Missed Causes of LBP: It's the Syndrome, Not the Subluxation
When I read the chart notes of other chiropractors, I am usually disappointed. They list what vertebrae are fixated or misaligned. They may describe the involved fascia and muscles.
New Opportunities for DCs
For decades, the model chiropractic practice has been the single-doctor practice. Recent surveys have found that approximately two-thirds of U.S. doctors of chiropractic still practice this way, with another 20 percent practicing in multiple-chiropractor practices.
Catch the Workplace Wellness Wave
Do you offer workplace wellness services to local businesses? If not, you might want to consider this lucrative channel for expanding your practice. Workplace wellness programs and wellness-related benefits have grown in popularity over the past several decades.
Practice Pearls: There's More to ROM Than Meets the Eye
As part of my neuromusculoskeletal examination, I perform range-of-motion (ROM) evaluations. I can "eyeball" the range and measure, I can use a goniometer and measure, I can use my phone app and measure, or I can use various other instruments to help determine degrees of motion.
News in Brief
Parker University Launches New Open-Access Research Journal for Chiropractic; Western States, Cleveland-KC Name New Deans of Chiropractic Colleges; Sherman College Goes Tobacco-Free; Life University Wins 11 Awards.
Official NCCAOM Practice Tests
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) is excited to announce the launch of the new NCCAOM Exam Preparation Center.
Bastyr University: On the Front Lines of the Pain Epidemic
At University of Washington's Harborview Medical Center, the Seattle region's only Level I Trauma and Burn Center, the demands for in-patient care are dramatically different from a private clinic environment.
First World Spine Care Graduate: Hildah Molate
Hildah Molate, the first World Spine Care (WSC) scholarship student, graduated from Palmer College of Chiropractic earlier this year and is now working at the WSC community spine clinic in Shoshong, Botswana.
Multi-Dimensional Acupuncture: 3D, 4D & 5D
Maggie is an intuitive healer and workshop leader who I met on a recent hike. While we were talking she told me how she had to take it easy because of her knees. She said that her doctor told her that she has the early signs of arthritis.
Old Trend, New Risks: Heavy Weight Training
With more opportunities to exercise than ever, a greater selection of exercise options, and the subsequent opinions supporting and challenging their merits, it's easy to be confused as to which approach is best.
A Novel Way to Prevent Elderly Falls: Toe Strength
In any given year, nearly 40 percent of senior citizens ages 70 and older will fall at least once. Each fall significantly increases the risk of not only sprains, strains and contusions, but also fractures.
State by State: Chiropractic Leads Changes in Health Care
Monumental legislative bills in support of the chiropractic profession were passed recently in Washington, West Virginia and Oregon. Here is a review of this important legislation, state by state...
NBCE to Reinstitute Computer-Based Exams
The National Board of Chiropractic Examiners (NBCE) has announced it will reinstate computer-based testing in January 2019 courtesy of a partnership with testing and assessment solutions provider Prometric.
Acupuncture's Standard of Care
Both a concern and critique of acupuncture, frequently espoused by the bio-medical community is, "there is no standard of care in acupuncture." The following is why I believe this statement is disingenuous at best.
Better With Chiropractic
While chiropractic care is receiving high levels of exposure these days, most pain patients who consult with a health provider still do so with their primary-care MD. And of course, that means in most cases, they're receiving standard medical care, not chiropractic.
Chiropractic's Next Frontier: Adjusting the Microbiome
Restoring a healthy microbiome to help treat disease may be the next frontier in chiropractic offices around the country.
Regenerative Medicine: How to Do It by the Books
The "lay of the land" for regenerative therapies, including but certainly not limited to adult stem-cell treatments, seems to change almost daily.
TCM Codes for the World
I just received an email concerning the ICD-TM11 codes. The World Health Organization (WHO) will be presenting the new ICD-11 codes to World Health Assembly very soon.
Dropping Insurance: 4 Steps
My office manager just got off the phone with the secretary of a long-standing patient. I have treated this woman and 10 members of her family for more than a decade. She has, as have all of my patients, paid my fee at the time of service since I dropped insurance in 1997.
Prevention: Stop Recurrent Urinary Tract Infections
The recurrent urinary tract infection (UTI) is one of those nuisance conditions that can play havoc with quality of life, and this particular infection is much more common than most people realize.
Transforming Exam Delivery
The NBCE Board of Directors has never wavered on its promise to deliver an excellent, on-campus computerized testing experience to students. Likewise, there has never been a compromise to the delivery of fair, valid and legally defensible exams.
Is Primary Spine Care the Answer for Chiropractic?
Recently, we sat down with Mark Studin, DC, FASBE(C), DAAPM, DAAMLP, to discuss the state of chiropractic and why primary spine care may hold the key to chiropractic's future. Read what he had to share in this exclusive interview.
Cyber Threat Checklist: Defend Your Business With These 10 Steps
Living in an internet connected society brings many conveniences and benefits. The power of the internet to connect us with customers, store data, and find information has opened the door for many small business owners to grow and flourish.
Paving the Way to Integrative Health & Wellness
Jared Polis (D-Colorado) and Mike Coffman (R-Colorado) launched the integrative health and wellness (IHW) caucus in October, 2018.
Prompting Memory: How to Stimulate Cognition
Recently I gave a talk titled, The Art of Memoir – Tapping the Past to Sharpen the Present at a senior lunch event in Austin, Texas.
It's Time for a Functional Approach to Chronic Illness
It seems one of the more modern buzzwords is chronic, referring to diseases – that is to say, "ongoing and incurable." However, we can take a different perspective and recognize that, although the body may have been traumatized and injured, healing should always be viewed in the realm of possibility.
Spring Allergies & The Spleen: Looking at Pattern Differentiation
As the season of Spring fades away and we shift into the warm summer months, many patients suffer from chronic allergies. This is by far one of the most common issues I see in the clinic as well as often mistreated and misdiagnosed.
Diagnosing & Treating Aggressive Energy
Recently, there has been an article, and subsequent discussion, about the subject of Aggressive Energy (AKA "AE"), including ways to detect its presence and an alternative method of treating it.
The Acupuncturist and the Opioid Crisis: Conquering Pain & Addiction in the U.S.
The current opioid epidemic dominates the discussion among national health leaders, recovery advocates and families nationwide. Opioids include heroin as well as prescription pain relievers such as oxycodone, hydrocodone, codeine, morphine, fentanyl, and others.
Reducing Allostatic Load & Stress Through Heightened Awareness
Your contemporary mental health and psychotherapy colleagues may often approach the treatment of allostatic load as a mental health condition and use prescription psycho-pharmaceutical medicine to affect general and specific central nervous system (CNS) pathways and brain neuro-chemistry medicine to alleviate the associated symptoms.
August, 2002, Vol. 02, Issue 08
TMJ: Primary Problem, or Tip of the Iceberg?
By John Upledger, DO, OMM
The diagnosis of temporomandibular joint (TMJ) syndrome came into its own in the 1980s, and still remains popular today. A myriad of mechanical devices have been placed in people's mouths to alleviate the painful symptoms of TMJ dysfunction.The success rate of the singular use of such devices, however, leaves much to be desired. All too often, symptomatic relief is only partially achieved, and leaving treatment dependent upon the ongoing use of the intraoral devices. In other words, when the "splint" comes out, the symptoms return.
My own experience with TMJ dysfunction leads me to believe that the condition is often a secondary or tertiary manifestation of another problem somewhere in the body. Underlying problems that contribute to TMJ dysfunction and secondary symptoms are frequently found in the craniosacral, nervous, musculoskeletal, myofascial and masticatory systems.
TMJ syndrome may also be secondary to - or receiving significant contributions from - previous or current traumatic injuries anywhere in the body, and/or from stress. In addition, there may be systemic disease processes in the background, along with allergic and/or nutritional factors that can significantly contribute to the presenting TMJ syndrome.
I have assigned the majority of contributing factors of TMJ dysfunction and the resulting syndrome to the following major categories: craniosacral system dysfunction; stress; neurogenic problems and dysfunctions; posttraumatic problems and residua; structural/somatic problems and dysfunctions; degenerative problems and diseases; and dental problems. I'll discuss several of these categories, including suggestions for the efficacious use of different treatment modalities.
Craniosacral System Dysfunction: The craniosacral system is composed of the membranes and cerebrospinal fluid that surround and protect the brain and spinal cord. It extends from the bones of the skull, face and mouth - which make up the cranium - down to the sacrum or tailbone area.
The bones of the skull most directly involved with the temporomandibular joints are the temporal bones and the mandible. In the case of TMJ dysfunction, the temporals are the most likely offenders directly related to craniosacral system dysfunctions.
The temporomandibular joints are located two-to-four centimeters anterior to each temporal bone's axis of rotation. Because of that articulating relationship, they are commonly involved in TMJ problems. Since the joint surfaces of the temporal bones are located in eccentric positions, when the temporal bone or bones are restricted into asymmetrical positions in relationship to one another, they provide malaligned joint surfaces for the temporomandibular joints on both sides. This malalignment results in mandibular imbalance and undue wear and stress upon the joints.
Temporal bone dysfunction can result from almost any problem within the craniosacral system, be it osseous or membranous. Only a thorough evaluation of the craniosacral system and the whole-body contributions to craniosacral system dysfunction will yield the primary cause of the problem. This can be accomplished through CranioSacral Therapy, a gentle method of releasing restrictions in the craniosacral system.
Remember, temporal bones can also be forced into abnormal positions when the muscles and ligaments that attach to them present with abnormal strains and tensions. CranioSacral Therapy aims at releasing temporal bones to restore normal function, regardless of the primary cause of the TMJ dysfunction.
The mandible, the other bone that contributes directly to the temporomandibular joints, is a single bone with one joint on each end. Therefore, you cannot distort one joint without causing a problem with the joint at the other end of the mandible. CranioSacral Therapy uses techniques to release and balance the joints at both ends of the mandible. It also releases undue muscle and ligament tensions upon this lower jawbone.
The hard palate is at the mercy of the sphenoid bone with which it articulates at both sides and, via the vomer, in the middle. Since the sphenoid is a major player in the craniosacral system, it is also important to evaluate the system's effect on the function of the hard palate. Distortions in sphenoid function or position often cause hard palate malalignment, which results in malocclusion of the teeth and secondary temporomandibular joint problems.
Within the domain of CranioSacral Therapy, we also have the balancing of all of the muscles of mastication. This means that bruxism, disc position and TMJ compression are all addressed effectively.
Stress: Stress can be caused by a number of factors. Physiological stress might be imposed by problems such as gallstones, kidney dysfunction or arteriosclerotic heart disease. Stress also can be induced by poor posture secondary to a shortened leg, for example. Psychoemotional stress, yet another category, is due to life frustrations, neuroses, or harbored destructive emotions like chronic anger. Environmental conditions - breathing polluted air or working in a noisy environment - produce stress as well.
No matter what the cause or type, stress exacts a toll from the body, as vital energy is required to cope with these conditions. While it's well-known that chronic stress may cause a range of health problems, stress has not been thoroughly considered as the root of TMJ problems (surprisingly). Teeth or jaw clenching is a natural response to increased stress, which compresses the temporomandibular joints and, in turn, causes the joint surfaces to be placed in jeopardy.
When excess stress is a factor in TMJ dysfunction, we must consider the use of stress management techniques. Among these modalities are therapeutic massage for relaxation and release, CranioSacral Therapy to reduce sympathetic nerve tone; SomatoEmotional Release to alleviate traumatic tissue memories and psychoemotional problems; hypnotherapy and/or biofeedback to develop conscious control of muscular hypertonus; and psychotherapy or counseling. Depending on the patient and the availability of therapeutic modalities, any or all of these techniques should be considered along with similar ones.
Dental Problems: I hesitate to discuss how dentists should treat TMJ syndrome. I only know that when direct orthodontic, occlusal and/or surgical interventions are put into play before the craniosacral system is functioning at its optimal level, the dental work must often be redone. Why? Because the involved structures change in response to the craniosacral work and other types of bodywork.
In CranioSacral Therapy, we specifically mobilize teeth in their sockets and encourage them to find their natural position in the mouth. When this happens, it changes the occlusion more toward what nature intended.
Dentists should not be excluded from being a part of the therapeutic team; however, they must recognize that occlusions, temporomandibular joint vitality, bruxism and compressive forces related to the masticatory system will most likely be changing as a result of the non-dental work. Therefore, the interventions imposed by dentists should be temporary and complementary to the holistic approach.
These examples show that TMJ syndrome may be the primary problem, or it may be just the tip of the iceberg. The condition is a part of the whole person, and the whole person must be evaluated to solve it.
Click here for previous articles by John Upledger, DO, OMM.
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