biting cheeks, chattering teeth, biting nails, chewing gum, biting pens the list could really go on and on. What tends to happen is normal asymmetries can get exaggerated in the orofacial muscle system that then has a domino effect on the joint, resulting in some asymmetries in the joint positioning.

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  • From my experience having increased joint laxity can often be a risk factor for increased clicking and further more some general TMJ dysfunction (however the jury is out according the literature and further studies are required). You might want to think of it as having more room for movement within the joint as the ligaments surrounding the joint have more give. See references for further reading.
  • Sometimes it occurs if you have had your mouth open for an extended period of time such as at the dentist or after surgery and having had an artificial airway in your mouth. It seems the muscles overwork and the disc is displaced out of the joint.

Because we use our mouths regularly to talk, eat and make facial expressions it can be quite debilitating if you have pain associated with clicking or any jaw pain for that matter. But rest assured there is help!

Ericka has a special interest in treating head, neck and jaw issues and has extended experience treating clicking jaws. Book here for a session

References

 

  1. Westling, L. 1992. Temporomandibular joint dysfunction and systemic joint laxity. Jan 81:1-79.
  2. Buckingham, R et al. 1991.Temporomandibular joint dysfunction syndrome: A close association with systemic joint laxity (the hypermobile joint syndrome). Vol 72, Issue 5, Pages 514–519.
  3. Dijkstra, P et al. 2002. The Association between Generalized Joint Hypermobility and Temporomandibular Joint Disorders: A Systematic Review. https://doi.org/10.1177/0810158

 

 

 

How meditation can assist pain management in my opinion …..

I recently saw a meme going around the therapy social networks, that I quickly resonated with, it showed a great reflection of how it can some times feel when discussing pain science and pain education in general. I mean “Sheriff Woody’s” body language says a thousand words!

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Pain is complex, I guess because humans are complex. At the National Pain Summit in 2010 an explanation for pain was described as “An individual human experience that is entirely subjective and that can only be truly appreciated by the individual experiencing pain”.  I think humans are multidimensional beings and to think of pain as simply being a biological process is limiting. Pain is complex because there is a significant amount of social and emotional suffering that comes along with the physical aspects of pain. Often we talk about treating pain within a bio-psychosocial model, that is a model that understands that pain is a dance between the biological factors, psychological factors such as mood, personality, behaviour and social factors such as culture and familial. To simply just treat the symptoms alone, I have found with my experience, keeps you in a positive loop pattern that only leads to more pain.

Professor in neuroscience Lorimer Moseley (late physiotherapist turned neuroscientist) once said “what are the barriers to really deeply adopting the bio-psychosocial model? Often the application results in clinicians suggesting that pain is in the ‘bio’ and suffering and disability is the ‘psychosocial”. It really is a dance, this is where I feel meditation comes in. I think it is a great adjunct to therapy, I mean we really are mind & body and not just the body so why just treat the body?

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The way I see meditation used as a pain mediator; is that it allows us to see our thoughts & feelings in a non-reactive way. Sure it takes practice to get to this point, but so does everything. To be able to feel discomfort and watch your thoughts, decreases the chance of feeding the symptoms and inevitably increasing them. It allows us to practice being non-reactive to every sensation. This might sound wishy washy but luckily there has been more and more evidence to back this up. In 2016 Cherkin Et-al studied mindfulness and chronic back pain in 342 adults and found that mindfulness based stress therapy resulted in greater improvement in chronic low back pain and functional limitations at 26 weeks compared to usual care.

Another factor that is strongly correlated with chronic pain is fear! Fear avoidant patterns of movement can often keep you in a pain loop = You move with fear, these movements are not bio-mechanically efficient. This causes your body to work in unusual ways likely to cause more stiffness and pain. In the study from Schutze Et-al found that low mindfulness predicts pain catastrophizing in a fear avoidance model of chronic pain.

In my experience meditation allows you to see your thoughts and perhaps the patterns that are so repetitive you may have never realised they are there …. in a loop. I find by seeing this you immediately press the pause button on that loop.

Of course I don’t think meditation alone will alleviate all physical symptoms, however as and adjunct to movement, strength and manual therapy you are definitely giving your body an environment conducive to healing from a mind & body perspective.

Ericka has completed a meditation teacher training and is a daily meditator. Ask her how to include this in your therapy. Meditation.

 

References:

  1. Checkin et al. 2016, Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain. March 22/29. doi:10.1001/jama.2016.2323
  2. Schutze et al. 2010, Low mindfulness predicts pain catastrophizing in a fear-avoidance model of chronic pain. January vol 148, page 120-127. doi.org/10.1016/j.pain.2009.10.030