TMJ and neck

Why Pain Can’t Tell You Where You Need Treatment: A TMJ Case Study

TMJ and neck

Jaw pain/TMJD is a very frequent problem we see in the office. It’s so frequent that I spend one day each week inside of a dental office in West Palm Beach doing consultations with a great local area dentist that specializes in pain syndromes of the jaw.

Most of the patients that see us with jaw pain have already seen a variety of jaw specialists. They’ve had MRI’s done, mouth pieces made, and various therapies done on the area of pain.

The problem of course is that pain, especially chronic pain, does a poor job of telling us what is wrong with you. Chronic pain is complex. Chronic pain is misleading. Chronic pain is also a poor locator for pathology.

Identifying the Pain Source

One of the common questions asked during a case history is to highlight or point to the area where you feel pain. It can be useful sometimes when pain patterns are reflecting specific nerve roots, and it also gives a general vicinity for a doctor to examine more closely. For most cases of chronic pain, examining the area of injury often leads to dead ends. There’s no damaged tissue to treat or remove that’s likely to explain why someone hurts.

Patients with TMJ pain frequently seek the treatment of these specialized dentists, and most of them do really well when in the right hands. However, sometimes jaw pain isn’t truly a problem in the jaw. Sometimes it’s a pain problem somewhere else in the body.

I recently took care of a patients who were was referred by another chiropractor. The patient had been to 6 different jaw and mouth specialists but could not get any form of relief from treating the jaw.

When we examined the patient, we didn’t pay much attention to the jaw itself. The patient already had imaging and tests done to their mouth already, so I wanted to spend my time elsewhere.

We found that the patient had poor motion in their shoulder and neck area on the right side. They were also showing a large amount of forward head posture characteristic of anterior head syndrome. Surprisingly, the patient’s jaw seemed to move pretty well. There wasn’t the clunky abnormal opening and closing of the jaw that you would usually see in a TMJ where the jaw displays a large side to side movement. From my view, the patient’s jaw movement looked really great, but the patient’s neck was moving poorly.

Correct the Neck and Pain Self-Resolves

We did our normal protocols with this patient. We did a gentle NUCCA correction to the patient’s neck. We post-x-rayed the neck to verify a neck improvement, and then we waited. You can see the x-ray results below.

Pre and Post X-ray shows a small shift, but an almost perfect correction.

Pre and Post X-ray shows a small shift, but an almost perfect correction.

3 days after her first appointment, we had our first follow-up appointment scheduled. The patient had gone 3 consecutive days without any jaw pain at all for the first time in 2 years!

Pretty good, but would it last?

3 months later, we re-examined the patient. The patient was now going 1 month between appointments because it would be important to see if the patient could go that long a distance between appointments without pain. The jaw was still moving normally, but now their head and neck could move in all ranges of motion smoothly. The patient also stopped showing a persistent right tilt of their head.

Most importantly, the patient could now talk with no restrictions, and had no more food limitations on what she could eat. For all intents and purposes, she became a normal teenager again.

Final Thoughts

Now if we had kept on trying to treat the jaw and identify pathology in the jaw, would she still have gotten better?

It’s hard to say, but after 2 years of doing every jaw therapy under the sun, it just seemed to make sense to look at other pieces of anatomy.

The complexity of chronic pain often means that we can’t look at things linearly. We have to know that someone has pain in one region, but we also have to think about all the different anatomy that shares a connection with the part of the body that hurts. This doesn’t mean that every person with chronic jaw pain will get better from a neck adjustment, because that’s not true either.

It means that we have to take care of people and see them for what they are globally instead of treating them as an object with a specific piece of meat that hurts today.

 

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Post-Concussion Syndrome

Case Study: 6 months of Post-Concussion Syndrome

Post-Concussion Syndrome

 

Read Time: [3 minutes]

Post-concussion syndrome has become a big deal with more athletes showing concern about the risks of chronic brain injury. Recovery from a concussion usually takes about 7-10 days for most people but many will have symptoms that last 30 days or more.

Our most recent case had post-concussion syndrome that lasted 6 months prior to visiting our office.

Background

A young woman was a passenger in a car that was struck from the side. The shock of the accident caused her head to whip from side to side and she lost consciousness immediately.

Although many concussions are a result of a direct blow to the head, a concussion can occur through rapid acceleration and deceleration of the head causing the brain to move and collide with the inside of the skull.

Following the concussion, the patient began having daily episodes of migraine headaches. During the migraine attacks, she would also have vertigo that led to a persistent feeling of nausea.

After being discharged from the hospital the patient was seen by an orthopedist and chiropractor. While chiropractic adjustments were helpful, she felt her symptoms come back repeatedly within hours of her treatment. The patient had an appointment with her orthopedist to receive neck injections, but was referred to our office before that to see if correcting her atlas would help.

Assessing the Neck in Concussion

The patient was put through a full examination to evaluate the  neck. In many cases of post-concussion syndrome, the neck has numerous pain-generating tissue that can be responsible for these neurological symptoms. This includes precise x-rays of the top of the neck, evaluation of neck muscle tone, structural positioning, and evaluation of head and neck control.

You can see some images of our head control laser testing below.

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Laser head positioning system

Testing head control using a maze

Testing head control using a maze

When people suffer a concussion or whiplash injury, it can cause damage to the muscles and allow us to control our head and neck movement. These injuries can lead to headaches, but they also cause problems with our sense of balance.

Once we have some baseline information on their current abilities, we can monitor how they respond and heal from the damage to their neck.

Results:

After her 2nd visit, the patient said that her headaches and nausea were almost completely non-existent.

Imagine that. Going from daily migraines, to no headaches for an entire week. All from a getting the head and neck into a better structural position.

Now that isn’t to say that life is perfect after that. There were certainly some ups and downs along the way. Overall, the patient’s headaches have improved about 80% in frequency and intensity. She has elected to skip getting injections, and is working hard everyday to get stronger.

Here’s the most important element and really the part that matters:

After the head injury, the patient was unable to do the things that made her life fun. She had trouble working out and getting motivated to exercise. Staying focused at work meant having to rely on pain killers. Taking care of a young daughter meant gritting her teeth through pain and nausea instead of being present in the moment.

That’s what all of this is about. It’s not about the pain reduction, it’s about the restoration of normal life!

For more information, you can read this patient’s testimonial below:

I’m a very active mommy that carries around the weight of a 6 year old and owning a salon full time. Work and mommy duties call for my body to be at all times ready and with it. There isn’t time for rest, much less any fatigue or achy-ness. Between playing sports when I was young, actively working out and having the burden of standing on my feet the majority of my work days, my simple adjustments just got me through. I didn’t realize that there could be a cure for my migraines, constant neck stiffness and what seemed to be a much older body that I was trapped in.

I was a back seat passenger in a car crash on New Years, where the car was deemed totaled. There were no major signs of trauma, besides the concussion and black eye I received, however, I knew something was wrong when my pain was continuing to get worse months after the accident. My routine visits to the chiropractor, became tedious weekly visits that just got me through; my pain kept coming back if I didn’t get adjusted that day. I refused to succumb to cortisone shots previously, but felt desperate. Instead of my Chiropractor sending me off the receive the possible relief from an invasive procedure, he referred me to his dear friend Dr. Chung that specializes in post concussion, migraines, fatigue and achy-ness.

Dr Chung was very thorough and did a series of X-rays and tests to see how my whole body was aligned and reviewed my MRI. He explained the symptoms and showed me what was happening to my brain and surrounding inflamed tissues. After one precise adjustment and many months of not being able to be active or myself, I felt 150%. I was scared and apprehensive as to when my pain would return. To my surprise, months later and just a few maintenance NUCCA adjustments, my pain has not returned and I was immediately able to carry on with my workouts, mommy life and my physically involved career. I was even able to hike, travel and do Cross-fit within weeks of being adjusted. My energy and range of motion has returned. I couldn’t be happier for the referral to such a dedicated, intelligent, passionate Doctor of Chiropractic. Thank you so much for your passion to treat your patients and wish you much success.
Jessica S.

From Pain To PR

Case Study: From Back Pain to PR

Pain to PR

Read Time: [5 minutes]

I’ve written a lot in the past about how an ideal structure can help increase athletic performance. If you want those articles, check them out here below:

Is This Silent Problem Killing Your Workout?

Can Your Spine Make You Harder to Kill?

The Physiology of Champions

With that being said, most people aren’t coming to see me for a competitive edge. They’re coming to see me because pain or some other factor has become an obstacle in their life. What happens when the 2 worlds collide where an injury to the spine may prevent someone from training for the sport of their choice?

Case Study:

Dina is a competitive weight lifter. In the past 2 years she has competed in the National University and the American Open weight lifting competitions. She’s all but 100 lbs soaking wet, but she can probably put more weight overhead than the average guy.

She was recently in a rough auto-accident that gave her a bad case of whiplash, but it also caused pain in her lower back. MRI’s revealed something that many athletes fear: Herniated discs in the neck and back. Then came the questions:

In my world, a herniated disc, even a large one is not the end of the world for most people or most athletes. There are just way too many people that get better and function pretty close to normal with most disc herniations, and there is a lot of evidence to support that. [1,2]

Her chief symptoms after the accident were headaches, neck pain, and back pain. A local orthopedic surgeon diagnosed her with a soft tissue injury and would be safe to take care of conservatively and sent her my way.

I took her case and gave some initial pre-cautions about lifting until her main symptoms started to get better.

 From Pain to PR

Being young and fit is typically a great predictor for fast healing. There’s something special about the combination of youth, muscle, and robust arterial circulation.

After 2 sessions of Atlas Corrections, Dina’s headaches got a lot better. In addition to her head, her hip and pelvis became more level and her back was getting much better. All within a couple of weeks. I gave Dina the okay to start training again but not to go too aggressive with heavy weights quite yet…..

But not all patients listen to their doctors, and many will go based on their own intuition. Dina was feeling good enough to go after a personal record, and she was kind enough to let us see it here below.

Here’s her Back Squat PR

 

and her Hang Clean PR

Increased Muscle Performance Through Better Structure?

A recent study published in the journal Experimental Brain Research provided a viable mechanism to show that getting a specific chiropractic adjustment has the capacity to decrease fatigue during maximal muscle contraction.

Another study in the journal Chiropractic and Manual Therapies provided some small evidence that kicking speed can be increased with spinal adjustments to the lower back region of the spine.

A 2012 study in the Journal of Manipulative and Physiologic Therapeutics showed that spinal manipulation to the neck increased grip strength in Judo athletes compared to a sham manipulation.

While the evidence is pretty light for the time being, the results seen in chiropractic offices and the growing demand for chiropractic research on athletic performance suggest there might be something to it.

Conclusion

Injuries like herniated discs don’t have to be a performance and athletic death sentence. While it’s important to realize that every case is different and some disc problems can be potentially serious, what really matters is how much functionality you have and NOT what your MRI says.

If you have weakness, problems going to the bathroom, or loss of sensation, then obviously that can be a serious problem. However, the large majority of disc problems might be a small correction away from being a non-issue.

It’s also a good reminder that chiropractic can enhance someone’s life beyond pain, and into the world of performance.

 

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Changing_lanes_Checking_the_right_blind_spot

“I can’t turn my head to drive” – Neck Pain in West Palm Beach – Cervical Spine Correction

“I can’t turn my head to drive” The Scary Truth About Neck Problems

Neck pain is one of the most common and brutal conditions that people in Wellington and West Palm Beach want treated in my office. I think people often underestimate how debilitating spine pain from the neck can be. We put such little thought to it because it’s not a named chronic disease or condition. I think that it’s easy to forget just how much having a bad neck can affect someone’s quality of life.

When you have bad neck pain, it affects most every part of your life. Here are some of the most common quality of life complaints:

  • “I can never find a comfortable position to sleep”
  • “I can’t work on the computer long before my neck kills me”
  • “I’m afraid to work out and hurt my neck worse”

However, there’s one complaint that stands out above the rest when it comes to people with chronic neck pain.

“I’m so scared of driving now because I can’t turn my head to look for traffic”

It’s a little scary when you really think about it. Our head and neck were evolutionary designed to turn like it does to recognize danger. When you have a neck injury that prevents your head from turning, you have very literally given up an evolutionary advantage that protects you on those not-so-safe Florida roads. Ever drive on I-95 in the midafternoon from Broward to Palm Beach? Now think about doing that 5 times a week when you can’t turn your neck without stabbing pain.

That’s a serious problem.

Ever Have Neck Pain for a Day? Try Having it for Years

“My neck was severely affected and limited my ability to turn left and right. When I would drive, my inability to move my head from side to side became almost dangerous for me. I tried to do exercises that I had been taught in physical therapy, but my mobility did not return”

Almost all of us have experienced neck pain of some sort in our lives.  Most of the time, it’s because we’ve woken up after a terrible night’s sleep, or falling asleep in a long car/plane ride with our head hanging off to the side. It is absolutely miserable. Your neck feels very tight. You have this incessant need to try to pop it. You probably have a headache to go along with the neck pain. Worst of all, you don’t want to go anywhere and look crazy because you have to turn your body to everyone you see.

Now take that one day experience, and imagine this is your day to day life.

Chronic neck pain may not carry the same disability status as people who have had suffered major back injuries, but the damage that neck pain has on health and quality of life is tremendous.

Treatment Options

One of the biggest challenges with chronic neck pain is that it is very difficult to treat. It’s such a sensitive area neurologically, and conventional treatments tend to be hit or miss.

  • Over the counter anti-inflammatory medication – control pain for a duration. Does not improve neck mechanics and range of motion is still limited.
  • Exercise/postural correction – unlike the back, there are no big bulky muscles available to take on the weight of a poorly loaded neck. Ergonomic changes have improved outcomes for low back pain, but done very little to change neck outcomes
  • Injections – one of the most common treatments for chronic neck pain. While it can be a huge source of pain-relief for people with neck pain, it also comes with the burden of side-effects
  • Surgery – No one wants to get neck surgery, but in the case of severe herniations or instability, it may be necessary prevent some serious neurologic consequences.

Structural Correction of the Cervical Spine

“In March, I was unable to turn my neck. I recalled my friend’s doctor and got his info and made an appointment with Dr. Jonathan Chung at Keystone Chiropractic. He specializes in the treatment of the structure of the spine known as the “Atlas” area near the brain stem.”

There are about 1000 chiropractors in the country who have devoted their entire practice to correcting problems in the upper cervical spine. In South Florida, there are about 7-10 doctors from Palm Beach County to Miami-Dade with this type of focus.

While we are pretty few in number, our goal is to provide a comprehensive solution to correcting the biomechanical and neurological nature of chronic neck dysfunction. A chiropractor focused on upper cervical correction is usually pretty distinct in a number of ways:

  • Very precise x-ray set up and analytics
  • Gentle corrective procedures using lower force methods. Usually does not have the popping, twisting, and cracking of a traditional chiropractic manipulation
  • Uses x-ray or scans before and after a correction to verify that the job has been done.
  • Encourages a less is more approach. His goal will be to correct/adjust you infrequently

Who Are the Best Candidates for Care?

Not everyone is a good candidate for upper cervical correction. Screening procedures are used to determine if you have a specific problem called Atlas Displacement Complex (ADC). The more chronic the problem is, the more likely that ADC is the primary cause.

Could your problems be the result of ADC?

Could your problems be the result of ADC?

Correcting the Atlas addresses the biomechanical, neurological, and vascular problems commonly seen in neck pain. Some of the common Secondary Conditions in the neck from ADC include:

  • Cervical disc disease
  • Cervical disc herniation
  • Torticollis
  • Fibromyalgia pain
  • Facet pain
  • Pinched nerve syndromes
  • Cervicogenic headache
  • Trigeminal Nerve Dysfunction

Case Study

“His treatment seems so minor and it makes you think that this small treatment can’t possibly be effective in any significant way! But, let me tell you….IT IS! I have been going for the last two months and I am amazingly mobile again, and this was accomplished with NO physical therapy on my part! I can now turn my head to either side, drive with mobility, and no longer arise from a sitting position stooped over.”

In April of 2012, I had an out of town patient come in from Chicago. She had been referred to us by one of our local Wellington patients to come down from Chicago and try Structural Chiropractic care through the NUCCA protocol. She had been suffering from chronic neck pain for 5-years and was diagnosed with pinched nerves from a herniated disc in her neck. While the pain was bad, the biggest problem was her inability to turn her head and the resulting depression from living such a restricted life.

She was desperate for relief. She had been through a course of physical therapy, acupuncture, and a long list of injections, but she had not been able to turn her head for years without a tremendous amount of pain.

She had put a lot of trust into her friend, and she was only going to be in town for a week to see if it would work for her.Needless to say there was a lot riding on one exam and a maximum of 2 visits.

We performed a full exam and series of precision upper cervical x-rays on her neck so we could design an exact Atlas Correction for her neck. In many ways, it’s like designing a key for a unique lock. Everyone has a unique misalignment that requires a precisely designed correction.

A gentle Atlas Correction procedure was performed and post-correction x-rays were taken to verify improvement in the alignment and mechanical position of the head and neck. She left the office skeptical and unsure if such a gentle procedure would help her overcome 5 years of pain and suffering. She was dismissed with instructions to come back tomorrow for follow-up.

The next day she came in late for her appointment and she had the puffy-eyed look of someone who had been crying. She said that she didn’t notice a difference in her pain level after her first correction. However, when she was driving to the office, she had passed our exit on the highway and turned her head back towards the exit sign in frustration.

It was then that she realized that she was able to turn her head without crumbling in pain for the first time in years. She had pulled off the side of the road to cry tears of hope and joy thinking that she may finally have an answer to her neck problems.

We had her continue care with another Structural Chiropractor in Chicago that used the NUCCA protocol for future follow ups. Although I don’t know what’s happened to her since then, after a dramatic reaction to her first correction, I feel confident that our work would help her if continued.

Did you like this article? Feel free to share it with the people you care about and see if a Complimentary Consultation is the next step to regain their health.

Dr. Chung is a practicing Structural Chiropractor in the West Palm Beach area. He has been published in peer reviewed scientific journals and is a sought after speaker in health and wellness. Follow his blog at http://chiropractorwellington.com/category/keystone-chiropractic-blog/ or find him on twitter at @drjonathanchung

 

Head Injury, Chronic Dizziness, Concentration Problems, and the Atlas – A Case Study

Concussion Head Injuries and the Atlas – A Case Study

Back Story

A 16-year-old girl presented to my office with complaints of dizziness, inability to concentrate, headache, and neck pain for 3 months. All symptoms began after she fell off a horse and struck her head against the ground.

After her fall, she went to the ER and had a CT scan performed on her head to rule out any potential bleeding in the brain. She was stabilized and sent home with a diagnosis of a concussion.

She began to  dizziness, generalized malaise, and neck pain immediately after the head injury. She was unable to do more than 30 minutes of school work at a time and had missed many days of school. After several weeks of being unable to concentrate and persistent pain, she sought a neurological consult.

Most testing was unremarkable. She was recommended vestibular therapy with a physical therapist and psychological testing to manage the concentration and memory problems.

She was also seen for accupuncture, massage, and traditional full spine chiropractic care.

She stated that the accupuncture helped a little bit with the neck spasms, but she got no improvement from chiropractic or vestibular therapy.

Structural Evaluation

With head injuries, what may people don’t realize is that it is extremely difficult to take a substantial blow to the head without disrupting the structure of the neck. After hearing her situation, we decided to see if a shift in her head and neck was affecting her brain.

 

The atlas on the left is almost 4 degrees twisted. The Atlas on the right is at just 1.5 degrees.

The atlas on the left is almost 4 degrees twisted. The Atlas on the right is at just 1.5 degrees.

We did a series of x-rays and scans to determine if her neck was the source of her problems. The x-rays showed a substantial twist in the top bone in the neck. With the degree of twisting at the top of the neck, it’s likely that the neck was affecting the way that blood was going in and out of her brain.

The x-ray shows that the twist in her neck went from 3.69 degrees down to 1.5 degrees after her first correction.

 

Scans of her paraspinal system

The scans on the right help us establish baseline measurements for how her nervous system responds when she is sick. The bottom scans show abnormal muscle tension and abnormal heat distribution in her spine. THe top scans show how her body responded after 5 weeks of getting her neck corrected. The muscle tension is gone and her heat distribution is just about perfect.

 

Results

After 6 weeks of check ups, the patient was able to study for 2-3 hours at a time without a problem. She could also go days without dizzy spells, and the intensity of dizzy spells were decreasing as she went on.

Even more exciting was the fact that she began to feel stable enough to ride her horse and compete in 2 competitions as her balance started to improve.

 Take home messages

1. Anytime you’ve had a head injury, the structure of your neck is likely to be compromised.

2. Though this girl felt symptoms immediately, many people will get a whiplash, hit their head against an object, or slam their head against the ground  and not feel any obvious symptoms.

Many times after going through someone’s history, we can trace their problem to some sort of accident from months or years before hand. Once the brain has enough deprivation, your body will eventually hear about it.

3. This patient responded very quickly, and she can thank her youth for that. Many people who have these types of problems in their 40’s and 50’s may take more work to stabilize.

Waiting till a problem gets unbearable is a recipe for needing a lot of care and treatment in the long term. The sooner a problem is caught, the easier it is to correct.

 

Did you like this article? Feel free to share it with the people you care about and see if a Complimentary Consultation is the next step to regain their health.

Dr. Chung Recently Published in Scientific Journal

Dr. Chung Recently Published in Scientific Journal

A new article about Structural Chiropractic helping a brain injured patient was published by Dr. Chung last month.

The article details the case of a 16 year-old girl who had suffered brain injury following a surgical procedure to remove a brain tumor. Following the surgery the parts of her brain that were damaged had a large impact on her posture and speech. She was unable to maintain balance, had increasing difficulty in social situations, and had little hope of doing routine tasks like driving.

Following a thorough exam and consultation, she began getting her atlas displacement corrected. Thanks to the remarkable ability for the brain to adapt and heal, her corrections began to stabilize and her secondary conditions began to improve. The structure of her spine was restored by 70%. As a result, her balance and speech improved dramatically. She even got to the point where her father had enough confidence in her stability that he actually bought her a car and allowed her to get her driver’s license!

At Keystone Chiropractic, we work on providing the highest quality of care to our patients. It also means that we will be active chiropractic research that helps make our corrective procedures even better and stay on top of the most current developments in chiropractic. For an abstract of the article, please click here.