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Spine Surgery

Getting a Safe Correction after Spine Surgery

Spine Surgery

Read Time: [3 minutes]

Over the past few weeks, I’ve been seeing a lot of posts about this article filling up my Facebook newsfeed. The article talks about how a specific type of spine surgery called spinal fusion has been found to be mostly ineffective. The author goes so far to say that the surgery should be put to rest.

rip-fusion

Article by Dr. Chris Centeno http://www.regenexx.com/nejm-back-neck-fusion-surgeries-not-needed/

I’ve seen a lot of patients with a previous history of spinal fusion. Some people feel like their life was made dramatically better by spine surgery, others feel like it didn’t have any effect at all, and some people will actually feel a lot worse. Overall, the verdict on fusion surgery seems to be pretty dim.

People Don’t Volunteer for Spine Surgery. It’s a choice made out of desperation

Here’s the thing. I don’t blame people who choose to elect spinal fusion even in the face of the world’s best evidence. Why?

I’ve never experienced the level of pain that makes someone consider spine surgery an option.

It’s the easiest thing in the world to be a chiropractor, physical therapist, or pain management doctor to tell someone that they don’t need spine surgery. Our professions are invested in the idea that you should choose us over surgery because you should exhaust your conservative options before being cut open.

However, someone who is choosing spine surgery is often someone who is desperate. Their pain is debilitating and costing them the ability to work and move like a normal human being. Many patients have tried numerous conservative options and feel like they have spent years feeling debilitated. They are tired, frustrated, and just want something, anything to make their pain go away.

I hear it in my office all the time. “Doc, can you just cut this thing out of me?”

Sure it’s said in jest, but it opens a window to what someone’s last option looks like. Just cut me open, and take whatever is causing this pain, and remove it.

You’ve had surgery, now what?

People that choose surgery often feel like they’ve exhausted all possible treatment options.

If your pain didn’t improve or if you develop or new and worse pain after surgery, it can be devastating to the psyche. You tried everything and it still didn’t work. Will you have to suffer like this for the rest of your life? Do I just have to rely on pain management and more surgery?

From time to time, I’ll meet people who tell me about how bad their back or neck problems are, but they’ll usually say something like:

But I’ve already had surgery, and my doctor says I shouldn’t have my back cracked.

I understand this fear. If I had hardware in my spine, the last thing I would want is someone just jerking my back or neck around and possibly hitting one of those fused parts.

Here’s the thing though. Not all chiropractic techniques require heavy force.

There are a lot of chiropractors trained to be extremely precise with their adjustments. With a high level of precision, you can avoid doing anything to the spine that may jar or disturb these fused vertebrae.

This is important to remember because precise Structural Correction of the spine is something that can really help these patients! It’s one of the reasons that there are doctors in Palm Beach County that refer cases to our office when patients still have pain after surgery.

The Problem Isn’t Just the Spine, it Might Be in the Brain

Pain is a complex physiological phenomenon. As doctors, we can sometimes oversimplify back and neck pain as a bad bone or a bad disc. The fact that people don’t get better after surgery isn’t the fault of the surgeon. The problem is that the bones and discs in the back may not have been the actual cause of the pain to begin with.

Pain can exist in the absence of physical tissue damage as is often seen in things like fibromyalgia or complex regional pain syndrome. In these cases, there is a problem with the way the brain perceives the environment. It is overreacting to normal stimuli.

When people have successful cases with surgery, then we can probably assume that a bad disc or some bad vertebrae were big contributors to the patient’s pain process. However, if we are operating on patients whose symptoms are coming from a brain that is overly sensitive to pain, we are giving that sensitive brain more ammunition to be in pain because of the surgery itself.

Sometimes the answer is not simply to change the bones, but we have to desensitize the brain to normal living.

That’s one of the biggest unknown benefits to Structural Correction with the NUCCA procedure. Normal Structure plays a vital role in normal input into the brain. Our gentle approach to correcting the spine is capable of changing the signals the brain should be focusing on and reducing some of the chronic inflammation impacting your sensitive brain tissues.

Changing the Conversation

Millions of people every year are going to have spine surgery. It’s up to the doctors and surgeons to decide if surgery is appropriate for a patient’s situation. There’s no use in beating a patient up for making a decision that they think is going to help them live a better life.

It’s our job to let people know that whether you had surgery or not, there are still options available to help people live a normal life without feeling debilitated.

Ask Dr. Chung a Question

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.

img_4266

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.

Pinched Nerve

Anatomy of a Pinched Nerve

Pinched Nerve

Read Time: [6-7 minutes]

After the wide success of my article Anatomy of a Headache I decided to tackle another common problem we see every single day in the office.

Pinched Nerves

When someone gets an acute pinched nerve, it can be amongst the most painful problems that afflict human beings. Pinched nerves can leave people in lying in bed with an inability to work, exercise, sleep or play. When it happens people take on really strange and awkward postures to try to avoid the pain.

If you are like Mr. Stock Image here where you lean away to one side and lift your arm, you might have a pinched nerve in your neck. Image Credit: Can Stock Photos

If you are like Mr. Stock Image here where you lean away to one side and lift your arm, you might have a pinched nerve in your neck.
Image Credit: Can Stock Photos

 

But there’s a lot of misconceptions about what a pinched nerve actually is. A lot of people feel like if their neck or back has a pinching or stabbing type pain, then it’s likely a pinched nerve. However, multiple types of neck pain can lead to a pinching type of pain.  A true pinched nerve involves multiple factors.

1. A Tissue Offender

There are several different types of tissues that can pinch a nerve. Bone, muscle, tendons, and calcified ligaments are all compress nerve tissue throughout the body. Even tumors can cause pinched nerves, but those are in much more rare circumstances.

The overwhelming majority of pinched nerve pain stems from a problem you’re probably familiar with. The slipped/herniated disc. Tearing of the outer part of the disc allows for a gel like material to spew out into a small space where a nerve travels.

Most herniated discs don’t cause problems. I can take an MRI of 100 random people with no pain and chances are high that many of them will have a disc herniation.

The herniation only becomes problematic when it is large enough, or you move in a way to force this gel into the nerve against some of the other hard structure in the spine.

When a disc breaks down and leaks a hard fluid on top of the nerve, the nerve can become pinched between a rock (bone) and a hard place (disc) Image Credit: Can Stock Photos

When a disc breaks down and leaks a hard fluid on top of the nerve, the nerve can become pinched between a rock (bone) and a hard place (disc)
Image Credit: Can Stock Photos

2. Soft and Sensitive Nerves

Nerve tissue is soft and sensitive. Even small amounts of pressure against a nerve can make it go haywire. They are like the iPhone charging cables of the tissue world. Just a little bit of stress and the whole thing comes unraveled.

That’s why your body protects the most sensitive nerve tissue (brain, spinal cord, spinal nerves) in a case of bone called your skull and your spine.

But it’s not just sensitive to pressure. It’s also sensitive to chemical signals like inflammation. Which brings us to the third important piece of anatomy.

3. Inflammatory Chemicals

Inflammation from a torn or damaged disc can build up around the nerve and stimulate the nerve to create a pain response. This is especially true when you injure a disc very suddenly….like in a car accident or picking up a heavy box. Cells from your immune system rush to the site of damage and try to clean up the mess. The result is a large number of inflammatory molecules called cytokines and substance P fills that area and can trigger a pain response from the nearby nerve.

I always compare the body’s use of inflammation to a fire/burning process. When your body uses inflammation it is like using a fire to burn away germs or damaged tissue in the body. The main problem with fire is that it can sometimes cause damage your own body too. This is especially problematic when inflammation affects a nerve.

Image from published article: Inflammation ain intervertebral disc degeneration and regeneration. Journal of the Royal Society Interface. 2015. http://rsif.royalsocietypublishing.org/content/12/104/20141191

Image from published article:
Inflammation ain intervertebral disc degeneration and regeneration. Journal of the Royal Society Interface. 2015.
http://rsif.royalsocietypublishing.org/content/12/104/20141191

 

When a Pinched Nerve is a Serious Problem

The pain from a pinched nerve can be excruciating. It’s not uncommon for someone with pain from a fresh pinched nerve to go to a hospital to get checked for something serious.

With that said, the pain from a pinched nerve is not the worst thing that can happen. The worst case scenario for pinched nerves are a loss of function.

If you have a pinched nerve and you start to have things like weakness and complete loss of feeling in your arm, legs, or hands, then it can be a serious issue that needs to be addressed by a surgeon. In cases of pinched nerves in the lower back, sometimes the nerves can affect bowel and bladder function leading to a condition called Cauda Equina syndrome which is a medical emergency.

If left for too long, your muscles can begin to atrophy and you may never get full function back. These are scenarios that shouldn’t be trifled with.

90% of Pinched Nerves Can Be Addressed Conservatively

That previous section wasn’t meant to scare you, but it’s a reality that we sometimes we have to face. The good news is that the vast majority of pinched nerves respond great to conservative care. That means things like physical therapy, anti-inflammatories, and decompression can all be helpful modalities in dealing with pinched nerves.

All of the above therapies can provide some relief from the pain of a pinched nerve, but one thing that is important is addressing some of the biomechanical issues that lead to a herniated disc becoming a pinched nerve.

 A Delicate Balancing Act

The spine has many functions. It protects the delicate spinal nerves, it’s the central attachment point for numerous muscles, and allows for a wide range of movement. Another key function is the way that it distributes force throughout the body.

One of the key facets of Normal Structure is that it provides an ideal way for the human frame to distribute force evenly through the body’s muscles and joints. When we lose normal structure, we start to put more stress on some parts of the body over others leading to increased joint stresses in select areas.

body imbalance

Loss of Normal Structure leads to abnormal joint stresses

Want proof that your structure exacerbates pain from a herniated disc. Look at the way that people hold their posture. People with pinched nerves usually can’t stand bending their neck or back in a specific direction, so they lean towards one side over the other. You’ll also see that they avoid forward bending too.

But why? Because bending forward and into the side of the pinched nerve will increase force into the disc and force it further into the nerve.

When your spine bends forward and to the right, it's going to push that purple-ish goo further into the nerve

When your spine bends forward and to the right, it’s going to push that purple-ish goo further into the nerve

That’s why correcting the underlying foundation of the spine helps with pinched nerves because we can help the body naturally equalize the forces going into your discs. Sometimes the body will actually find a way to make the herniated disc go away! Although it’s not expected, the body is always going to move in a direction of healing itself, and sometimes that means getting rid of an offending disc problem.

Ask Dr. Chung a Question

Normal vs Fatty Muscles

Whiplash Disorders: Why You Should Get Your Fat Neck in Shape

Whiplash Disorders: Why You Should Get Your Fat Neck in Shape

 

Read Time: [7-8 min]

I know it’s a little bit of a crazy headline, but today we’re going to talk about how a fat neck can contribute to chronic whiplash pain.

But I’m not talking about the width of someone’s neck. The neck I’m talking about can be thin on the surface, but have fat tissue build up in places where it shouldn’t. Namely, inside of your muscles.

It’s helped us to reveal a problem that many doctors miss when looking at conventional MRI findings.

Don’t Put So Much Stock in Disc Problems

For better or for worse, injuries from auto accidents are usually made or broken by MRI findings. That’s why your attorney has likely pushed you to get an MRI even though your doctor may have chosen against it.

If your doctor is like me, they avoid too jumping to MRI’s too quickly because sometimes it can really cause more harm than good. MRI’s give you the most highly detailed images available to the average consumer, but those extra details can be counterproductive.

In a patient’s eyes, an MRI report can be intimidating and scary. It’s common for most MRI reports to say things like:

  • Disc herniation
  • Degenerative changes
  • Stenosis
  • Loss of disc space
  • etc

Which is fine if you’re a health care professional and you need to know what’s going on. However, a lot of patients will look at these words, do a quick google search, and end up looking like this:

 

There’s a couple things to remember when seeing some of your MRI findings:

  1. Many of these findings are seen in normal aging
  2. Just because it’s on an MRI doesn’t mean it’s causing your pain or condition

To add more insult to injury (pun intended), things like herniated and degenerated discs are very disempowering as a diagnosis. In most cases, those findings are going to stay with you throughout your life, and that’s okay because even healthy pain-free people will have it throughout their lives too!

….even healthy pain-free people will have have herniated and degenerated discs throughout their lives too!

Whiplash and Fatty Neck Muscles

Generally we all wish we had a little less fat around our waist lines. In recent years, researchers have been seeing that fat can build up in muscular tissue and is associated with problems of aging. You can read some more about the science behind this problem in a great article on the Strength Theory Blog here.  This includes chronic pain which is the major concern for patients with whiplash.

Some recent studies are starting to show that identifying fat build up in your neck muscles can predict how well someone with whiplash will recover. [1, 2, 3, 4]

If you don’t want to read the abstracts, here’s the summary:

Patients with greater fat build up in neck muscles after an accident are more likely to have more persistent whiplash symptoms.

This runs counter to people with herniated discs because the presence of herniations is generally a poor predictor of pain.

Normal vs. Fatty Muscle Tissue

 

The problem with fatty muscles is that they don’t work the same way as lean muscle. Fatty muscle tissue is weaker in strength and endurance than lean muscle tissue.

But if you’re in pain, you don’t really care that much about your strength and endurance. You just want to feel better. As my friend Morpheus from the Matrix says:

What if I Told You

When muscle tissue becomes dysfunctional, your body loses a valuable neurological input to the brain that helps to modulate pain. That’s why exercise is such an effective form of medicine for people with various types of pain.

On top of that, when fat builds up in muscle tissue, it has neuroendocrine effects on the muscle tissue itself. These effects include:

  • Reducing sensitivity of muscle to insulin (Translation: muscle won’t eat as much sugar as it normally does)
  • Reducing Kreb’s cycle activity of muscle (Translation: muscle won’t use energy as efficiently)
  • Increasing the release of pro-inflammatory cytokines (Translation: more inflammation around muscle –> More pain)

Ultimately, fatty muscle tissue effects how the muscle contracts, how the muscle eats, how the muscle digests, and it predisposes your muscles to pain and inflammation.

While the evidence is still pretty new , it does seem to reflect why people who are stronger and have more muscle seem to be more resilient to pain problems.

Unlike Bad Discs, This Problem is Fixable

Fatty muscles can result from prolonged periods of inactivity. So it seems like a pretty simple fix. Move more, exercise, and get stronger. A small study on exercise for women with whiplash disorders show that neck exercise can reduce fat content in neck muscles and improve someone’s prognosis, so it does look like this problem is fixable. [Source]

However, one of the things that triggers inactivity after a whiplash accident is the immediate pain itself. When you have a whiplash, even small amounts of movement tend to be painful or instigate symptoms. The thought of exercising just sounds….painful.

So what can you do after an accident? Fortunately, these same rules apply with or without an MRI.

  1. Get the initial pain under control – There’s no shortage of therapies that can help control pain. Some use ice, heat, TENS, acupuncture, spinal manipulation, massage,  meds, etc. In order for you to get your body moving, you have to overcome the fear of movement that pain can cause.
  2. Position Matters – the ability to control the position of the neck is a key piece in normal movement. Developing this control depends heavily on establishing normal structure and normal positioning of the neck. This is where a structural approach to chiropractic plays a major role in recovery.Abnormal loading of the joints in your neck from Atlas Displacement Complex can contribute to pain, but it also can lead to Secondary problems like vertigo, headache, and brain fog after a whiplash.
  3. Gradual Progressive Loading – As the neck feels better and your positioning improves, you will want to gradually increase the strength of the muscles in the neck. Basic neck exercises like the chin tuck and chin nod can help train the small deep muscles of the neck. As the muscles get stronger and more functional, you will protect your muscles from fatty degeneration.Starting slow and gradually building up the resistance and endurance of your neck muscles is a key step in getting a good long term result after a car accident.

With a great understanding of the problems associated from chronic whiplash, we can utilize better tools to make sure that you don’t become a victim to chronic pain.

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What a 10 mph car accident does to the neck

What a 10 mph car accident does to the neck

Pain after a car accident can be very strange and confusing. Take a look at these examples from my office and tell me if this reminds you of a situation that you or someone you know have been in.

Person A: Healthy and fit 37-year-old man in a car and gets hit at 45 mph+. The impact drives his car into the car in front causing extensive damage.

Person B: Healthy and fit 29-year old woman. Sitting in line in a parking lot when another car runs into the back of her at 10 mph or less. Minimal damage to the car and wore a seat belt.

Which one do you think had a worse whiplash injury and had pain immediately and which do you think just had soreness that they wanted to to get checked out?

Both had substantial biomechanical changes on their x-ray and MRI, but only one had a significant amount of pain immediately after the incident.

If you guessed that Person B with the parking lot bumper tap had the most pain, then you win! Congratulations on using the article title to your advantage.

The Deceptive Nature of Pain

Pain is one of medicine’s greatest tricksters. To this day, researchers and scientists don’t have a strong grasp on the nature pain disorders.

Why is it tricky? Because the pain someone feels isn’t necessarily related to the amount of damage in the body. Patients with fibromyalgia have crippling pain despite not having any visible damage to their bodies.

On the flip side, you can have someone like the image below with a broken neck and walk into an office with 3 days of shoulder pain after hitting his head. Thank you to my favorite radiologist, Cliff Tao, DC DACBR for letting me share this case.

Image credit to Cliff Tao DACBR http://www.clifftaodacbr.com

Show this to a doctor or health care provider if you want to watch them squirm. Image credit to Cliff Tao, DC DACBR http://www.clifftaodcdacbr.com

 

Pain is the most important factor to a patient, but it can be the most deceptive factor to a clinician. When it comes to taking care of people after an accident, we have to measure a patient’s function regardless of their pain status.

What Happens to the Neck After an Accident?

Insurance companies will only consider it a accident-related whiplash injury if you see a doctor within 14 days of the accident. So if you have no pain after the accident or the pain wasn’t bad enough to drive you to a physician until day 15, then you didn’t have a whiplash (I know how silly it sounds).

But going back to the previous example, we know that both Patients A and B had biomechanical flaws as a result from trauma to the spine. Despite the fact that there were 2 very different accidents and 2 different pain statuses, there are similarities in what can happen to the neck even after the smallest collisions. Take a look at the video below which simulates an accident less than 10 mph.

What Happens to the Neck in an Accident?

After watching the video, you can get the impression that a collision at just 5-7 mph causes rapid movement of the head and neck.

Despite the fact that your body is encased by a 2 ton metal box, it’s easy to see that even though the vehicle stops moving, there is still a transfer of energy into the body. When you’re wearing your seat belt, it causes a rapid deceleration of your body, but your head will continue to move forward and backward very rapidly.

In fact, a large enough force to the neck can actually produce a concussion even if there’s not direct contact to the head! These accidents would need somewhere around 90 G’s of force to the head.

While that would cease to be a small accident, the smaller 10 mph accidents can produce 3-5 G’s of force which is enough to damage the tissues of the neck. The way your head accelerates and decelerates can put 3-6 G’s of force into the cervical spine. This force gets transferred into the ligaments, muscles, discs, and joints of the neck more than any other piece of anatomy.

While the body can tolerate large amounts of force in brief periods, a large amount of force applied to a small region of anatomy as seen in a car accident can damage the tissues of the neck.

Whiplash
Ligament Injury

Ligaments are like the rubber bands of the spine. They can be stretched, but once they stretch too far, they can’t go back to normal again. As ligaments are damaged, scar tissue is used as a patch, but it’s not as functional as the stuff you were built with.

Just like when you sprained your ankle as a kid and that ankle never worked the same, damage to ligaments of your neck can happen the same way. Fortunately, true sprains of the neck take a lot of force and don’t happen with most accidents.

Muscle Strains

When muscle works beyond it’s capacity, or gets stretched beyond it’s end range, it forms small tears within the muscle belly. That’s why there’s no consensus as to whether you’re better off knowing about a coming accident and bracing, or if you’re better off being surprised.

Either way, damage to the muscle tissue can happen depending on the nature of the collision.

Muscle strains can be painful, but they can and do heal with time. Strain to muscle tissue is one of the most common sources of pain from whiplash injuries and resolve well with chiropractic and exercise.

Disc Damage

Accidents are one of the most common ways that people under 30 can suffer herniated discs in the spine. When the force of an accident overcomes the resistance of the disc materail, small tears in the disc can result in the inner fluid spilling into the spinal canal.

Sometimes this results in a pinched nerve, but most of the time it does not. A disc problem doesn’t have to be a big problem. Many people have disc damage and have no idea because it’s not symptomatic.

Structural Shifting

The muscles, ligaments, discs, and nerves of the neck help dictate the Structural Positioning of the spine. The force of an accident can deform one or all of these tissues leading to abnormal positioning of the head and neck.

This leads to abnormal neurological input to the brain and what manifests as poor posture (slouching, head tilt, antalgic lean). While poor posture is not the problem that needs to be treated, it’s an objective sign of a nervous system is operating at less than it’s full capacity.

Remember That It’s Not About Pain

Remember at the beginning of the article we talked about how pain can be deceptive. The reason I wanted to point that out is because you can experience damage to all of the above structures and not feel an immediate onset of pain. Pain is just tricky like that.

Whether you feel immediate pain or not, your neck should always be evaluated even after minor accidents because it gives the earliest and best opportunity to correct a silent problem.

Talk to Dr. Chung

TMJ Ruining

TMJ Pain is Ruining My Life

TMJ Ruining

Outline:

  • When treating TMJ pain seems hopeless
  • Surgery may not be your best solution
  • TMJ pain may not be a jaw problem

I’ve seen a lot of patients with TMJ in my Wellington office in the past couple of months.

Patients with TMJ often see a large drop in the quality of their life:

  • “I feel like a baby because I can’t eat solid foods anymore”
  • “There are times where I just have to stop talking because all I can think about is the pain”
  • “That popping sound creeps me out and drives me nuts”

A lot of people will experience jaw pain for a day or two if they bite into a hard/chewy piece of food, but imagine if your life was plagued with jaw pain every single day. We underestimate the importance of our jaw, but it’s the piece of anatomy that allows you to enjoy some of the finest pleasures in life. Everything from kissing, to chewing, to a casual conversation with friends becomes a burden when your jaw fails to function.

Desperate Times and Desperate Measures

Severe cases of TMD can make people reach their breaking point quickly. Many of the patients that come to see me are usually looking at surgery as their next and final option because they don’t know what to do.

Even worse is when a patient spends tens of thousands of dollars for surgery but the pain doesn’t go away. Procedures that help to remove or replace a degenerated disc in the joint is sometimes performed to eliminate this pain sensitive piece of anatomy. The problem is that a degenerated disc can show up on imaging, but it isn’t necessarily the cause of the pain.

Unfortunately this happens more often than you might think, and it’s something that can make a patient with TMD hopeless if even surgery couldn’t get the job done.

This isn’t to say that surgery is not the answer, or that surgery can’t help, but we have to remember that TMD is a problem that science has yet to reveal all of the answers, and dental surgery is still working on figuring out what works and when it’s appropriate. Source

TMJ Pain May Not Be A Jaw Problem

There are many different causes for TMJ pain. They can range from abnormal jaw movement, tight jaw muscles, and degenerated discs. These can all be problem areas for a TMJ patient, but  they all have something in common.

In fact, their commonality goes back to some of the same neurological mechanisms that contribute to neck pain and headaches. That’s why people with TMJ don’t just have jaw pain, they often have neck pain and headaches at the same time. It’s because almost all pain signals from the head and neck go through a small piece of spinal cord called the trigemino-cervical nucleus.

…..Trigemino what????

Sometimes Pain is a Computer Problem

So if you don’t have a medical background, some of that terminology might jump over your head.

Instead of thinking anatomy, let’s talk about it like a computer.

garbage in garbage out

Your brain and spinal cord are like a computer chip. The part of your computer chip that feels head and neck pain is the trigemino-cevical nucleus.

Just like all computer chips, the quality of information that comes out is dependent on the quality of information that comes in. If you put junk information in, you get junk information out.

The computer chip of your body relies heavily on information from the muscles and joints. These signals are like computer programs. Whenever these joints move poorly from bad positioning, then it’s like a bad program that gives faulty information about what’s happening inside the body. This can occur from malpositioning of the jaw, faulty jaw movement, neck positioning errors, and faulty neck movement.

It’s like a computer virus going into your system and scrambling important signals into the brain.

This tells the body to produce a junk signals including:

  • Tight and tense jaw muscles
  • Inappropriate inflammation
  • Central pain sensitivity

Can This Program Get Shut Off?

Fortunately your body’s program for pain can be re-written by changing the way these joints move.

A specialist like a neuromuscular dentist can use non-invasive methods to change the way your jaw moves and alter your bite with an orthotic.

Chiropractors that can correct the craniocervical region can create a dramatic impact on the pain programming in the brain.

That’s why both of these doctors frequently see similar patients, and will actually co-manage them between each other. Neck pain patients may get better relief from a dentist changing their bite, while some TMJ patients will get better relief from correcting their neck.

While we can’t say for certain which takes priority, but many patients can benefit from an interdisciplinary approach to care. Take the time to get a Complimentary Consultation to find out what method fits with you. You may even find that getting the entire jaw/neck complex fixed may be the key to solving your TMD.