About the condition: The ankle joint and joints of the foot are very important to the movement and support of the human body. As humans use two limbs for walking the whole weight of the body is transmitted through the ankle and foot.
Most of us will have twisted an ankle at some stage of our lives. The most common injury to the ankle, the ‘ankle sprain’, is usually caused by turning the ankle by stepping on a stone or the edge of a kerb or during participation in sports. Only occasionally, the end of the bone on the outside of the ankle breaks. More often, however, it is the ligaments of the ankle on the front and side that tear and produce swelling and bruising.
Treatment: It usually takes between four and six weeks to recover naturally from the immediate injury but sometimes the joints and ligaments of the foot don’t fully heal. This can cause problems to recur in the ankle or other areas to be put under strain such as the knee, hip and even the joints in the lower back. The ankle, or other joints in the foot, may remain restricted, or the ligaments may not repair satisfactorily on their own. Because the injury may have healed poorly in this way, it is common to roll the ankle and sprain it again after the initial injury.
Dr Nina talks about the importance of healthy ankle and feet joints and his personal experiences:
“Because of the extremely important function of the foot and ankle joints as a Chiropractor I take into account the full impact on the body problems in the lower leg might have. This includes the knee, hip and joints in the low back. I aim to speed up the natural healing process and through various techniques promote the body to heal naturally and in the strongest way possible so the problem does not recur. I personally suffered with Achilles tendonitis for a long time and it was getting to the point where I was in pain and having trouble walking. I saw my chiropractor eventually and she was brilliant. She adjusted the locked joints in my feet, stretched out the muscles in my legs and gave me effective exercises to relieve the tension in my muscles. It was no quick fix and took dedication from my chiropractor and myself but I am now pain free and even back running and competing in sports again.”
About the condition: Arthritis simply means a painful condition of the joints.
There are different types of the disease – many inflammatory, for example rheumatoid arthritis (RA), and others more degenerative in nature, for example osteoarthritis (OA). Here we will focus on the most common form of the problem and the one most people will consult a chiropractor for help with known as osteoarthritis (OA) but has a number of other names which means the same thing such as “wear and tear” and degenerative joint disease (DJD).
Osteoarthritis (OA), the most common joint disorder, often becomes symptomatic in the 40s and 50s and is nearly universal (although not always symptomatic) by age 80. Only half of those with pathologic changes of OA have symptoms. Below age 40, most OA is in men and results from trauma. Women predominate from age 40 to 70, after which men and women are equally affected.
Symptoms: Onset is most often gradual, usually beginning with one or a few joints. Pain is the earliest symptom, sometimes described as a deep ache. Pain is usually worsened by weight bearing and relieved by rest but can eventually become constant. Stiffness follows awakening or inactivity but lasts less than 30 min and lessens with movement. As OA progresses, joint motion becomes restricted, and tenderness and crepitus or grating sensations develop and ultimately cause the joint enlargement characteristic of OA.
Degenerated joints are generally a result of surrounding joints not doing their duty – so that the load is not managed equally. Chiropractic aims to restore natural joint function by spreading the workload and taking excess strain away from bad joints.
Treatment: Treatment goals are relieving pain, maintaining joint flexibility, and optimizing joint and overall function. Primary treatments recommended are physical measures including chiropractic treatment that involve rehabilitation; exercise for strength, flexibility, and endurance; patient education; and modifications in activities of daily living.
Increasing movement in the joints using various manual techniques and manipulation often relieves pain, increases movement and allows a return to regular activity dependant on the severity of the arthritis. Manipulation of the spine is a gentle and effective way to relieve the symptoms of arthritis in the spinal joints. Rehabilitation techniques are best begun before disability develops. Immobilization for any prolonged period of time can promote contractures and worsen the clinical course. However, a few minutes of rest (every 4 to 6 h in the daytime) can help if balanced with exercise and use. Modifying activities of daily living can help.
Dr Nina talks about chiropractics role in the treatment of arthritis:
“Arthritis cannot be reversed, once these changes have occurred in the joints of the body there is no way to reverse or cure it. Anyone who claims to do so is not being totally clear. What I aim to do with chiropractic treatment is reduce the symptoms of osteoarthritis such as reducing pain and stiffness and through a specific exercise and rehabilitation programme including chiropractic supportive care, maintain the joints as best we can slowing the rate of degeneration and allow you to carry out your daily activities with as little impact from the arthritis as possible. I have had great results using this approach with the many patients with arthritis that I have seen”.
About the condition: Frozen shoulder affects about 1 in 50 adults at some stage in their life. It most commonly occurs in people aged between 40 and 60. It is more common in women. It is more common than average in people who have diabetes and some other conditions.
It is thought that some scar tissue forms in the shoulder capsule. The capsule is a thin tissue that covers and protects the shoulder joint. The scar tissue may cause the capsule to thicken, contract and limit the movement of the shoulder. The reason why the scar tissue forms is not known.
A frozen shoulder occasionally follows a shoulder injury. However, this is not usual and most cases occur for no apparent reason.
Symptoms: The typical symptoms are pain, stiffness, and limitation in the range of movement of a shoulder. The symptoms typically have three phases:
Phase one – the ‘freezing’, painful phase. This typically lasts 2-9 months. The first symptom is usually pain. Stiffness and limitation in movement then also gradually build up. The pain is typically worse at night and when you lie on the affected side.
Phase two – the ‘frozen’, stiff (or adhesive) phase. This typically lasts 4-12 months. Pain gradually eases but stiffness and limitation in movement remain and can get worse. All movements of the shoulder are affected. However, the movement most severely affected is usually rotation of the arm outwards. The muscles around the shoulder may waste a bit as they are not used.
Phase three – the ‘thawing’, recovery phase. This typically lasts anywhere between five months and four years. The pain and stiffness gradually go and movement gradually returns to normal, or near normal.
Symptoms often interfere with everyday tasks such as driving, dressing, or sleeping. Even scratching your back, or putting your hand in a rear pocket, may become impossible. Work may be affected in some cases.
Treatment: The progression of frozen shoulder cannot be halted and it is a case of waiting for the symptoms to subside naturally. Since the actual disease process can’t be stopped chiropractic can help by trying to reduce some of the symptoms of the disease as Dr Nina explains:
“You often find a good deal of the discomfort and pain from frozen shoulder is actually coming from the surrounding structures. The muscles become very tight and tender as they are not being used as normal, ligaments in the shoulder get inflamed and all of these cause pain. Chiropractic can help by working on the muscles ligaments and relieving any restrictions in the neck and mid back which are quite common.”
There are a range of other things that can be done to help ease the pain. Dr Nina has seen a number of patients with these conditions and says:
“Frozen shoulder can be very uncomfortable and painful but I have treated a number of patients and although all the pain did not go they noted much less pain, better sleep and one patient was even able to return to work after going through a few treatment sessions”.
About the condition: Knee joint pain can be related to overuse where small stresses are repeated a large number of times without allowing adequate recovery, for example running too much too soon, or excessive jumping. Or injuries can be acute where the injury is caused by an impact or twisting such as an anterior cruciate ligament injury. An overuse injury can also be considered to be acute if it is painful or inflamed.
The knee joint is a complex articulation and there are a number of structures in and around the knee that may be injured. These are:
The knee joint involves 3 bones. The thighbone or femur comprises the top portion of the joint. One of the bones in the lower leg (or calf area), the tibia, provides the bottom portion of the joint. The kneecap or patella rides along the front of the femur. The remaining bone in the calf, the fibula, is not involved in the knee joint but is close to the outer portion of the joint.
Ligaments are fibrous bands that connect bones to each other. The knee includes 4 important ligaments, all 4 of which connect the femur to the tibia: The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) provide front and back (anterior and posterior) and rotational stability to the knee. The medial collateral ligament (MCL) and lateral collateral ligament (LCL) located along the inner (medial) and outer (lateral) sides of the knee provide medial and lateral stability to the knee.
Tendons are fibrous bands similar to ligaments however instead of connecting bones to bones, tendons connect muscles to bones. The two important tendons in the knee are the quadriceps tendon connecting the quadriceps muscle, which lies on the front of the thigh, to the patella and the patellar tendon connecting the patella to the tibia.
Cartilaginous structures called menisci line the top of the tibia and lie between the tibia and the femur. Menisci provide both space and cushion for the knee joint, meniscus tears are common in twisting injuries and commonly occur with an injury to the cruciate ligaments.
Bursae are fluid-filled sacs that help to cushion the knee and allow tendons and ligaments to move over each other and bone smoothly. The knee contains three important groups of bursae. The prepatellar bursae lie in front of the patella, the anserine bursae are located on the inner side of the knee and the infrapatellar bursae are located underneath the patella. These bursae can become inflamed or infected and cause pain.
Symptoms: Symptoms vary with the structures that are injured or not functioning correctly. You may experience popping, grinding, locking, the sense of giving way, swelling, pain or a combination of any of these. The onset may be immediate after an injury, a few hours after trauma or gradually over time.
Treatment: There are a number of options open to treat knee injuries using chiropractic techniques and exercise rehabilitation. These include using the RICE principle in the initial stages of injury to reduce inflammation and ease pain, various mobilisation, manipulation and soft tissue techniques can be used depending on the cause of the problem in conjunction with specific exercise rehabilitation.
About the condition: Dr Nina talks about low back pain, “Low back pain is by far the most common condition I see and treat, a huge number of people seek my services after suffering for a very long time. After a treatment course many say they wish they had come earlier”.
A survey found that at any one time 33% of the population is suffering with back pain and up to 80% of the adult population will suffer significant back pain at some time in their life. Repetitive activities such as bending, lifting or twisting, as well as poor posture or injury may lead to back pain.
Common causes: Most mechanical spine disorders that cause neck or back pain involve a nonspecific mechanical derangement:
Muscle strain, ligament sprain, spasm, or a combination is most common
Only about 15% involve specific structural lesions that clearly cause the symptoms, primarily the following:
Disk herniation/Slipped disc
Lumbar spinal stenosis/Trapped nerve
Osteoarthritis/Wear and tear in the joints
Non-specific low back pain means that the pain is not due to any specific or underlying disease that can be found. It is thought that in some cases the cause may be a sprain (an over-stretch) of a ligament or muscle. In other cases the cause may be a minor problem with a disc between two vertebrae, or a minor problem with a small ‘facet’ joint between two vertebrae.
Symptoms: Sometimes a pain may develop immediately after you lift something heavy, or after an awkward twisting movement. Sometimes it can develop for no apparent reason. Some people just wake up one day with low back pain.
The severity of the pain can range from mild to severe. Typically, the pain is in one area of the lower back, but sometimes it spreads to one or both buttocks or thighs. Once the pain has eased or gone it is common to have further bouts of pain (recurrences) from time to time in the future. Also, it is common to have minor pains ‘on and off’ for quite some time after an initial bad bout of pain.
Treatment: A national guideline (from NICE) recommends the following treatments should be considered. Each of these treatments has evidence from research trials to suggest that they will help to ease low back pain:
Manual therapy including Chiropractic. Typically this includes sessions of massage, spinal mobilisation and/or spinal manipulation. With spinal mobilisation the therapist moves the joints of the spine around in their normal movement range. In spinal manipulation, the therapist moves joints beyond the usual range of movement.
Structured exercise programme. This means a programme of exercise supervised by a professional. Exercises may include aerobic activity, movement instruction, muscle strengthening, posture control and stretching.
“In general the sooner you seek treatment and have the underlying problem resolved the quicker the episode will clear and then the focus is on rehabilitating the spine to prevent recurrences.”
“Chiropractic is also very effective for chronic or long term back pain but treatment normally takes longer to be effective as it will take time to retrain and re-educate the joints and muscles in your body. So don’t hesitate to get your spine back to health.”
About the condition: Headache is due to activation of pain-sensitive structures in or around the brain, skull, face, sinuses, neck or teeth. Headache may occur as a primary disorder or be secondary to another disorder. Primary headache disorders include migraine, cluster headache and tension-type headache. Secondary headache has numerous causes. Overall the most common headaches are tension-type and migraine. Some causes of headache are common; others are important to recognize because they are dangerous, require specific treatment, or both. This is where a chiropractor can evaluate, test and diagnose your headache and if there are reasons for concern you will be referred to the appropriate healthcare professional.
Headaches where the pain originates in the cervical spine, neck and upper shoulders is referred to as a cervicogenic headache. Many times, these headaches can be a by product of whiplash, neck injury or muscle trauma due to poor prolonged posture or severe stress. Many people are surprised how the neck can become a source of severely painful episodes of headaches.
One of the most common ailments in modern society, more than 42 million Americans suffers from headaches each year. Usually these are minor stress or tension related headaches, and in some people are more severe migraine headaches. Unfortunately, one type of headache that is often overlooked and misdiagnosed is the cervicogenic headache.
Symptoms: Cervicogenic headache, which is clinically defined as pain that is present in the head, but which originates in the cervical spine. Pain can occur at the base of the skull, radiate over the ear and into the forehead area or behind the eyes. A number of people confuse these symptoms with migraine or sinus headaches and it is crucial to differentiate between these separate conditions.
Migraine is an episodic primary headache disorder. Symptoms typically last 4 to 72 hours and may be severe. Pain is often one sided, throbbing, worse with exertion, and accompanied by symptoms such as nausea and sensitivity to light, sound, or odours. Auras (lights in your vision) occur in about 25% of patients, usually just before but sometimes after the headache.
Treatment: A recent research study concluded that “spinal manipulation demonstrated a benefit in terms of a clinically important improvement of cervicogenic headache pain.”
Studies have also shown that “spinal manipulation/mobilization is effective in adults for cervicogenic and migraine headaches”.
A series of case studies on the effects spinal manipulation had in the treatment of migraine headaches reported “the four selected cases of migraine responded dramatically to SMT, with numerous self reported symptoms being either eliminated or substantially reduced. Average frequency of episodes was reduced on average by 90%, duration of each episode by 38%, and use of medication was reduced by 94%. In addition, several associated symptoms were substantially reduced, including nausea, vomiting, photophobia and phonophobia.”
Dr Nina talks about headaches:
“Headaches can be a huge problem to those suffering, they can affect your sleep, work and social life and many times is simply put down to migraine and left at that. I feel it is very important to get to the bottom of the cause of the pain and then resolve it. I use various techniques depending on the type of headache and spinal manipulation or the adjustment has helped reduce the frequency, duration and severity of migraine and cervicogenic headaches. Don’t suffer with headaches, come and see if we can help you, in most cases we can.”
About the condition: There is such a huge variety of sports injuries ranging from the minor tweak to a ligament or muscle rupture or tear. Knees, ankles, shoulders and elbows are the most common but any joint in the body can be injured through sports. Tears may occur in ligaments (sprains), in muscles (strains), or in tendons. Tears may be graded as minimal (1st degree), moderate to severe (2nd degree), or complete (3rd degree). In most cases a severe injury such as full rupture, tear or fracture would normally involve a prompt trip to your local hospital. In general as a chiropractor I see a good deal of muscle strains, ligament sprains or mechanical joint pain.
Symptoms: Generally Sprains, strains, and tendon tears cause pain, tenderness, and usually swelling. Second-degree sprains are very painful when stretched. Third-degree sprains often cause joint instability because ligaments that stabilize joints may be disrupted. In 3rd-degree tendon tears, the muscle cannot move the bone normally attached to it by the tendon.
Treatment: Before commencing treatment it is very important that the correct diagnosis is reached and this is where a Chiropractors training, expertise and experience will be very important on your road to recovery.
Generally in minor sprain or strain injuries:
Rest, ice, compression, and elevation (RICE)
Immobilization and repair as indicated based on injury location and severity
Specific stretching and strengthening regime
Severe 2nd-degree and some 3rd-degree sprains and tendon tears are immobilized. Many 3rd-degree sprains and tendon tears require surgical repair.
“Again the diagnosis is crucial before any treatment and directly affects the next stage to resolving the injury. In cases of minor injuries chiropractic techniques working on the muscles, ligaments and joints of the body can decrease the time taken to return to full activity in my experience, combined with a specific exercise regime and supportive chiropractic care to keep your body at its optimum we can work together to keep you at the top of your game and hopefully prevent recurrences of your problems” says Dr Nina.
About the condition: Pain located in the neck is a common medical condition and one chiropractor’s see on a very regular basis. Neck pain can come from a number of disorders and diseases of any tissues in the neck, such as degenerative disc disease, neck strain, whiplash, a herniated disc, or a pinched nerve. Neck pain is also referred to as cervical pain. Depending on the cause, neck pain may be accompanied by neurologic symptoms such as tingling, numbness or pins and needles into one or both of the arms.
X-rays are generally not taken at Camden Chiropractic and should never be a routine part of a Chiropractic examination. If required patients will be referred to have further imaging taken and the reasons for this will be explained.
Symptoms: Neck pain is commonly associated with dull aching. Sometimes pain in the neck is worsened with movement. Other symptoms associated with some forms of neck pain include numbness, tingling, tenderness, sharp shooting pain into he arms. Due to the many causes of neck pain there is a wide variety of presentations and this is something Alex the Chiropractor will examine thoroughly with you.
Treatment: Initially, short term musculoskeletal pain is treated with:
Heat and cold
Spinal manipulation which chiropractors specialise in may help relieve pain caused by muscle spasm or an acute neck or back injury.
“Often initially with acute (short term) neck pain ice and painkillers will help settle the pain however it will take time. Chiropractic treatment is aimed at trying to speed this process up and reduce the period of time that you are in pain and in most cases it is very effective. After we have settled the pain it is again a job of rehabilitating the neck and keeping it healthy and making sure the problems don’t come back” explains Dr Nina.
“If you have suffered a new episode, recurrent episodes or have had long term neck problems you need to think to yourself, why is this happening and what is causing these problems. That is where chiropractic can help not just short term pain relief but long term optimal health.”
About the condition: Sciatica is not a disease but the name given to any sort of pain that is caused by irritation or compression of the sciatic nerve.
The sciatic nerve is the longest nerve in your body. It runs from the back of your pelvis, through your buttocks, and all the way down both legs, ending at your feet.
When something compresses or irritates the sciatic nerve, it can cause a pain that radiates out from your lower back and travels down your leg to your calf.
Sciatica is commonly caused by irritation of joints of the lower back most frequently the sacro-iliac joints between the base of the spine (the sacrum) and the pelvis. Other common causes are ‘slipped discs’ or disc protrusions pressing on the nerves that exit the spine. Less common causes are piriformis syndrome, muscular tightness, arthritis of the spine or infection. Sciatica is also common during pregnancy.
Symptoms: Pain often radiates along the course of the sciatic nerve, most often down the buttocks and back of the leg to below the knee. You may also experience numbness and weakness in the legs.
Sciatic pain can range from being mild to very painful and can last for weeks or months.
Treatment: Treatment is dependent on the cause of your sciatica. Your chiropractor will be able to diagnose the cause and, depending on the findings you may be sent for an X-ray or recommended for an MRI scan.
Dr Nina says: “There are a large number of causes of sciatica and it’s important to work out the origin of your pain and then in the majority of cases, using a number of techniques we then work to alleviate the pain and keep you healthy well into the future. If not corrected fully sciatica is one of those problems that can come and go in episodes for a long period of time if not treated properly.”
About the condition: The discs are made from a tough, fibrous case, which contains a softer, gel-like substance. A slipped disc occurs when the outer part of the disc ruptures (splits), allowing the gel inside to bulge and protrude outwards between the vertebrae.
The damaged disc can put pressure on the whole spinal cord or on a single nerve fibre. This means that a slipped disc can cause pain both in the area of the protruding disc and in any part of the body that is controlled by the nerve that the disc is pressing on. Slipped discs are most common in people between the ages of 30 and 50. The condition affects twice as many men as women.
A slipped disc occurs most frequently in the lower back, but any disc can rupture, including those in the upper back and neck.
Disorders affecting spinal nerves, but not directly affecting the cord, cause sensory or motor abnormalities or both only in the areas supplied by the affected spinal nerves, chiropractors are trained to evaluate and diagnose which spinal level and segment the cause of the problem is originating from.
Symptoms: With most slipped discs, pain is caused when part of the disc begins to press on one of the nerves that run along the spine. The sciatic nerve is the most commonly affected nerve.
The sciatic nerve is the longest nerve in the body and is made up of several smaller nerves. It runs from the back of the pelvis, through the buttocks and all the way down both legs, ending at the feet.
If you have pressure on the sciatic nerve, it can cause a lasting, aching pain, numbness, a tingling sensation in one or both of your legs. These symptoms often start in the lower back and travel down the buttocks, into either of the legs.
If the slipped disc presses on any of the other nerves that run down your spinal cord, your symptoms may include:
muscle paralysis (weakness)
muscle spasms, when your muscles contract tightly and painfully
loss of bladder control
Muscle spasms and paralysis tend to occur in your arms, legs and buttocks. The pain that you experience when a disc presses on a nerve is often worse when you put pressure on the nerve.
Treatment: A recent research study stated: “although some patients will ultimately require surgical intervention, given that many patients will improve with non-operative therapy, a trial of conservative management (including chiropractic treatment) is appropriate.” Studies have shown that chiropractic manipulation alone and in conjunction with soft tissue techniques and exercise will alleviate pain resulting from slipped disc and aide recovery.
“With disc injuries and trapped nerves the resulting pain is commonly caused not by direct pressure of the disc protrusion or bony outgrowth but from the inflammation that these problems cause. If you can settle the inflammation and increase the movement of the nerve at that level the pain will significantly subside. These injuries will take time to resolve as they are a severe injury and can often be long term in nature, I aim to try and speed up the healing process and then maintain the improvements we have seen and try and limit these problems happening again”, explains Dr Nina.
Cost and use of conservative management of lumbar disc herniation before surgical discectomy. Spine J. 2010 Jun;10(6):463-8. Epub 2010 Apr 1. Daffner SD, Hymanson HJ, Wang JC.
Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J. 2006 Mar-Apr;6(2):131-7. Santilli V, Beghi E, Finucci S.
About the condition: Theories about the causes of tennis elbow (lateral epicondylitis) include nonathletic and occupational activities that require repetitive and forceful forearm twisting, as well as overuse or weakness (or both) of the muscles of the forearm, which originate from the outside of the elbow. For example, during a backhand return in racket sports such as tennis, the elbow and wrist are extended (backwards), and the muscle extensor tendons, can be damaged when they roll over the bone on the outside of the elbow. Contributing factors include weak shoulder and wrist muscles, a racket strung too tightly, an undersized grip, hitting heavy wet balls, and hitting off-center on the racket.
In resistance trainees, injuries often are caused by overuse (too much activity or doing the same movements too often) or by muscle imbalance between the forearm muscles. Nonathletic activities that can cause or contribute to tennis elbow include those involving grasping and twisting the elbow (eg, turning a screwdriver).
Symptoms: Pain at the outside part (lateral) of the elbow is most common, which can radiate into the forearm. Pain initially occurs in the extensor tendons of the forearm and around the lateral elbow when the wrist is extended against resistance (eg, as in using a manual screw driver or hitting a backhand shot with a racket).
Treatment: “There are certain techniques chiropractors can use to reduce the recovery time of tennis elbow that include working on the involved muscles and tendons in the forearm. Most cases require a degree of modification of the activity that caused the problem and icing of the area, after this stretching and strengthening the involved muscles have been shown to be the most effective treatment for this condition, all of which we hope to help you with”, Dr Nina says.
About the condition: The temporomandibular joint (TMJ) is the site where the upper jaw (maxilla) and lower jaw (mandible) meet in front of the ear. The temporomandibular joints are complex and are composed of muscles, tendons, and bones. Each component contributes to the smooth operation of the TMJ. When the muscles are relaxed and balanced and both jaw joints open and close comfortably, we are able to talk, chew, or yawn without pain.
Temporomandibular joint (TMJ) syndrome is pain in the jaw joint that can be caused by a variety of problems. These include:
Teeth grinding and teeth clenching (bruxism) that increases the wear on the cartilage lining of the TMJ. Those who grind or clench their teeth may be unaware of this behaviour unless they are told by someone observing this pattern while sleeping or by a dental professional noticing tell tale signs of wear and tear on the teeth. Many patients awaken in the morning with jaw or ear pain. Habitual gum chewing or fingernail biting causing inflammation of the joint and surrounding structures and dental problems and misalignment of the teeth (malocclusion) can all cause TMJ pain. Patients may complain that it is difficult to find a comfortable bite or that the way their teeth fit together has changed. Chewing on only one side of the jaw can lead to or be a result of TMJ problems. Trauma to the jaws: Previous fractures in the jaw or facial bones can lead to TMJ disorders. Stress is a very common cause of TMJ disorder, it is very common for people under stress to release this nervous energy by either consciously or unconsciously grinding and clenching their teeth. Occupational tasks such as holding the telephone between the head and shoulder may contribute to TMJ disorders.
Headache: Approximately 80% of patients with a TMJ disorder complain of headache, and 40% report facial pain. Pain is often made worse while opening and closing the jaw. Exposure to cold weather or air-conditioned air may increase muscle contraction and facial pain.
Ear pain: About 50% of patients with a TMJ disorder notice ear pain and do not have signs of ear infection. The ear pain is usually described as being in front of or below the ear. Often, patients are treated multiple times for a presumed ear infection, which can often be distinguished from TMJ disorder by an associated hearing loss or ear drainage (which would be expected if there really was an ear infection). Because ear pain occurs so commonly, ear specialists are frequently called on to make the diagnosis of a TMJ disorder.
Sounds: Grinding, crunching, or popping sounds, medically termed crepitus, are common for patients with a TMJ disorder. These sounds may or may not be accompanied by increased pain.
Dizziness: Of patients with a TMJ disorder, 40% report a vague sense of dizziness or imbalance (usually not a spinning type vertigo). The cause of this type of dizziness is not well understood.
Fullness of the ear: About 33% of patients with a TMJ disorder describe muffled, clogged, or full ears. They may notice ear fullness and pain during airplane takeoffs and landings. These symptoms are usually caused by eustachian-tube dysfunction, the structure responsible for the regulation of pressure in the middle ear. It is thought that patients with TMJ disorders have hyperactivity (spasms) of the muscles responsible for regulating the opening and closing of the eustachian tube.
Ringing in the ear (tinnitus): For unknown reasons, 33% of patients with a TMJ disorder experience noise or ringing in the ears (tinnitus). Of those patients, half will have resolution of their tinnitus after successful treatment of their TMJ disorder.
Treatment: TMJ pain disorders usually occur because of unbalanced activity, spasm, or overuse of the jaw muscles. Symptoms tend to be chronic, and treatment is aimed at eliminating the precipitating factors.
Jaw rest: It can be beneficial to keep the teeth apart as much as possible. It is also important to recognize when tooth grinding is occurring and devise methods to cease this activity. It is advisable to avoid chewing gum or eating hard, chewy, or crunchy foods such as raw vegetables, candy, or nuts. Foods that require opening the mouth widely are also not recommended.
Heat and ice therapy: These assist in reducing muscle tension and spasm. However, immediately after an injury to the TMJ, treatment with cold applications is best. Cold packs can be helpful for relieving pain.
Physical therapy including chiropractic: Passively opening and closing the jaw, massage, mobilisation, muscle release techniques and specific exercises help to decrease pain and increase the range of motion and strength of the joint.
Medications: Anti-inflammatory medications such as aspirin, ibuprofen or steroids can help control inflammation. Muscle relaxants, such as diazepam (Valium), aid in decreasing muscle spasms. In certain situations, local injection of cortisone preparations into the TMJ may be helpful.
Stress management: Stress support groups, psychological counseling, and medications can also assist in reducing muscle tension.
Occlusal therapy: A custom-made acrylic appliance which fits over the teeth is commonly prescribed for night but may be required throughout the day. It acts to balance the bite and reduce or eliminate teeth grinding or clenching (bruxism).
Correction of bite abnormalities: Corrective dental therapy, such as orthodontics, may be required to correct an abnormal bite. Dental restorations assist in creating a more stable bite. Adjustments of bridges or crowns act to ensure proper alignment of the teeth.
Surgery: Surgery is indicated in those situations in which medical therapy has failed. It is done as a last resort. TMJ arthroscopy, ligament tightening, joint restructuring, and joint replacement are considered in the most severe cases of joint damage or deterioration.
“TMJ problems can often be very painful and severely affect every day life, when it’s hard to chew, eat or even talk because of the pain. There are a variety of gentle and effective techniques to help ease TMJ (jaw) pain. Initially as with most injuries rest, ice and some gentle work on the muscles and TMJ itself will settle the pain. One pain levels have decreased further techniques to mobilise the jaw, stretch and loosen the muscles and eventually try to re-train and re-educate the jaw function are used to prevent the problems recurring as the jaw is one of the most used joints in the body”, Dr Nina explains.
Motor vehicle accidents do not have to be severe for a person to develop whiplash, with neck pain and associated injuries often developing following low-speed collisions. In rare cases, whiplash can also sometimes occur following a violent blow to the head – for example, after a fall or during contact sports such as boxing and rugby.
Symptoms: Following an accident, the symptoms of whiplash often take a while to develop. Any inflammation (swelling) and bruising that occurs in the neck muscles will not usually be evident at the time of the accident.
It may take 6-12 hours for the symptoms of whiplash to become apparent, and the neck pain and stiffness is often worse on the day after the injury. The pain may continue to worsen for several days afterwards.
The common symptoms of whiplash include:
neck pain and stiffness
tenderness along the back of the neck
reduced movement in the neck or loss of movement
Other symptoms of whiplash can include:
lower back pain
pain, numbness or paraesthesia (pins and needles) in the arms and hands
difficulty swallowing (dysphagia)
vertigo – the sensation that you are moving or spinning while standing still
tinnitus – the perception of noise in one ear, both ears or inside the head
Treatment: The outlook for whiplash will vary depending on how severely the neck has been sprained.
The recovery time may take a few weeks if the neck ligaments and tendons are only slightly damaged. However, in severe cases, whiplash and whiplash-associated injuries can last for several months or even years. One study found that the average recovery time for a whiplash injury without any other associated symptoms was 32 days, and that out of 2,627 participants 12% had not recovered six months later (chronic whiplash).
Massage and manipulation to promote healing and wellbeing is recommended. It can often help to restore a person’s range of movement following an injury such as whiplash. As well as helping to relieve pain and stiffness in your neck using massage and manipulation, your chiropractor will also be able to advise you about neck exercises that you can do at home.
“Neck pain after whiplash injuries is very common and one study showed whiplash may occur in accidents at speeds of as little as 6mph. With chiropractic we aim to restore the function and reduce inflammation in the joints and tissues of the neck. After that a specific rehabilitation programme and chiropractic care to maintain the benefits I have in my experience to be most effective”.