Neck Wrenching Pain and Stiffness

How many times have you woken up in the morning with "a crick in your neck" or pain so bad that you just want to roll back over and go to sleep? You are not alone, it's estimated that 70% of people will have neck pain at some point in their lives. Neck pain is not only a literal pain in our necks but it can also effect productivity and our quality of life too. Many of those people will ignore their neck pain but some will get treatment from a doctor or other health care practitioner. But how do you know what treatment is right for you?

In a recent study published by the annals of Internal Medicine in January of 2012, researchers looked at treatments such as medication, home exercise, and spinal manipulative therapy (chiropractic adjustments) to find out what is most effective in the treatment of acute and subacute neck pain. 272 participants with neck pain for 2-12 weeks were assigned to treatment group for 12 weeks and then results were measured for short and long term effectiveness over 52 weeks. Read the full study.

So what did those results show? After 12 weeks of treatment, the spinal manipulative therapy (SMT) group had a greater reduction in pain that the medication group. In addition, the SMT treatment group showed greater reduction in pain than both the home exercise and medication groups at 52 weeks. The SMT group also reported higher global improvement, patient satisfaction with care, and assessed physical function than the medication group. The home exercise group also showed a greater reduction in pain than medication and after 12 weeks a higher percentage of participants reported pain reduction of at least 75% over medication.

So this tells us that in cases of acute or sub-acute neck pain, spinal manipulative therapy is superior to medication in short and long term situations for pain reduction, global improvement, patient satisfaction with care, and physical function. Home exercise is also a valuable tool and faired better than medication in pain reduction in short and long term use as well as having a higher patient satisfaction rating.

So if you do have neck pain, talk to your doctor about referring you to a chiropractor or to another specialist for some home exercises! Your local chiropractor would be more than happy to talk to your medical doctor if there are any concerns with treatment.

Jawbreaker Jabber

After reading a blog post from Lisa White about clenching her teeth while lifting weights, I decided to do a quick blog post about jaw pain. Many of us clench our teeth or jaws when stressed or while working out. This causes the muscles in the jaw to clench and load the temporomandibular joint (TMJ) which can lead to dysfunction and even headaches if done chronically.  We have many muscles that work together to help us open and close our jaw as well as move it side to side and even thrust it forward as well. These muscles also help us to chew our food and talk as well. Below find a cutaway picture of the jaw and the main muscles that "run the show". The jaw itself is made up of two main bones the maxilla (the upper jaw) and the mandible (the L shaped lower jaw) that come together in the temporomandibular joint (TMJ). The TMJ is cushioned by a small disc that's similar to the discs in your spine except that it is shaped like a backslash on your keyboard and its anchored by ligaments. This disc should allow the top of the mandible to glide gently over it without grinding or clicking, but many people that have degeneration or have injured this joint have grinding, clicking, or popping sounds emitted upon opening of the jaw.



Notice the temporalis muscle that runs along your "temple" and the side of your head. Many headache sufferers report having pain in this area and frequently link it to high stress levels. This muscle not only helps to clench your jaw tight but also has blood vessels that run in close proximity to it. Due to this anatomical mapping, many people that report throbbing headaches or a dull ache in the "temple" area after a high stress situation may be experiencing a side effect of temporalis muscle spasm from jaw clenching. Incidentally, there are also a few conditions such as temporal arteritis and polymyaliga rheumatica that may effect that same area and as a result may have similar symptoms. These conditions are more often found in older individuals (over 50) that suffer from immune dysfunction such as autoimmune disorders, frequent infections, and high doses of antibiotics. Consult your doctor for more information on these conditions.

The masseter muscle is the top layer of muscle that helps to pull the jaw shut tightly. I don't frequently find any issues with this muscle as its motion is pretty straight forward and with talking and chewing daily usually gets enough motion and stretching to avoid spasm.

The second layer of muscle underneath the masseter muscle is home to two muscles, the medial and lateral pterygoids. Refer to the picture below for a better understanding of where they attach. Notice the lateral pterygoid muscle attaches at two different points on the maxilla (upper jaw) while the medial is made up on one attachment. The two pterygoid muscles work together to not only lower the jaw but also open and thrust it forward in motions necessary for chewing and talking. Because these muscles are involved in a complex motion process, I frequently find them in spasm and very tender when palpated.

The other muscle shown is the digastric muscle which aids in allowing the jaw to open by pulling the mandible downward. In high stress individuals and jaw clenchers I typically find this muscle to be tender due more to overuse rather than spasm.

So now that we've covered the anatomy a bit more let's talk about what happens in TMJ dysfunction. TMJ dysfunction can be characterized by a number of different things including generalized jaw pain and weakness to jaw tracking variants as well as clicking, popping, and grinding upon opening the jaw. Jaw pain and weakness is usually a combination of issues due to nerve involvement in addition to the mechanical dysfunction caused by muscle imbalance and spasm. Jaw tracking variants can be due to improper muscle balance of the jaw muscles due to muscle spasm. The clicking, popping, and grinding sounds are usually due to degeneration and/or injury to the disc that cushions the mandible and as a result the disc is either not allowing a smooth gliding mandibular motion or the ligaments holding the disc may be injured or torn allowing the disc to "click" during jaw motion.

The nerve involvement associated with jaw pain and weakness may be due to irritation or direct pressure on a nerve from inflammation in the TMJ or from muscle spasms in the surrounding musculature. The muscle involvement can frequently be affected by your misaligned "bite" as well as clenching. Teeth are supposed to overlap and contact at the same time in your bite, however many factors such as a history of braces or tooth extraction can cause these contact points to shift. The shifting can cause high points on the teeth so that one side or one tooth contacts first in your bite. This high point can not only put stress on that tooth (causing loose teeth and a painful gum line due to exposed nerve) but also can cause the jaw muscles to react and contract unevenly which can lead to muscle spasms.

So what can you do about it? Talk to your dentist! Many dentists are now trained in a procedure called occlusal adjustments which reshape the surface of the teeth to eliminate or lessen the high spots in your bite. In addition to your dentist, talk to other health professionals you see such as a chiropractor and/or massage therapist as they can address the muscle spasms and may be able to offer stress management techniques to help prevent teeth clenching. Some chiropractors are also trained in adjustment procedures that are gentle and specific to help realign the TMJ joint using soft tissue and Activator techniques.

So much for a "quick" blog post right???