Q: "My dentist told me I have TMD and referred me to physical therapy for treatment. He said I grind my teeth at night and he thinks therapy will help. What can therapy do for me? "
Answer (Lisa Edwards, PT, CCI):
Tempormandibular disorder (TMD) refers to dysfunction that occurs at the jaw. The jaw has several muscles and ligaments, as well as a joint that can be affected when people grind their teeth at night. The muscles may go into spasm in the neck, jaw and head, so some people not only have jaw pain, but neck pain and headaches and well. The joint can be compressed with clenching of the jaw, which in turn can squeeze the disc that sits in the joint. As the pressure increases, the synovial fluid is pushed out of the joint. The pressure and the lack of synovial fluid can cause the joint to wear down and lead to pain.
Physical therapy combined with medications, splint therapy and relaxation training can help patients who grind or clench their teeth. A physical therapist will perform an evaluation of the joint and the muscles of the neck, jaw and head. Treatment may consist of modalities such as heat, ice, electrical stimulation or ultrasound. The therapist may work on soft tissue mobilization inside and outside of the jaw, and massage techniques to the neck and head. Joint mobilization may be necessary if there is a loss of motion at the joint. Exercises may also be appropriate for stretching, strengthening, posture or relaxation.
Patients who are clenching/grinding their teeth at night are causing the muscles around the jaw to work overtime and stay contracted or in spasm. The goal of therapy is to help break the pain/muscle spasm cycle. The more pain a person has, the more muscles can guard and go into spasm. The more spasm, the more pain and the cycle continues. By using modalities such as massage, mobilization and exercise, the spasm can be alleviated and the pressure on the jaw can be decreased. Relaxation techniques can help reduce the stress which can increase muscle tension. Splint therapy can help unload the pressures on the joint, and medication may be prescribed to help with pain and muscle relaxation.
Having TMD can be very painful and affect your ability to eat hard foods, yawn and even talk due to the stresses placed on the joint and muscles. If you are having pain in the jaw, headaches or neck pain, talk to your doctor or dentist and see if physical therapy is appropriate for you. Sheltering Arms has several therapists who specialize in this area of treatment. ■
Q: “I have one leg longer than the other. Do I need to put something in my shoe?”
Answer (Nick Hopson, PT, DPT):
Probably not. Having a longer leg is also known as a leg length discrepancy and is one of the most common finds during a physical therapy evaluation. Although many people think having one leg longer than the other is normal, it really is not. A leg length discrepancy can cause or be part of the problem for several diagnoses seen in physical therapy. Back pain, hip pain, knee pain and even plantar fasciitis, just to name a few, can be affected by such a discrepancy. The most common cause of the difference is a rotated pelvis in which the pelvis becomes “stuck” causing improper pelvic movement. If, in fact, it is a rotated pelvis, a simple manual therapy technique called a Muscle Energy Technique can be used to correct it. A combination of manual therapy and strengthening of specific muscles will help prevent pelvic rotations from occurring in the future. There are some cases in which the difference can’t be corrected, and only in these instances should something be put in the shoe. If a person does not have a true leg length discrepancy and places something in his or her shoe, it can cause more harm than good. An evaluation by physical therapist is an important step in staying healthy! ■