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My Jaw Hurts!

Have you ever experienced pain with chewing gum or opening your mouth widely to yawn? Does this sometimes send pain up your temples and give you a headache or even ringing in your ears? Do you sometimes hear popping or clicking in your jaw? There may be many reasons for this but more than likely, you are experiencing some form of Temporomandibular Disorder (TMD).

Let’s break this down. The Temporomandibular joint (TMJ) is the junction between your skull bone (temporal bone) and your jaw bone (mandible). There are several muscles that control the opening, closing, forward, backward, and sideways motions of this joint. There is also a disc inside this joint that acts as a shock absorber. After all, the TMJ is the most used joint in the body! We need it to talk, eat, cough, make facial expressions, sing, and more. So this disc is very important in preventing degenerative joint disease here. Sometimes, this disc can become displaced and cause popping or clicking sounds when we open or close our mouth.

A big reason for TMDs is poor posture. Let me lead you through a quick exercise. Assume the worst posture you could ever have: round your shoulders, jut your chin forward and up, and let your trunk slump. Notice where your jaw is sitting. You might find that the bottom row of your teeth is drawn backward towards your ears and the front of your neck is long and stretched out. Now assume the best posture you could ever have: roll your shoulders back, tuck your chin in, and sit up nice and straight. You might now find that the bottom row of teeth is more in line with the upper row. Now imagine that you spend most of your time in bad posture… it makes sense that you might start to chronically stress the ligaments, muscles, and the joint in ways that they weren’t meant to be!

Another large reason for TMDs is stress. Stress can cause an array of body habits. One of them is clenching the jaw, which creates tension and constant compression at the TMJ. With this comes muscle spasm, which can then send pain upward, giving you a splitting headache.

To help alleviate symptoms, it is important to avoid poor posture, chewing gum, eating hard or large pieces of foods, biting your nails, sleeping on your stomach, and grinding your teeth. Try to stifle yawns if this worsens your symptoms. You may need to see a dentist to determine if a mouth guard is appropriate for you if your partner or loved ones have mentioned that you grind your teeth at night. Since the TMJ can be affected by stress, it is also important to relax your mind and body with breathing techniques, exercise, and mindfulness.

Severe forms of TMDs can be quite debilitation. Imagine you can’t even open your mouth or chew down to eat your favorite chocolate chip cookie! Physical Therapists at EMH specialize in the treatment of TMDs. We can help release muscles from both the outside and inside of your mouth, mobilize the jaw to decrease pain and restrictions, guide you through importance exercises to help normalize your jaw movements, and work on strengthening and stretching tissues around your face, neck, and shoulder to improve your posture and jaw control. This will ultimately set you up for success as you eat that favorite cookie of yours! Now check out two great exercises to relax your jaw below.

 

Strong Abs during Pregnancy and for New Mom’s

The staff Doctors of Physical Therapy at EMH specialize in pre and postpartum physical therapy for a healthy pregnancy and a fast recovery after delivery. Preventing Diastasis Recti is one aspect of our expertise.
Please forward to all your pregnant/new mom friends and family!

Diastasis Recti Abdominis (DRA) can occur in up to 66% of pregnant women due to hormones that allow ligaments and joints to relax, the increasing baby size in utero, improper weight lifting (ie heavy food bags, other children, furniture etc), a history of prior C-section or abdominal surgery and repetitive poor mechanics during daily activities and lack of regular exercise.

Men can also develop DRA due to faulty weight lifting mechanics, obesity and chronic medical conditions that result in frequent coughing such as bronchitis.

What is a DRA?

DRA is defined as the separation and thinning of the rectus abdominus muscles (see diagram in green) and stretching of the linea alba (see diagram in blue). The linea alba runs from the xiphoid process (base of sternum) to the symphysis pubis (center of pelvic bone). Both the rectus abdominus muscle and linea alba are the main support for the front of the abdomen, keeping the visceral organs in place and functioning well. They also maintain pelvis stability during walking, lifting, bending and squatting.

What are the symptoms of DRA?

Symptoms may include:

  • Noticeable small or large bulge in the center abdomen
  • Sharp or burning abdominal pain during bending, lifting, standing and walking
  • Lower back pain
  • Feeling like the intestines or stomach may fall out
  • Poor posture
  • Longer term problems of prolonged DRA may include Stress Urinary Incontinence, Fecal Incontinence and Pelvic Organ Prolapse.

How To Measure for a DRA?

The best way to measure is a finger width measurement. Lie on your back, knees bent, head resting on floor/pillow. Place tips of 4 fingers across the body at naval or just above/below the naval per your comfort. Now raise your head and shoulders slightly upward. If your fingers descend inbetween the parallel rectus abdominus muscles on either side of your naval, measure how many fingers move downward. If there is a true split of the linea alba, your finger will fall into a space that feels squishy (your intestines live here!). A positive DRA is one where there more than 2 fingertips (1 inch or 2.5cm width) that lower. We have measured women with 3 to 4 inches ( 8cm) wide and have helped them narrow back to 1 inch (2.5cm) wide.

 

What to Do if you have a DRA?

Best to first consult a pelvic physical therapist for a tailored postural, stabilization and home exercise program targeting the Tranversus Abdominus (deepest and lowest muscle of our abdomen), the pelvic floor muscles and the multifidi muscles (lower back stabilizers). Here are some tips to help you immediately:

  • Avoid positions that may further separate the recti muscles, like doing sit ups, crunches, strong stretches of the abdomen, quick trunk rotation movements
  • Stand and sit symmetrically (not to weight bear more on one side vs the other)
  • During standing, gently unlock your knees and gently pull your stomach inward while breathing normally
  • Self bracing of your stomach with your hands pushing the rectus together when sneezing, coughing or laughing
  • Wear a pelvic and abdominal support product to help maintain erect trunk posture and decrease pain until your muscles are aligned and strong

 

 

Diastasis Recti Abdominis (DRA) or “Split Seams” can be treated by Pelvic Physical Therapy

Diastasis Recti Abdominis (DRA) can occur in up to 66% of pregnant women due to hormones that allow ligaments and joints to relax, the increasing baby size in utero, improper weight lifting (ie heavy food bags, other children, furniture etc), a history of prior C-section or  abdominal surgery and repetitive poor mechanics during daily activities and lack of regular exercise.

Men can also develop DRA due to faulty weight lifting mechanics, obesity and chronic medical conditions that result in frequent coughing such as bronchitis.

What is a DRA?

DRA is defined as the separation and thinning of the rectus abdominus muscles (see diagram in green) and stretching of the linea alba (see diagram in blue).  The linea alba runs from the xiphoid process (base of sternum)  to the symphysis pubis (center of pelvic bone).  Both the rectus abdominus muscle and linea alba are the main support for the front of the abdomen, keeping the visceral organs in place and functioning well.  They are also maintain pelvis stability during walking, lifting, bending and squatting.

What are the symptoms of DRA?

Symptoms may include:

Noticeable small or large bulge in the center abdomen

Sharp or burning abdominal pain during bending, lifting, standing and walking

Lower back pain

Feeling like the intestines or stomach may fall out

Poor posture

Longer term problems of prolonged DRA may include Stress Urinary Incontinence, Fecal Incontinence and Pelvic Organ Prolapse.

 

How To Measure for a DRA?

The best way to measure is a finger width measurement.  Lie on your back, knees bent,head resting on floor/pillow. Place tips of 4 fingers across the body at naval or just above/below the naval per your comfort.  Now raise your head and shoulders slightly upward. If your fingers descend inbetween the  parallel rectus abdominus muscles on either side of your naval, measure how many fingers move downward.  If there is a true split of the linea alba, your finger will fall into a space that feels squishy (your intestines live here!).  A positive DRA is one where there more than 2 fingertips (1 inch or 2.5cm width)  that lower.  We have measured women with 3 to 4 inches ( 8cm) wide and have helped them narrow back to 2.5cm width

 

What to Do if you have a DRA?

Best to first consult a pelvic physical therapist for a tailored postural, stabilization and home exercise program targeting the Tranversus Abdominus (deepest and lowest muscle of our abdomen), the pelvic floor muscles and the multifidi muscles (lower back stabilizers).

Here are some tips that you can do immediately:

Avoid positions that may further separate the recti muscles, like doing sit ups, crunches and quick trunk rotation movements.  Avoid being on “all fours”  or on hands and knees for too long during exercise classes.  Assuming the yoga, “cow position” where your belly drops down as your head and hips arch upwards,  puts too much pressure on the already stretched linea alba.  Plus, the yoga position of  “Up dog” and extensive backward bends are not recommended.

Stand and sit symmetrically in good posture  (don’t stand on one leg or sit with crossed legs leaning on one hip for too long)

When you are standing, gently unlock your knees and pull  your stomach inward while breathing normally to give abdominal  support and prevent “hanging out” on your ligaments

When you sneeze, cough or laugh you you can self bracing of your stomach with your hands pushing each side of the rectus abdominal muscles towards the midline, or hold a pillow against your stomach for bracing

Wear a pelvic and/or  abdominal support product to help support the growing baby in uteruo , maintain erect trunk posture and decrease pain until your muscles are stronger by doing core exercises.

By keeping your core toned during pregnancy and taking the steps to prevent further widening of your recti muscles, you can prevent extensive DRA.

 

 

SHOULDER PAIN SUCCESSFULLY TREATED WITH PHYSICAL THERAPY

Have you ever injured your shoulder? There are many diagnoses that your doctor can give you and some of the terminology they use can be confusing or even scary!  For example, “rotator cuff strain”, “subacromial impingement”,” bursitis”,” labral tear” and” shoulder osteoarthritis” are some of the most common names, but what do they mean and how can your shoulder become painfree with physical therapy?

Most shoulder diagnoses are very specific to the actual structure or tissue that is injured in the shoulder complex.   As physical therapists, our job is concerned not only with what structures are injured but HOW you injured your shoulder so we can teach you to heal and protect your shoulder.  Did you play tennis for a number or years?  Do you lift weights at the gym?  Did you slip and fall on an outstretched hand?

None of the above?  A poor ergonomic  work place or performing repetitive, incorrect movements at work/home and even some incorrect sleeping positions could throw off a very delicate system of muscles and nerves that control the mobility and stability of one’s shoulder.

Your doctor has probably mentioned the importance of the rotator cuff, a group of 4 muscles:  the supraspinatus, subscapularis, infraspinatus and teres minor that very closely surround the ball and socket  of the shoulder joint.  Studies have shown that these muscles contract together in a “presetting phase” which begins before any movement of the actual shoulder occurs to enhance the joint’s stability.  Without proper flexibility and strength of these small but important muscles, the “presetting phase” is altered or delayed and the bigger muscle groups such as the chest muscles, biceps and trapezius take over causing altered muscle patterns and joint mechanics which can lead to many shoulder injuries

Physical therapists (PT’s) are trained to palpate all the muscles of the shoulder  for tenderness or myofascial restrictions and can test the flexibility, strength of each muscle so we can create an treatment plan for you.    At EMH Physical Therapy we perform manual therapies to your neck, shoulder, upper back and arms; we teach an individuallized stretching and strengthening program and we  incorporate neuromuscular re-education techniques to help you return to optimum shoulder health.  Your posture and/or mechanics of your sporting activity are also evaluated and corrected to ensure you do not go back to old habits once your pain is eliminated.   By following our guidelines, most patients with shoulder injuries can return to full painfree function!