One of the most common and troublesome problems is a condition known as Temporomandibular joint dysfuction, or TMD for short. In fact, many of you may have heard someone talk about their TMJ or having TMD, but didn’t quite know what it was. TMD involves the joint that connects your jaw to your head. Proper movement of this joint is critical to proper function. It has a profound affect on people because dysfunction of that joint can cause a variety of problems including: Sharp/stabbing jaw pain Inability to open the jaw properly Headaches Neck pain Painful clicking Teeth grinding Clenching and much more... It has rapidly become one of the more common reasons for visits to a neurologist and pain clinics, because of the dramatic impact that this sensitive piece of anatomy has on a person’s quality of life. Many times, this condition is treated with medications. In some cases, muscle relaxers or injections to the joint. What does this have to do with the neck? A search of PubMed will show numerous references for increased incidence of TMD in conjunction with a whiplash injury, or head/neck trauma. A systematic review of these papers show that people with whiplash/head injury actually have more severe pain and more pronounced dysfunction of the joint. Another review showed that just treating the TMJ in these whiplash related cases poor outcomes suggesting that the cause of the problem may be outside the joint itself. The whiplash associated cases showed just a 48% improvement compared to the non-whiplash cases which improved 75% of the time. That leaves a huge amount of people who are still in pain and suffering because the primary insult to the body was not addressed properly. TMD usually comes in 2 varieties: 1. Muscular dysfunction – the muscles of the jaw (pterygoids, masseter, temporalis) become hypertonic and dysfunctional creating painful musculature and sloppy movement. 2. Articular dysfunction – the joint itself can have problems. Dislodging of the disc, arthritic degeneration, and inflammation can irritate the very sensitive nerve endings that cover the joint. Not much can be done about arthritic breakdown of a joint. However, this is a less common cause of TMD. The most common causes of TMJ problems stem from muscular imbalance and dislodging of the articular disc. In a way, these two problems are intimately related. When you have bad jaw muscles moving the jaw abnormally, then it leaves more room for the articular disc to shift out of place. So what can make these jaw muscles dysfunctional? To know that, we have to know what controls the muscle. Every muscle in your body is controlled by a nerve. Whether it be a big bulky bicep, an achy sore back muscle, the blood pumping heart muscle, and the food digesting stomach. For the jaw muscles, a special nerve called the Trigeminal Nerve emanates from the skull and provides innervation for the face, jaw muscles, teeth, brain, and other important structures. (as seen in the above image) The trigeminal nerve is one of twelve specialized nerves called Cranial Nerves. The unique thing about Cranial Nerves is that they do not exit out of the spine. They actually begin come out of the brain and the brainstem, and exit out of the skull. Therefore, a problem with one of the cranial nerves is usually indicative of a problem at the brain stem. Cervical Displacement, Whiplash, and the Brain Stem One of the reasons that our office gets referrals is because of how Cervical Displacement impacts the health and function of the brain stem. While the top of the neck doesn’t apply direct pressure to the brain stem, the movement and function of the neck has large implications for this important piece of anatomy. When someone has an episode of whiplash, there can be substantial damage and injury to the neck, but the more concerning portion is what happens to the nervous system. A phenomenon known as Central Sensitization occurs. This problem happens when the brain stem fires inappropriately to the limbic system (controls the basic emotions (fear, pleasure, anger) and drives (hunger, sex, dominance, care of offspring)) and reticular activating system (the places where pain is interpreted in the brain). When this happens, even the slightest touch or movement can trigger a pain sensation in the brain. This is why many doctors can find no physical damage to the body, but people will suffer with chronic pain issues like fibromyalgia. People recognize this quickly when the pain is stemming from the neck, shoulders or back, but the reality is that this same thing is happening in the jaw muscles. To get to the root of someone’s problems, we have to evaluate this critical, but under studied part of the nervous system.  How does Structural Chiropractic address this? 1. Restore healthy biomechanics to the spine – create a state of Normal Structure in the neck so that the proper signals get to the brain. 2. Increase circulation through the brain – proper alignment ensures that blood to and from the brain stem properly. Proper blood flow means better nerve firing. 3. Restore health biomechanics to the jaw – Once the neck alignment is restored, most of the time the jaw will reset on it’s own. However, sometimes gentle jaw adjustments may be necessary. 

“Doc, I know that you can help me get better, but what can I do on my own to keep this problem from coming back again?” Almost everyone who comes to my office want to know what they can do to protect their neck from shifting into a bad position again, and one of the most important things someone can do to protect their neck is to create an optimal position for sleep. Why is sleep important? Aside from the obvious benefits it has on mood, energy, healing, and overall longevity, the way we sleep also impacts the structural integrity of the spine. Just think about it, most of us spend almost 1/3 of our lives sleeping, and that time is often spent in one of a few postures. In fact, I’ve seen numerous patients tell me that their problem began upon waking, or that they think that their problem began because they slept funny. The fact is that a prolonged period in a structurally poor position can affect the neck and affect the neurovascular tissues that travel through the neck. This can lead to Secondary Conditions like torticollis, neck pain, headaches, and back problems. So how do we protect our neck and the nerves that pass through it? These  tips should get you off on the right foot. Positioning Matters There are 3 primary positions, and sub variations around that. Stomach Sleeping – Avoid it: If you haven’t been told already, stomach sleeping without a specialized pillow can put your neck in too much twist in your neck. Just try this. Turn your head to your right. Now keep it there for an hour. I bet that sounds pretty terrible. Now think about how that must feel to have your neck sitting like that for 6-8 hours by the time you wake up. Stomach sleeping also puts the spine in a hyper-extended position which can also lead to back pain on rising. Side Sleeping Side sleeping is a position where almost anyone can get their spine into a neutral position. It allows thelumbar, thoracic, and cervical spine to line up in one plane when the correct pillows are used.  A pillow between bent knees helps keep the pelvis neutral, while a head pillow should be high enough to support the neck, but not be so high that it pushes the neck upwards like you see on the right.  Side sleeping can cause shoulder pain on the side of the low shoulder. This can be corrected by laying on the shoulder blade rather than the arm itself. Back Sleeping Sleeping on your back is probably the easiest way to protect your neck. However, it is associated with higher incidences of snoring and sleep apnea. Back sleeping can also be excruciating for someone suffering from acute low back pain. If this is the case for you, then a side sleeper may be your best resort. What Pillow Do I use? EVERYONE wants to know about pillows. It’s almost like they’re looking to justify buying $100 pillow as long as it’s approved by their doctor. What’s the best brand? Does it need to have contours? What should it be made of? Water? Foam? Feathers? While I do make specific recommendations for my patients in the office, the truth is that the brand and material matter far less than what the pillow is looking to accomplish. Pillows should comfortably support the structure of your spine. If your head feels jammed or you feel too extended, then you are not getting the necessary support. Any conversation about investing in a pillow should involve measurements of your head and neck so that your pillow fits your specific anatomy (it keeps your spine inline when lying down). The material should be hypoallergenic and supportive for long term use. That will usually leave feather based pillows out of the conversation, which they are shown to increase discomfort in pain patients. Side sleepers – Side sleeping puts your shoulder distance between the head and the bed. Alarger pillow with firmer material is best to support the head and reduce cervical strain. Back sleepers – Sleeping on your back puts a small distance between the head and the bed. A thinner pillow is usually helpful here. However, if you have severe Anterior Head Syndrome, than a flat pillow may be very uncomfortable and force too much hyperextension. Measurement is key to address your pillow concerns here, but correcting the anterior head syndrome will require a chiropractic approach. While this may not solve all of your sleep dilemmas. It’s a fast and easy way to start getting better sleep today.

Migraine headaches are among the most debilitating and dreadful neurological problems that exist. They may not be fatal, but the effect on someone’s quality of life can be dramatic. Imagine having days where the sight of light cripples you. Imagine having terrible nausea, and a constant pounding in your head so bad that you wish that someone would just cut the darn thing off your neck. Imagine that pain lasting for hours or even days at a time. You probably already know that feeling, and you’ve almost certainly been in the same room as someone going through a migraine attack. Fortunately, most people experience a migraine on rare occasion. However, there are those among us that experience these terrible headaches several times a month, and others even experience them on a DAILY basis. This is the typical life of a chronic migraine patient in my office. Many times these patients have seen several headache specialists. They’ve seen the best neurologists that the Mayo Clinic and Cleveland Clinic have to offer, and have been through every MRI and brain scan available. They’ve tried several different medication regiments, altered their diets, and spend their lives in fear of triggers like meat, wine, and sometimes caffeine. Many have even tried alternative therapies like acupuncture and conventional chiropractic with no change. When they finally sit down and speak with me, they’ve been suffering for years, and almost numb to the fact that they have constant pain in the head. Some look a little pale, others need the lights off in the office, and some even come in wearing sun glasses. All of them are a little doubtful and skeptical that their condition can be cured. Less Focus on Cure, More Focus on Cause When most people walk into a doctor’s office with an ailment, what they are most often searching for is a cure. Though migraines are terribly common, and have been around for centuries, a cure has been elusive for the millions of patients suffering on a daily basis. Over the counter migraine medications are usually a first line of treatment, followed by prescription medications. There is also a focus on removing triggers from a person’s life like chocolate, caffeine, and certain scents/perfumes. The truth is that headaches (especially migraines) cannot be treated as a simplistic disease that is the same in all people. Headaches are a dynamic entity with causes that are multi-factorial. Instead of looking at a migraine as a disease entity, it should be seen as a symptom of a neurophysiological process gone haywire. The Trigeminocervical Complex: The Pain Gate Keeper of the Head/Neck Don’t get hung up on the terminology, the name is not important for the casual reader. It is important to understand that near the top part of your spinal cord. In the area surrounded by your top 3 neck vertebra is a very important bundle of nerve cells. These specific nerve cells filter incoming signals from the outer covering of the brain known as meninges. They also filter incoming signals from the blood vessels of the brain, as well as signals that come from the neck. You see, the brain does not have any receptors that trigger pain. It’s kind of crazy to think about, but it’s true.  However, the outer protective covering of the brain, and the blood vessels are very pain sensitive. When the receptors from these structures get set off, then a cascade of events can take place leading to the blood vessels in the brain opening up and becoming inflamed. It’s important that we have ‘filters’ like the trigeminocervical complex around to make sure that not every pain signal gets to the brain. In that way, it acts like a gatekeeper. If it let every pain signal through, you would be in a state of pain without end. So what went wrong with the built-in gate keeper of pain to the brain? The normal alignment and movement of the head and neck serve as a buffer to pain signals that go into the gate keeper. When you lose the normal alignment, several things can happen. Blood flow in and out of the brain is compromised Inflammatory molecules stay in the brain’s blood supply longer Muscles and ligaments of the neck misfire Low grade inflammation persists in the joints of the neck Small muscles in the neck may pull against the brain’s outer covering When this happens, you have an environment where the trigeminocervical nucleus can get overloaded with pain signals without the buffer of signals from normal head and neck movement. All of a sudden, a seemingly harmless trigger can send someone with a tendency towards migraines can be sent in a downward spiral of a pounding headache. Correction not Cure Our focus is on correcting the Structural positioning rather than curing migraine headaches. The truth is that Structural Correction has benefits that go beyond treating or curing a specific illness or disease. Correction of Spinal Displacement does one thing, and only one thing: It mobilizes the self-healing, self-restoring potential within your own body. If we believe that our bodies were meant to be healthy, pain-free, and vibrant, then we must only find what is inhibiting the body’s self-healing potential.

What’s a Normal Headache? This is truly one of the more frustrating things that I hear is when someone tells me about their “normal headache”.  From a physiology standpoint, it would seem silly for the human body to make head pain a normal part of body’s day to day functions. How do you know what type of headache you have? What type of treatments are best for each headache? We’ll break all of that down today. Tension Headaches These are the most common headaches, and what most people classify as a “Normal Headache”. This type is known for having a band like compression around the temples, forehead, or back of the head. Many people call this a stress headache because it is exacerbated by a person’s response to stressful situations. These headaches are typically mechanical in nature (tight muscles, associated with neck pain) There is a lot of variation in the duration and intensity of this type of headache. Even though the pain can become severe (as high as a 8 or 9/10 on the pain scale), the lack of neurological symptoms imply that the nature of the headache has a different origin. Most people control these headaches with massage, over the counter medications, and conventional chiropractic to provide short-term relief. Things like Yoga and stress management techniques are also popular treatments. Migraine Headaches A severe headache is NOT the same as a migraine. It’s important to recognize this because the nature of a migraine headache goes beyond mechanical dysfunction. Migraines are characterized by abnormalities in blood flow to the brain, which creates some distinct neurological symptoms. Most migraines feature: Severe headache Sensitivity to light Aura and other visual disturbances Nausea Pins and needle sensation Post headache hangover Treatments usually go beyond over the counter medications. Other headaches Of course there are several other types of headaches. Things like cluster headaches, sinus headaches, and trigeminal nerve pain fall into the spectrum of common headaches. Another emerging class of headache include those that come from chronic use of pain medication, which has led to a search for new drugs or non-drug therapies to try to manage this common debilitating problem. The truth is, because headaches are experienced differently by so many people, it might be best to figure out where headaches have a commonality. The Craniocervical Junction and the Trigeminal Nucleus The craniocervical junction is a fancy term for where the head meets the neck. A tremendous amount of research is going on in this part of the body because of how big a role it plays on the brain and overall neurology. One of the things that they have found is that this part of the body has a big influence on a part of the spinal cord called the trigeminal nucleus. The trigeminal nucleus is where the nerve cells exist that provide innervation for head, neck, face, jaw, the brain’s outer covering, and the blood vessels of the brain. Here’s a surprising fact: The brain itself does not feel pain When you feel pain in your head, it is coming from brain’s outer covering called the meninges, and the blood vessels. All of these structures feed into the trigeminal nucleus and this piece of anatomy tells our brain what it should feel. Symmetry Matters In the world of Chiropractic we find that symmetry of the cervical spine matters. When you lose your normal structural symmetry of the spine, then the trigeminal nucleus is less likely to work properly. That’s why headache patients usually respond so quickly to this unique type of care. Of course it may not help every person with headaches. The truth is that headaches can be affected by tumors, chemicals, and even food for some select cases. However, a gross majority of the population’s headaches are likely secondary to a structural shift of the head and neck.