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Face, Jaw and Head Conditions

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Facial and Jaw Pain

Why Should You See the Specialized Physical Therapists of PhysioPartners Renaissance CranioFacial Group for Your Facial and Jaw Pain?

Dr. Jennifer Hobson has had the privilege to work directly with one of the most influential people in the field of head and neck TMJ, Dr. Mariano Rocabado.  He is a known expert in this field, recognized by many dentists, oral surgeons, and physical therapists as the most knowledgeable in the biomechanics and function of the head and neck/TMJ.  Dr. Hobson began her training with Dr. Rocabado in 2001 and has continued with a yearly residency in Santiago, Chile where he has resided since 2004.  This yearly training keeps Dr. Hobson's skills current with the newest research-based techniques that Dr. Rocabado teaches all over the world.  She works directly with him and his patients and also assists in training his staff in Chile.  Dr. Hobson is the only physical therapist that has completed such extensive training with Dr. Rocabado over the past 20 years, leading him to allow her to teach his techniques to the physical therapists in the Cranial-Facial Certification program at the University of St. Augustine in Florida.  Dr. Hobson's brings this ongoing commitment to learning, expertise and knowledge to the therapists of PhysioPartners Renaissance CranioFacial Group.

The Importance of Treatment for Temporomandibular Joint (TMJ), Headaches & Neck Pain

An estimated 75% of the U.S. population has experienced signs or symptoms associated with disorders involving the TMJ.  Temporomandibular disorder (TMD) is a more accurate term that describes the two types of TMJ disorders, including either pain caused by the muscles surrounding the TMJ or pain from changes in the TMJ joint. Many areas of the body affect the TMJ and a comprehensive evaluation will help identify the root of the problem.

A loss of spinal alignment can contribute to the development of TMD and the specialized physical therapists of PhysioPartners Renaissance CranioFacial Group can help identify the causes and reverse the effects of poor posture. For many people, sedentary computer work accelerates the loss of spinal alignment, and we encourage you to schedule an evaluation. Our treatment plan will include simple exercises to help you regain and maintain alignment to address your pain, typically in just a few weeks. Failure to address these issues with early intervention can contributed to degenerative disc/joint disease of the cervical spine, poor posture, chronic clenching, tooth fractures (need for extensive dental work) from grinding (bruxism), TMJ arthritis, poor sleep, painful chewing, limited mouth range of motion, and poor breathing patterns.

What Are Typical Symptoms of TMJ Disorders or TMJ Dysfunction (TMD)?

TMJ or TMD symptoms consist of pain in the ear, face, jaw joint, facial muscles and neck and may be caused suddenly, such as when biting into something hard and straining the joint. The jaw and facial pain may fluctuate in intensity and frequency over months to sometimes years. There may be joint sounds, such as grinding, grating, clicking or popping of the joint when moving the jaw during daily activities, such as talking or eating. Locking may occur which may be an indicator that there is a temporomandibular disc displacement problem. At times, there may be a deflection or deviation to one side when opening the mouth. Headaches are also very common with TMJ disorders, along with difficulty eating due to pain or limited opening.

What does TMJ, Headache and Neck Pain Treatment Consist of?

Dr. Hobson and her team of head and neck specialized therapists are all trained in the Rocabado approach to treating the head and neck for both children and adults. Dr. Mariano Rocabado is a world-renowned head and neck physical therapist who has been teaching physical therapists and dentists for years, and which Dr. Hobson now is teaching herself. The Rocabado approach consists evaluation of the head, neck and TMJ joints to determine the cause of jaw clicking, jaw pain, headaches, migraines, and ear and neck pain.

Your physical therapist will complete a thorough examination of your spine, starting at the pelvis to evaluate alignment up to the cranium and TMJ. The Rocabado approach restores the proper position of the head on the neck, called the cranio-vertebral angle. Slouching can promote loss of alignment and development of a “straight neck” or “inverted cervical lordosis”. Cervical lordosis promotes healthy neck joints and use of the neck with the least amount of load or compression. Loss of cervical lordosis can promote lower cervical degenerative changes such as osteophytes, bone spurs, degenerative disc disease, herniated discs and more. Restoring proper posture promotes improved neck range of motion, normal lordotic curvature of the neck, restoration of cranio-vertebral angle, decreased facial and shoulder tension and more.

Should Children be Screened for TMJ, Head and Neck Problems?

Absolutely! Children with poor posture are on their way to becoming adults with poor posture and can experience chronic tension and pain in the body. Children frequently are undertreated and should be evaluated.

An evaluation is also recommended for any child prior to initiating orthodontia or braces to determine if an underlying mouth/TMJ condition or posture may worsen with monthly orthodontia treatments that require wide opening. In fact, at Dr. Mariano Rocabado's facility in Santiago, Chile, all children are screened before application of braces to ensure that their joints are “ready” to undergo orthodontia. If a clicking of clenching problem is detected, resolving it ahead of time may help avoid a degenerative problem in the future.

If your child has clicking and popping in jaw joints, poor posture, or mouth breathes, consider scheduling an evaluation. We will identify the problem and guide your child to improved head and neck posture, breathing mechanics and mouth and tongue posture. Dr. Hobson has been selected as a reviewer for the GOPex program, an app-based intervention that can be used in the convenience of your own home.

What Should I Expect During the Head, Jaw, and Neck Evaluation?

A licensed physical therapist will evaluate the following:

  • Review of MRI’s and x-rays of the head, neck and/or TMJ or they may be requested to further evaluate the joints
  • Review of detailed history and causes of jaw, neck and headache pain, including prior history of dental work, questions about work, work-related positions, depression, anxiety, diet and family, as well as pattern of any headache can help the therapist develop a treatment plan.
  • Evaluation of spinal alignment, from your pelvis to cranium with assessment of muscle tension in the surrounding areas
  • Evaluation of gait or walking pattern to see if ankle, knee or hip limitations are affecting the biomechanics of your head, neck and TMJ
  • Evaluation of the atlas (1st vertebra or C1), head-on-neck position and their influence on the jaw bone
  • Evaluation of joint mobility of the spine and neck and influence the functioning of the TMJ, as well as identify abnormalities or asymmetries
  • Assessment of the TMJ and neck to determine the cause of clicking, jaw pain, headaches, and neck pain
  • Full evaluation of the muscles and soft tissues of the neck, shoulder and face for tenderness and activity level 
  • Examination of the cranium and facial bones
  • A comprehensive assessment of the problem and recommended treatment will be explained to the patient. A home exercise program will be developed to address all aspects of the problem and with the goal of immediately reducing TMJ symptoms
  • Review of the manual therapy or hands-on treatment plan to address TMJ problem. If problem is muscular-based, we will teach you how to reduce facial and neck tension through exercise, posture and also apply manual therapy techniques. If an internal joint problem is present, we will explain treatment options to alleviate joint noise and pain
  • The breathing pattern of the headache patient is examined mechanically and with a capnometer to measure CO2 levels and breathing rate.

What Should I Expect During Treatment of the Head, Neck and TMJ?

  • Specialized Manual Therapy: To restore full range of motion, joint mobility and decrease pain of the jaw, neck and upper back
  • Soft Tissue Mobilization: To decrease your facial swelling and pain
  • Dry Needling: May be recommended to address active trigger points of the head and neck muscles 
  • Education: To decrease chronic headache and jaw pain through exercises and postural correction.  We may not realize the daily habits that are actually hurting us and overloading our joints and soft tissues
  • Postural Screening and Re-education: To decrease pressure in the jaw, face, neck and shoulders
  • Facial Exercises: To decrease tension in the face, head, neck and upper body
  • Breathing Exercises: To restore nasal diaphragmatic breathing patterns to reduce neck tension and chest or mouth breathing
  • Gait Training:  To improve and optimize our alignment during gait to reduce head and neck tension
  • Myofunctional Therapy:  Training the tongue to rest up gently on the palate, strengthening the tongue when it is weak, and positioning it for optimal swallowing function will restore proper support to the throat airway and reduce stress to the head and neck
  • Rocabado TMJ Approach: To treat TMJ disc displacements, locked jaw, clicking and popping, painful opening and painful chewing

How Long Are Treatment Sessions?

The initial evaluation may be longer, but most visits are typically 45-60 minutes.

What is the Frequency of Treatment?

A typical treatment plan might consists of twice per week for one month and then as symptoms improve, tapering to once per week.  Changing automatic habits, such as proper mouth and body posture and breathing habits, takes time. When a frequency of twice per week is not possible, stabilizing the condition may take longer.

How Do I Learn to Manage My TMD or Facial Pain Problem?

Many TMDs require ongoing self-management as these problems do not typically resolve with a "quick fix." Learning why symptoms are occurring and how to minimize the cause is key to success. You may need a few daily exercises to reduce tension in the area and promote better alignment of the neck and jaw. We may recommend a reduction in hard or crunchy foods to reduce the compressive forces of the joint, which is particularly important with degenerative changes of the joint or a disc displacement. At times, collaboration with mental health professionals can decrease the stress and overwhelming feelings that life or the facial pain may be creating. We collaborate with multiple health care practitioners to address all aspects of the TMJ problem.

How Is My Treatment Affected By Dental Appliances, Night Guards or Splints?

The specialized physical therapists of PhysioPartners Renaissance CranioFacial Group work closely with dentists who may provide night splints to help reduce muscle tension at night. TMJ splints or appliances protect the teeth and may help decompress the joint. At times, splints can initially contribute to increased pain, but our hands-on manual therapy techniques can help improve tolerance. If you have been recommended to wear a splint, physical therapist care can help address limitations in the cranium and first vertebrae that may contribute to headaches if you have poor posture and / or limited space at the base of your skull. We will collaborate with your dentist to optimize your ability to adapt to and tolerate your new appliance. 

Please call (312) 986-9833 for more information or schedule an onsite or virtual appointment.

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