How your posture is related to your teeth … in my opinion

Until recently (the last few years) I have never thought about the link between straight teeth and ‘good’ posture, it wasn’t something taught in my physiotherapy studies at university. However having worked as a head, neck and jaw physio for a few years now I have gone down the rabbit hole of everything to do with the mouth including the teeth. I mean you have to become familiar with the teeth when you are treating the jaw… the systems are working together!

In the past the jury has been out in terms of finding a clear link in the literature between postural control (the ability to assume and maintain an upright position that is considered neutral) and occlusion (another name for the way your teeth meet together). However; a recent study found has found that there is a positive relationship with posture and occlusion. What the researchers found in the study was that postural control was improved when the diverse malocclusions of the participants were corrected artificially by positioning the jaw into a neutral position. The results were not as strong (statistically weak) when the participants were standing in a stable condition but there was a lot stronger correlation when the person was fatigued or standing on unstable conditions.

The researchers have a neurological explanation for this relationship, they think that sensory information from the trigeminal nerve, a cranial nerve that is responsible for innervating the muscle’s of mastication, is having an effect on postural control.

How is this all likely to be happening?

First lets look at the basic dental occlusions in the picture below.

Dental occlusion could be altering the position of the head and neck which then has an effect on the muscles of the this area. It is likely to alter the functional pattern of the muscles and then alter our sense of balance. So let’s talk a little bit about class II occlusion. Studies have found that Class II is linked to altered head position as well as altering the functional pattern of the masticatory muscles. As well as this some have suggested there is an increase in cervical hyperlordosis (a deeper than normal curve of the neck) and weak body posture.

So how do we get a class II occlusion?

Well this all starts before the age of 7. To develop a class 1 occlusion you really need your jaw and cranial bones to have developed well, when this happens you will grow a straight dental arch as an adult. As well as this you need good tongue posture, have a nasal breathing pattern and good lip muscles that allow lip closure. A fantastic blog post from functional dentist Dr Steven Lin explains this in his post What causes crooked teeth.

If you would like to know more about this subject feel free to contact me at hello@mettaphysiotherapy.com

References:

Julià-Sánchez, S., Álvarez-Herms, J., Gatterer, H., Burtscher, M., Pagès, T., & Viscor, G. (2015). Dental Occlusion Influences the Standing Balance on an Unstable Platform. Motor Control, 19(4), 341–354. doi:10.1123/mc.2014-0018

The use sauna to improve your health … in my opinion

I have recently been posting a lot of photos of myself sitting in an infrared sauna at my local yoga studio. It probably comes at a surprise to the Brisbane community as the average temperature here has been 30 degrees + every day for the last 2 weeks!! But since moving to the area, I have been going twice a week to sit in the infra red sauna set to 60 degrees celsius for 30 minutes…. & I love it! I started to ask myself, why I love the sauna experience so much, seeing as most might find it counterintuitive to sit in a hot room when outside might just do the trick! Once I thought about it I realised there is not only the obvious relaxation I get while I am in the sauna but after, there is a re-energizing feeling. So I decided to do some research to see if there was some scientific evidence to back up my feelings.

The use of saunas isn’t new. Humans have been doing it since the middle ages around Europe. In particular the people in the Scandinavian regions such as Finland love it and they are as common as the family car. In fact going down the research rabbit hole I read a statistic that said there are 5 million inhabitants in Finland and 3 million saunas which averages out to be 1 per household. It makes sense, it gets cold in places like Finland but I really feel there is more to saunas then just keeping warm.

Before we go into seeing what the evidence says lets think about what happens physiologically. When we sit in a sauna our body endures thermal stress and as a result the following happens:

  • Heart rate increases
  • Cardiac output (the amount of blood that the heart pumps through the circulatory system in a minute) increases
  • There is an increase in peripheral resistance and increasing circulation (arteries dilate decreasing the pressure needed for the blood to flow through them)
  • There can be a decrease in blood pressure
  • Metabolic rate increases

Do these effects sound familiar? I mean if you went for a brisk walk with your dog the physiological effects would be similar! But don’t get me wrong there is really nothing that can replace regular exercise but it makes sense that it would be great as an adjunct therapy!

Historically there has been a small amount of low quality evidence that has shown that the use of regular saunas can assist with respiratory function to those who have asthma and bronchitis (although contraindicated in acute respiratory infection). The use of sauna in these individuals resulted in an increase in Forced Vital Capacity (the total amount of air exhaled during the Forced Expiratory Volume test), Peak expiratory flow (maximum speed of expiration) and Forced expiratory volume (forced expiratory volumes that a person can do in 1 second).

A study that looked at 2315 middle aged Finnish men over a 20 year period, showed that regular sauna use (4-7 days a week) could in fact extend your life span. The study showed that an increase frequency of sauna use is associated with a decrease risk of coronary heart disease (CHD), cardiovascular disease (CD) and all causes of mortality. The researchers suspect this happens because there is a physiological effect that is similar to low to medium intensity physical exercise, such as, an increase in heart rate up to 100-150 beats per minute. With repeated treatments there is an improvement of endothelial function (the endothelial is a thin membrane that lines the inside of the heart and blood vessels) in patients with CHD and therefore there it could have a preventative role in improving the integrity of our blood vessels.

What about the use of saunas for exercise and sports recovery?

A very small study looking at male distance runners found that using a sauna after exercise resulted in an increase in blood volume and as a result an improvement in their endurance running performance. After 3 weeks of using saunas after exercise they could run 32% further before exhaustion.

As well as all the changes in circulation there was also an experiment with rats that showed intermittent heating releases specific proteins called heat shock proteins. What the researchers found was that when the rats were immobilised (not using their muscles) and then mobilised and heated the heating improved muscle growth up to 30%.

Now with most of the literature out there, confounders make it very difficult to confidently make definite statements about correlations and because of this there is always a need for more research. If you unsure if it is safe to use a sauna regularly then check with your health professional first otherwise give it a go and see how it feels for yourself.

References

  1. Laukkanen, T., Khan, H., Zaccardi, F., & Laukkanen, J. A. (2015). Association Between Sauna Bathing and Fatal Cardiovascular and All-Cause Mortality Events. JAMA Internal Medicine, 175(4), 542. doi:10.1001/jamainternmed.2014.8187
  2. Crinnion, W. (2011). Sauna as a Valuable Clinical Tool for Cardiovascular, Autoimmune, Toxicant- induced and other Chronic Health Problems. Altern Med Rev,16(3):215-225 .
  3. Scoon, G. S. M., Hopkins, W. G., Mayhew, S., & Cotter, J. D. (2007). Effect of post-exercise sauna bathing on the endurance performance of competitive male runners. Journal of Science and Medicine in Sport, 10(4), 259–262. doi:10.1016/j.jsams.2006.06.009
  4. Selsby, J. T., Rother, S., Tsuda, S., Pracash, O., Quindry, J., & Dodd, S. L. (2007). Intermittent hyperthermia enhances skeletal muscle regrowth and attenuates oxidative damage following reloading. Journal of Applied Physiology, 102(4), 1702–1707. doi:10.1152/japplphysiol.00722.2006

Changing habits with mindfulness in my opinion …

I have been working with people who suffer from temporomandibular joint dysfunction for a few years now and have noticed that an increase in oral habits such as biting nails, clenching, grinding, lip biting, biting hair (I could go on) can really exacerbate symptoms. As a result I ask people to watch out for their oral habits daily as it can be crucial for their rehabilitation. Over the years I have realised that when I ask people to try and stop their oral habits (which is easier said then done and perhaps even a little unrealistic) what I am really asking them to do is to be more present in their day to day lives.

What do I mean by “being present”?

I guess another word you could use is mindfulness. So how does one get better at being more mindful? I have found with my own health journey of trying to decrease old habits and trying to start new ones, meditation has really helped.

In contrary to what people might think, meditation doesn’t involve trying to stop your train of thoughts, rather, it involves watching the traffic of our mind, emotions and sensations, through this we can improve our ability to notice these gripping distractions within us – the trick is to notice these not just while we are meditating but also in our everyday life – for example – while we work, cook, exercise, parent, basically while we do life. By practising mediation we are able to increase our self awareness which is exactly what you need when you are trying to change a habit.

Habits are behaviours that are performed so frequently that they then become automatic. Often they are so automatic, they are deeply engrained and we don’t even know that we do them. This is why practicing mindfulness helps because when we are mindful we attend to what we are doing, what is happening and how we are feeling. When this happens we can actually catch ourselves doing things we never even knew we did. Practicing this self awareness helps most peoples see their habits and change, especially if it is the habit we are trying to decrease. If we don’t stop, we can pay attention to how we feel and possibly any triggers that are connected to our habits.

Working in the physiotherapy/manual therapy world I find meditation is a useful adjunct to the healing process as most of the time we are trying to decrease habits be it, favouring one leg, walking with an abnormal gait pattern, clenching etc. What mediation and mindfulness does is give more freedom from our conditioned responses, mental and physical. It is useful, as the process of meditation involves taking the time to pay attention to our bodies which is key, you can start asking “how I am standing while I’m waiting in this line at the supermarket?”. “What does my body do when I’m under the pump at work?”, “What is my go to sitting position?”.

I will admit it can be a long process changing a habit, because when you think about it the way to make a new habit is the same way you made the habit you are trying to get rid of! Repetition, repetition AND more repetition. Yep, you just have to keep at it. Your nervous system needs multiple times of doing the one thing before the pathway is strong, clear and direct. It is kind of like walking through the long grass and making a path, the first time you walk through the long grass you might only very slightly bend the grass, the second time you walk through it the grass gets a little more bent but you can only just make out the path you walked last time but if you repeat it enough the grass would have laid down and bent enough that it is a clear open space and it will be much quicker to walk through. Your nervous system works the same way.

I know that sometimes it seems like such hard work being present in your day to day movements but don’t worry this discipline will inevitably give you more freedom from your conditioned responses. So if you’ve been trying to stop a bodily habit in your life that isn’t serving you trying asking yourself these questions in your day to day; “how am I standing right now?”, “What am I doing with my mouth?”, “I feel really busy and overwhelmed right now, how am I breathing?”, “What does my normal walking pattern look like?”. Give it a go and feel free to tell me what happens.

Words that harm and words that heal in my opinion ….


Pain is one complex topic! If you suffer from chronic pain you would know that there is no simple solution and hopefully through your journey you might have noticed that there are some things that can really increase and decrease your symptoms outside of the pathophysiology (see my stress and healing blog post and the sleep/pain cycle blog post).

In particular, communication plays a major role. That is, communication from your health care provider and communication to yourself. O’sullivan & Lin (2014) reported that negative beliefs are predictors of pain intensity, disability levels and chronicity. They report that negative emotions and beliefs can play a role in sensitising spinal structures via the central Nervous System. In other words thinking negatively about your situation can make things hurt more!

In the health care setting most of our beliefs of our physical issues come from health care providers who have given us advice and education around our issues. Have you ever stopped and thought about how your health care professional communicates with you? Is your health professional using words that generate fear, anxiety, despair and hopelessness?

Now don’t get me wrong; I am certain that your therapist has no calculated intention of instilling fear… but sometimes without thinking, analogies and phrases can come out of our mouths that inevitably create anxieties about the whole situation.

Let’s do an experiment, have a think about how you feel when you read these words:

“Your back is damaged”

“You have a back of a 70 year old”

“Your back is weak”

“You have to be careful” (Really, what could happen if I don’t?”)

“This will be here for the rest of your life” (Great! I am doomed, stuck with issues forever”)

“Your back wears out as you get older”

“Let pain guide you” (You mean pain is always bad and should be avoided?”)

For myself they produce fear and leave me with a feeling of hopelessness. When there is a feeling of hopelessness it is hard to feel motivated to do anything… from exercise, to daily self care and inevitably it can be difficult in becoming an active participant on your healing journey.

Now once you have seen your therapist and you get home and friends and family ask you “how’s your back going, what did they say?”. You naturally reflect back the beliefs and the communicated messages your therapist gave you. Resulting in an affirmation of the negative emotions and beliefs.

This leads me to my next question, have you taken the time to consider the words you are telling yourself? Words infused with optimism are healing! O’Sullivan and Lin (2014) reported that people who have positive beliefs are less disabled. Why? Because positive beliefs bolster your strengths and increase self reliance which means you may have better coping strategies and are more likely to exercise and move in a more natural way throughout your day.

Now have a think about what these words illicit in you:

“Back pain does not mean damage, it means it is sensitised”

“The brain acts as an amplifier, the more you worry and think about your pain the worse if gets”

“Your back is one of the strongest structures in the human body. It is very rare to do permanent damage to your back”

“Your scan changes are normal, like grey hair is”

“Movements may be painful at first but like an ankle sprain they will get better as you get active”

The language you use can lift your spirits, so next time your symptoms are high watch out for words that intensify any negative emotions and potentially destroy hope and remember words infused with optimism are healing!

O’Sullivan, P & Lin, P. (2014). Acute Low back pain beyond drug therapies. Pain Management today, 1(1):813.

Main, C. J., Foster, N., & Buchbinder, R. (2010). How important are back pain beliefs and expectations for satisfactory recovery from back pain? Best Practice & Research Clinical Rheumatology, 24(2), 205–217. doi:10.1016/j.berh.2009.12.012

Imaging for the Lumbar back pain in my opinion ….

Often when a client comes to see me after a few weeks of persisting pain and symptoms in the lower back area I get asked the question, “Should I go get a scan done?”. I get it! As someone going to a health professional you have some clear expectations, you want to know what is going on and you want a clear diagnosis. We are lucky enough that we live in the future! In a world where technology allows us to see the inner workings of the human body, something that was only available to the super heroes you saw on TV not that long ago. The inner realm of the body is no longer a mystery. But is imaging such as MRI scans always a necessary tool when you have lower back pain?

The American College of Physicians reissued the guidelines for imaging patients with lumbar back pain, stating that there are not only inefficiencies of early imaging of the lumbar spine but early imaging can also be potentially harmful.

Why could it be inefficient?

It has been found that there is a high prevalence of what some might call ‘abnormal‘ findings on MRI in pain free populations. These are some common findings in pain free populations:

  • Disc degeneration 91%
  • Disc bulges 56%
  • Disc protrusion 32%
  • Annular tears 38%

So if the odds are high that you will find some changes in the spine that may not be associated with your symptoms it could very well be a waste of time, money and radiation (if you get an x-ray).

Also the words ‘abnormal findings’ should be taken lightly as disc bulges, protrusion and annular tears can all be considered normal degenerative changes that come with every humans ageing process. In fact a study that looked at MRI scans to 33 asymptomatic tennis players aged between 17-18 years old found that ‘abnormalities’ such as Pars injuries, facet joint arthroses and disc bulges were all relatively common.

But often we take what is written on radiography reports as gospel. If it says abnormal findings this can often be taken that there is a problem and can leave you feeling like there is something more sinister going on… which brings me to my next point.

Why is it potentially harmful?

O’Sullivan and Lin reported that imaging for non traumatic lumbar back pain can lead to; poorer health outcome, greater disability and work absenteeism due to the fact that often when we see abnormal findings on scans there can be a need to pathologize the issue without realising that these findings are very likely normal changes.

This could lead to unwarranted anxieties which can often make the whole situation worse. O’Sullivan and Lin reported that negative emotional factors play a significant role in sensitising spinal structures through the central nervous system.

Now it is important to note that there is a very small 1-2% of people with lower back pain who will have a serious or systemic disorder where scans will be a useful tool for guiding treatment options. As well as this Jarvik et al reported that severe central stenosis, root compressions and disc extrusions on scans are likely to be diagnostically and clinically relevant.

I think the moral of the story is that if it you fall into the small group who have a severe and serious pathology, scans are likely to be an important tool in helping health professionals direct individuals to the most appropriate treatment options but outside of this population it is not likely to be useful and possibly have some negative effects.

References

  1. Alyas, F., Turner, M., & Connell, D. (2007). MRI findings in the lumbar spines of asymptomatic, adolescent, elite tennis players. British Journal of Sports Medicine, 41(11), 836–841. doi:10.1136/bjsm.2007.037747
  2. Chou, R. (2011). Diagnostic Imaging for Low Back Pain: Advice for High-Value Health Care From the American College of Physicians. Annals of Internal Medicine, 154(3), 181. doi:10.7326/0003-4819-154-3-201102010-00008
  3. Jarvik, J. J., Hollingworth, W., Heagerty, P., Haynor, D. R., & Deyo, R. A. (2001). The Longitudinal Assessment of Imaging and Disability of the Back (LAIDBack) Study. Spine, 26(10), 1158–1166. doi:10.1097/00007632-200105150-00014
  4. McCullough, B. J., Johnson, G. R., Martin, B. I., & Jarvik, J. G. (2012). Lumbar MR Imaging and Reporting Epidemiology: Do Epidemiologic Data in Reports Affect Clinical Management? Radiology, 262(3), 941–946. doi:10.1148/radiol.11110618
  5. O’Sullivan, P & Lin, P. (2014). Acute Low back pain beyond drug therapies. Pain Management today, 1(1):813.