Have you ever heard the words “Come back in 2 weeks and see me if you still have the symptoms.”
If a patient comes into a doctor’s office with excessive daytime sleepiness, depression, and excessive fatigue! Cognitive impairment, un-refreshing sleep, frequent awakenings, and chronic pain, this could be many things. Symptoms are often treated with medication.
“However, medications may have side effects!”
Often, after a serious disease has been eliminated as to cause of those symptoms, oxygen intake and excessive CO2 build up in blood stream could be considered as part or source of a problem.
If you suffer from the above symptoms, ask your health care professional to send you for investigations to evaluate sleep disordered breathing, and intake & absorption of Oxygen
Last month I wrote about Sleep Apnea. This month I ask you to think about “Are you or loved ones breathing properly? Has it become another job on your “to do” list? Clinically I see the results of poor breathing habits daily… Make time to breathe! This cartoon says it all.
You may suffer from UARS, “Upper Airway Resistance Syndrome” which is a sleep disorder characterized by airway resistance tobreathing during sleep.
Read more on Wikipedia for difficulty doctors have to confirm diagnosis, explanation & treatment. Alternatively, I have full information on my blog.
Over time poor breathing habits can lead to symptoms of UARS which show up as low blood pressure/ Hypotension, excessive daytime sleepiness, depression, snoring and excessive fatigue! Also maybe present are, cognitive impairment, un-refreshing sleep, frequent awakenings, and chronic pain. As this mimics other dis-eases in the body, UARS is often misdiagnosed as Fibromyalgia or similar disorders.[2] Guilleminault et al. write that up to 75% of adult patients with sleepwalking have UARS.
Quick test to feel effects of poor prolonged breathing can be felt when trying to breathe through a regular/or coffee straw with tissue in both nostrils and walking up a flight of stairs. Please only try this if no previous medical condition. One starts to feel chest tightness, light headedness, unable to focus. A patient tried this. Only then did he understand that poor breathing could be affecting his heart and blood pressure as well as mind.
At a recent lecture given by a dentist, Dr Steve Olmos, I realized that many of my patients may suffer from sleep apnea or Upper airway resistance syndrome.
One of the problems with criteria for sleep apnea is that if you stop breathing for 9 seconds at a time, and you stop breathing 50 times every hour, then officially you won’t have the diagnosis of sleep apnea and then you get into the realm of UARS which is not widely known about.
(There is question in the medical community as to not only the existence of this syndrome, but whether it should be classified as a separate syndrome or part of the larger group Sleep-disordered Breathing (SDB). This unfortunately has led to a poor understanding of the illness by the medical community at large).
Diagnosis
It is difficult to confirm diagnosis, as few sleep testing centers have the proper test equipment to recognize the illness.
Treatment There are a number of conservative measures that are recommended to treat UARS, Learn from kids. They sleep more, take work seriously but selves lightly, play often and live in moment.
Seriously, treatment of snoring and sleep apnea includes weight loss, positional therapy. In theory this is fine except, it’s hard to lose weight because you’re so tired and it’s hard to exercise!
In terms of trying to sleep on your side or on your back, you only have so much control over that when you’re sleeping.
One note about snoring treatments: over-the-counter snoring treatments have been found to work sometimes in a recent controlled study, which looked at three popular snore aids, including a nasodilator strip, an oral lubricant and a pillow. All were found objectively not to have any significant benefit. However, I have many patients who swear by these over-the-counter snore aids, but in my experience, it only works with some people.
If you’re found to have obstructive sleep apnea, the best way to treat this condition is via what’s called a Continuous Positive Airway Pressure machine, or CPAP. This is a small device that acts as an air pump which blows some positive gentle air pressure through your nose and it stents your airway open so you don’t stop breathing at night. When used effectively, it works. You wake up feeling much more refreshed; have much more energy and all the medical problems start to get better. One of the problems with CPAP, however, is that people just don’t like to use it, but with good counselling and proper follow-up from clinic staff and the equipment people that administer the device, many people can do well with this device.
However, there are certain people who just can’t use CPAP for other reasons despite trying different kinds of masks, headgear and devices. These people end up going to different devices, one of which is a mandibular advancement device, which are oral appliances that dentists make. They make an impression of your teeth and the bottom part, the mandible. The jaw bone slowly is pushed forward. The way this works is that it pulls the tongue forward, which is one of the reasons for sleep apnea, amongst many other reasons. Again, when applied properly and when patients use it, this device does work especially for snoring and for mild to moderate sleep apnea. As with medication side effects can be horrible. Therefore compliance is a problem due to jaw pain, dry mouth, ear pain, headaches, and bite problems. In summary “Just Breathe, it makes life worth living!”
Do you feel touchy, can’t think straight, are excessively tired during the day, & your bed partner says that your snoring is disrupting his/her sleep…Your only bedmates that love you are the spiders in the basement. This is stressful!
I hope by reading this article it could change your life. Do you want to remember what it’s like to be refreshed and alert every day?
First, take this test and notice how your body reacts to stress.
Make a fist and squeeze it tight. Keep squeezing—as hard as you can—while you count to 10. Most people find that they completely stop breathing. When we’re under stress our breathing patterns change for the worst. This becomes a habit which can be very damaging to your mind and body health over time. Many people in my practice justify and normalise the symptoms of sleep disordered breathing habits by saying, “my mother/father did this or that.” Always had an afternoon nap! I ask them …What quality of life did your Mum/Dad have when they retired? I believe genetics and family anatomical traits (narrow airway, palate, sinuses and faces, poor posture) play a key role in sleep apnea. You are not alone
Did you know? One in five Americans are having difficulty breathing during sleep. Those who suffer with Obstructive Sleep Apnea are 8-10 times more likely to experience heart attack and stroke. 50% of patients with impaired cardiac function suffer from sleep related breathing disorders.
In summary, snoring and sleep apnea are common sleep disorders breathing problems that can affect your sleep, health and quality of life!
Clinically I see daily people who have Sleep Apnea, airway and jaw issues which has been “undiagnosed” and untreated for decades. According to Mayo clinic, 80-90% of people who have sleep apnea are being treated for the end result.
Symptoms from lack of sleep are often what prompt people with obstructive sleep apnea to visit their doctor
These may include;
Excessive daytime sleepiness,
poor concentration,
poor memory
depression,
acid reflux,
diabetes,
allergies,
Think how many people you know are taking pills. How many people do you know who have pills to reduce high blood pressure, have had abnormalities in heart function & have ongoing gastric issues? (It is also known that significant sleep apnea happens in 35% of chronic snorers. It’s also important to note that you don’t need to snore to have sleep apnea) It could be UARS (Upper airway resistance syndrome). I will talk about this in next news letter
I remember filling out a health insurance form and the agent kept repeatedly asking if my husband and I were sure, that I did not take pills for high blood pressure, because everyone does! We were obviously freaks
I hear patients explaining their symptoms as their hormones, busy schedules and stressful jobs. True but what is this doing to their physiology? One lady told me today, that she almost wished the doctor would insist on her taking time out of busy life as health professional, mum and wife to have a hysterectomy! Someone else taking charge of her schedule was the only way she could make herself take a holiday! Does this sound familiar? Woman are worst for this. We love to feel needed!
We think that when we go on holiday then we will feel better …well, how many holidays can you go on? ….and the cycle starts again and we get stressed when we’re not better!
What is sleep apnea?
Sleep apnea affects the way you breathe when you’re sleeping. In untreated sleep apnea, breathing is briefly interrupted or becomes very shallow during sleep. (18 breaths a minute/ normal is 10-12 breaths a minute) These breathing pauses typically last between 10 to 20 seconds and can occur up to hundreds of times a night.
Untreated sleep apnea prevents you from getting a good night’s sleep. When breathing is paused, you’re jolted out of your natural sleep rhythm. I know someone who has trained themselves to lie on their side at night and therefore had forgotten that prior this adaptation, he had woken up gasping for air! As a consequence, one spends more time in light sleep and less time in the deep, restorative sleep one needs to be energetic, mentally sharp, and productive the next day.
Chronic sleep deprivation results in daytime sleepiness, (ask any new mum if this is true!), A new baby typically results in 400-750 hours lost sleep for parents in the first year. It also slows reflexes, affects concentration, and one has increased risk of accidents in some cases
In summary, sleep apnea can lead to serious health problems over time, including diabetes, high blood pressure, heart disease, stroke, and weight gain.
The good news is with treatment, you can control the symptoms, get your sleep back on track, and start enjoying what it’s like to be refreshed and alert every day.
Types of sleep apnea
Obstructive sleep apnea is the most common type of sleep apnea. It occurs when the soft tissue in the back of your throat relaxes during sleep, causing a blockage of the airway (as well as loud snoring).
Central sleep apnea is a much less common type of sleep apnea that involves the central nervous system, rather than an airway obstruction. It occurs when the brain fails to signal the muscles that control breathing. People with central sleep apnea seldom snore.
Complex sleep apnea is a combination of obstructive sleep apnea and central sleep apnea.
Anatomy of a sleep apnea episode: (Watch this hilarious video of visit to dentist to make sure you are breathing and can take in following information!)
As air flow stops during a sleep apnea episode, the oxygen level in your blood drops. Your brain responds by briefly disturbing your sleep enough to kickstart breathing—which often resumes with a gasp or a choking sound. If you have obstructive sleep apnea, you probably won’t remember these awakenings. Most of the time, you’ll stir just enough to tighten your throat muscles and open your windpipe. In central sleep apnea, you may be conscious of your awakenings.
It can be tough to identify sleep apnea on your own, since the most prominent symptoms only occur when you’re asleep. But you can get around this difficulty by asking a bed partner to observe your sleep habits or recording yourself during sleep.
Do you suffer from:
Loud, chronic snoring, especially when lying on back. Most of us don’t think of snoring as something to be overly concerned about—unless our bed partner is disrupting our sleep! But frequent, loud snoring may be a sign of sleep apnea, a common and potentially serious disorder in which breathing repeatedly stops and starts as you sleep.
Waking up in the middle of the night, with an “Adrenaline spike”, choking or gasping for air
Sleepiness during the day and people at Starbucks know your name!
High blood pressure (taking pills that make you see dots in front of eyes if stand up too quickly)
Had numerous root canals for fractured teeth due to nightly teeth clenching /grinding
Mood swings or personality changes; eg: feeling depressed
Feeling un rested & dry throat when you wake up
The Epworth Sleepiness Scale is an on-line questionnaire which will help you decide if you have a sleep problem.
In the meantime…
Try a “Breathing better program for 6 weeks” Awareness of Breathing (red dots everywhere to remind you, signs Just breathe! /do yoga/ pilates/ wear a pedometer to walk 10,000 steps daily, or swim regularly)
Here are some quirky stress busting technique
Heart-Calming Breeze
If you’re feeling anxious and can feel your heart racing, call your thumb into action. By blowing on your thumb, you can get your heart rate back to normal.
Throat Tickle Cure
To relieve that constant feeling in the back of your throat, tickle something else…your ear. Touching the area around your ear creates a reflex in the throat that eases the annoyance.
Stuffed Nose Cleared
Your body has a natural mechanism to unclog your nose. Just push your tongue against the roof of your mouth, then press between your eyebrows with a finger. Keep it up for about 20 seconds and your sinuses will start to drain.
Read more about Sleep Apnea…..it might save your life and answer many health questions.
Medline’s description of Obstructive sleep apnea syndrome (OSA); is
1. Recurrent interruption of breathing during sleep due to obstruction usually of the upper airway especially by weak, redundant, or malformed pharyngeal tissues, that occurs chiefly in overweight middle-aged and elderly individuals, and that results in hypoxemia and frequent arousals during the night and in excessive sleepiness during the day. Many people tell me that needing a nap is a hereditary habit not a possible health issue!
Who’s at risk?
A typical description of physical features for someone at risk for obstructive sleep apnea is an overweight, male, who is an obnoxious snorer whose neck is greater than 17 inches. One physical finding that’s rarely mentioned is tongue scalloping. This is when you have impressions or ridges on the sides of your tongue where it sits against your molars. One past study showed that having tongue scalloping can positively predict the presence of apnea or hypopneas and oxygen desaturation in 89% of cases. Overall, having scalloping is about 70 % sensitive in picking up obstructive sleep apnea.
The traditional explanation is that the tongue is too big, but for sleep apnea patients, the jaw is too small for the normal sized tongue. If you add additional inflammation due to chronic reflux from the stomach with each obstruction, the swelling of the tongue will only aggravate the dental impressions on the tongue. Along with the small jaws and scalloping, you’ll also have a high-arched hard palate, and the tongue sits very high in the mouth, preventing you from seeing the back of the throat more fully.
This condition is also described in hypothyroid patients, but sleep apnea can cause hypothyroidism.
A person with sleep apnea can stop breathing from 10 to 50 to even over 100 times every hour with each episode lasting anywhere from 10 to 30 seconds.
Central sleep apnea, which occurs when your brain doesn’t send proper signals to the muscles that control breathing
Additionally, some people have complex sleep apnea, which is a combination of both.
A BUNCH OF FACTS YOU MIGHT NOT HAVE KNOWN ABOUT SLEEP.
Do you fall asleep in under five minutes at night? This means you’re sleep deprived. The ideal is between 10 and 15 minutes, meaning you’re still tired enough to sleep deeply, but not so exhausted you feel sleepy by day.
In an interesting study that came out in the Journal of Paediatrics, researchers recruited 78 children who were about to undergo a tonsillectomy for various reasons including recurrent infections or sleep apnea and compared them against 22 other children undergoing other types of surgical procedures. All these children underwent formal sleep studies and a battery of psychological tests including that for attention deficit disorder and found that 22 children, or 28% of the tonsillectomy group, were found to have ADHD by official psychiatric criteria. The control group only had 7% that were found to have sleep apnea. After surgery, one year later, 11 children or 50% of the children who originally had ADHD, no longer had by official criteria. Furthermore, after the surgery, the incidence of sleep apnea in the tonsillectomy group was equivalent to that in the control group.
The record for the longest period without sleep is 18 days, 21 hours, 40 minutes during a rocking chair marathon. The record holder reported hallucinations, paranoia, blurred vision, slurred speech and memory and concentration lapses.
It’s impossible to tell if someone is really awake without close medical supervision. People can take cat naps with their eyes open without even being aware of it.
Experts say one of the most alluring sleep distractions is the 24-hour accessibility of the internet. Also the invention of the light bulb has upset our circadian rhythms
The extra-hour of sleep received when clocks are put back at the start of daylight in Canada has been found to coincide with a fall in the number of road accidents.
UARS – More about that in next month
One of the problems with these criteria for sleep apnea is that if you stop breathing for 9 seconds at a time and you stop breathing 50 times every hour, then officially you won’t have the diagnosis of sleep apnea and then you get into the realm of UARS (Upper Airway Resistance Syndrome).
I am often asked “What can you do as a physiotherapist to help a patient who comes into a dental office and says “I have jaw pain… my bite is off… my back teeth won’t touch when I bite down.”
The purpose of this article is to enhance knowledge of TM Joint and soft tissue management to assist dental profession to recognize and treat occlusal dysfunction which is valuable to ensure success in restoring function to the TMJ.
Dr Mariano Rocobado, a world authority on TM joint dysfunction told the Pacific dental conference that success with STM joint dysfunction must be a team approach. The dentists are 50% of the professionals involved because of the influence of occlusion on the TMJ. They have the tools to evaluate and treat teeth and bones. The other 50% of evaluation and treatment, such as measurements of range-of-motion in the cervical spine/ cranium, muscle tests, joint-play tests, postural evaluations, acupuncture & massage therapy are performed by physical therapists.
What is STMJ dysfunction? * Synovial Temporomandibular Joint Dysfunction*
Wikipedia says that “The temporomandibular joint is the jaw joint and is frequently referred to as TMJ. There are two TM Joints, one on either side of the face. In a normal joint they work in balanced unison. Research has shown that TM Joint dysfunction can happen as early as 7 years old.
Anyone every shanked or sliced a golf shot off the tee box? The jaw is affected by similar mechanics. If range of motion is unequal the end result might be deviation towards the tighter or hypomobile side. Like golf the performance can be affected by mood!
ANATOMY: The name is derived from the two bones which form the joint: the upper temporal bone which is part of the cranium (skull), and the lower jaw bone called the mandible. The unique feature of the TM Joint is a biconcave articular disc. The disc is composed of fibrocartilagenous tissue (like the firm and flexible elastic cartilage of the ear) which is positioned between the two convex bones of the condyle and cranium that form the joint. It is one of the only synovial joints in the human body with an articular disc, (It is a thin, oval plate, placed between the condyle of the mandible and the mandibular /glenoid fossa.
It is thicker at its periphery, especially behind, than at its center.
Its upper surface is concavo-convex from before backward, to accommodate itself to the form of the mandibular fossa and the temporal tubercle. Its under surface, in contact with the condyle, is concave.Its circumference is connected to the articular capsule; and in front to the tendon of the Lateral pterygoid.It divides the joint into two cavities, each of which is furnished with a synovial membrane. Therefore the disc divides each joint into two. The lower joint compartment formed by the mandible and the articular disc is involved in rotational movement — this is the initial movement of the jaw when the mouth opens. The upper joint compartment formed by the articular disk and the temporal bone is involved in translational movement — this is the secondary gliding motion of the jaw as it is opened widely.
Palpation of joint:
You can locate this joint by putting your finger on the triangular structure in front of your ear. Then move your finger just slightly forward and press firmly while you open your jaw all the way and shut it. Alternatively say “NO” and “NEVER” Feel different motions in the TMJ. (You can also feel the joint motion in your ear canal)
Test occlusion changes with different neck posture. Look down, side flex neck and notice how bite moves from side to side (if does not often upper cervical needs realigned)
Sit with legs crossed and notice if bite changes
Typical symptoms of STMJ (synovial temporomandibular dysfunction)
Biting or chewing difficulty or discomfort
Clicking, popping, or grating sound when opening or closing the mouth.This is NOT normal for any synovial joint?
Dull, sharp, or aching pain in the face each time you swallow, yawn, talk, or chew,
Earache (particularly in the morning) – many referrals to Ear, Nose and Throat physicians are because people think they have an ear infection.
Headache (particularly in the morning)
Temple/cheek / eye or forehead pain
Hearing loss
Migraine (particularly in the morning)
Jaw pain or tenderness of the jaw
Reduced ability to open or close the mouth
Tinnitus
Frequent head/neck aches / Neck and shoulder pain
Sinusitis (can lead to mouth breathers)
What to do if patients come into your office complaining of the above symptoms
Ever find your self saying to patients “Come back in two weeks” Ask yourself ..why wait to start treating pain or wait for pain to hit?
Think about this analogy. The jaw should be treated the same way.
Which is most important finger to the dentist? If the thumb started to make a noise or hurt when you picked up a tool, you would not ignore the situation because it could effect your business and ability to enjoy life.
Think about your golf game. If you start pulling shots to the right and lose consistency, you take your swing to the pro shop. Why do humans procrastinate to get help or change their ways?
Frustration and anxiety will fan the flaming symptoms of a hot joint!
It is my opinion that patients should NOT be sent away. STMJ is progressive in nature therefore patients should be treated immediately. Reduction of pain of muscle origin is often accomplished with a bite guard or night splint. Sometimes ice packs and /or anti-inflammatory medications can be used
Why?
The most common disorder of the TMJ is disc displacement. In essence, this is when the articular disc, attached anteriorly to the superior head of the lateral pteygoid muscle and posteriorly to the retrodiscal tissue, moves out from between the condyle and the fossa, so that the mandible and temporal bone contact is made on something other than the articular disc. This, as explained above, is usually very painful, because unlike these adjacent tissues, the central portion of the disc contains no sensory innervation.
In most instances of disorder, the disc is displaced anteriorly upon translation, or the anterior and inferior sliding motion of the condyle forward within the fossa and down the articular eminence. With the invention of MRI ‘s the disc has been seen in 13 different locations.
On opening, a “pop” or “click” can sometimes be heard and usually felt also, indicating the condyle is moving back onto the disk, known as “reducing the joint” (disc displacement with reduction). Upon closing, the condyle will slide off the back of the disc, hence another “click” or “pop” at which point the condyle is posterior to the disc. Upon clenching, the condyle compresses the bilaminar area, and the nerves, arteries and veins against the temporal fossa, causing pain and inflammation
In disc displacement without reduction the disc stays anterior to the condylar head upon opening. Mouth opening is limited and there is no “pop” or “click” sound on opening. (see videos)
Role of the dentist
Assessment of the teeth occlusion and function of the jaw joints and muscles in functional position. I have always wondered why bite assessment and filing down teeth Is performed lying supine and not sitting which is more functional?
Education on early intervention if acute not chronic Rest the muscles and joints by eating soft foods.
Do not chew gum.
Avoid clenching or tensing. Evaluate stress levels and coping skills honestly. Try relaxation techniques and stress reduction, (Yoga, zumba fitness, dancing and singing),patient education, non-steroidal anti-inflammatory drugs, muscle relaxants or other medications may be indicated in a dose given by a doctor…many patients self medicate
Avoid biting nails/cuticles/pencils
Relax muscles with moist heat (1/2 hour at least twice daily). In cases of joint injury, ice packs applied soon after the injury can help reduce swelling.
Improving your posture is the key to reducing neck and headaches. Start with your feet and soles of shoes: uneven wear-spots show the need for correction.
2. Refer to a physiotherapist who will take a detailed history, from birth to present time
3. An exercise program by Dr Mariano Rocabado addresses postural relationships with the head to neck, neck to shoulders and lower jaw to upper jaw. The objective of his home exercise program is for patients to: learn a new postural position, fight the soft tissue memory of the old position, restore the original muscle length-tension relationships, restore normal joint mobility and restore normal body balance. Rocabado advocates the instruction of six fundamental components of activity for treatment of TMJ dysfunction. He recommends that patients complete each activity 6x/session and 6x/day.
The activities are as follows:
1) Rest position of the tongue a) Make a clucking sound with the tongue x 6 b) Find normal resting position = holding one third of tongue gently against the roof of the mouth just behind the front teeth c) Diaphragmatically breathe through nose while tongue is in resting position x 6 breaths
2) Control TMJ Rotation on Opening – tongue on roof of mouth and open x 6 reps
3) Mandibular Rhythmic Stabilization – shown in my march blog, apply light resistance to opening, closing, and lateral deviation with the jaw in a resting position holding for 6 seconds (this is key when a patient has instability as this assists with visualization/neuromuscular reeducation)
4) Stabilized Head Flexion = upper cervical flexion (nodding) – facilitate upper cervical flexion as most of these patients have forward head posture resulting in upper cervical extension deviation. Nod head x 15 degrees back and forth 6 x reps.
5) Lower Cervical Retraction – chin tuck x 6 second hold
6) Shoulder Girdle Retraction – pull shoulders back and down – hold x 6 seconds
7) Functional activities like eating ,singing and whistling should them be assessed and changed if necessary
Joint mobilization
When the TMJ is restricted joint mobilization can be performed in various directions to improve joint play at the temporomandibular joint.
9) Strengthening/Stabilization
Expectations of patients
When treating patients with an acute onset or post traumatic injury they are more likely to respond better to physical therapy intervention while patients with a chronic TMD tend to not respond as quickly.
Personally I treat many areas of the body in conjunction with the the jaw because this affects jaw and postural alignment… ie: cranium, palate, cervical spine/related musculature, shoulder girdles, thoracic spine/related musculature, lumbar spine and pelvis
Future
Computerized tomographic scanning holds promise for the future compared to conventional
radiography, as it offers the advantages of greater accuracy in determining the position and possible perforation of the disk, better definition of sclerosis and early ankylosis, and much less radiation.
In olden days if people consulted with a tribal medicine man about being depressed or feeling unwell, he would not give them herbal potions or advice. Instead, he asked, “When was the last time you danced, sang, told your stories, had time alone outside or helped someone else?”
Maybe that is why dancing in the form of Zumba fitness has taken off world wide. Imagine how much fun it is dancing to music associated with salsa, cha cha, samba, tango, meringue, with hints of flamenco, calypso, hip-hop and belly dancing. I call this my fun anti-aging, calorie-burning elixir which has improved my body shape, joint health, increased muscle mass and built my self confidence which has spilled into every aspect of my life.
Recently I was speaking in Florida at a conference whose theme was “Through the looking glass“. Attending a conference is far more fun in my opinion, if the company organises a themed event for the partner/spouse who is attending conference. In this case it was a Mad Hatter Tea Party.
The Ladies sat in the gardens of the hotel underneath palm trees and sunny skies. The tables were decorated in multicoloured fabric held together with fresh flowers and the centrepiece was a multicoloured dotted teapot. Color coded daisies arranged on a vertical oasis came out of its centre. We all wore straw hats decorated with flowers, boas, and gloves and nibbled on sandwiches shaped like card deck suits. As they sipped on champagne and orange juice, they listened to my stories, I had them tell stories using something I learned at Improv classes, then they joined me dance away our worries to Salsa music. Click here to view video.
Over the years, I have always believed like Marcia, the Jan Pro International’s President & CEO’s wife who put on the event, that if something is fun, they will come! Also real presents are not always the type you wrap up. Each day comes bearing its own gifts. That day we all untied the ribbons!
Watch the video to get an idea of how much fun and laughter we had, leaving the tea party filled with more energy and vitality. Maybe the medicine man was right!
“I’m really glad I went to the tea party, it was a lot of fun!“ ` Karen Bates JPI Central Ontario
1. To promote pain free function even if the disc is out of place
2. If there are concerns regarding disc position or condition consider MRI
3. Consider topical diclofenac applied to the preauricular region (in front of ear) if there is pain during meals
4. Consider a referral for Physiotherapy
5. Ask your dentist about
- An Oral appliance
- Whether you are grinding or clenching your teeth
- If you have lost posterior support ie: missing teeth, this could be increasing the joint loading or occlusal instability.
Begin with:
o Basic self care, see blog
o Controlled opening exercise 10 times a day
Controlled Opening Exercise
Awareness of posture and breath.
Breathe in slowly and place the tip of tongue in the mid part of roof of the mouth
While keeping the tongue in contact with the roof of the mouth, allow the jaw to drop open and close back
When closing, do not bring the teeth together fully
Open and close 10 times and with every repetition keep the tongue up, do mindful breathing and have good relaxed posture
Do this 10 times a day
This exercise should not cause discomfort
Jaw / Mandibular Stabilisation Exercises
Objectives:
1. To strengthen jaw muscles
2. To balance the strength and function of the right and left TMJ Muscles
3. To establish a normal jaw position at rest and in the open mouth position
4. Isometric muscular contractions are performed which means that the muscle length is maintained at constant; fixed tension develops in the muscle as patient contracts against an equal counterforce applied by therapist or own finger. This technique primarily reduces hypertonus and resets resting length, thereby restoring more normal articular mobility
Important considerations:
The following exercises require the application of light pressure to the jaw using the index finger
(Important the resistance you use should be amount of pressure you would apply when touching eye when eyelid closed or the intensity of the pressure should be 2 on a scale of 1-10)
The lower jaw should not move during application of pressure (monitor in mirror) This is an
Phase 2 builds on phase 1 and phase 3 builds on 2. Consequently, the earliest phases are continued as the higher phases are added.
Phase 3 (2 knuckle opening) is an advanced exercise performed by patients with no jaw pain and good performance of Phase 1 and 2 stabilization. Not all patients will automatically be progressed to phase 3.
Good general posture
Place jaw in a restful position and slow breathing should be done throughout exercises,
Mandibular Stabilisation Phase 1
1. Breathe in, tongue tip up on roof of mouth, and apply pressure to the jaw with index finger as shown in pictures A-F
2. Hold breath and pressure on jaw for 2 seconds from left, right, underneath, diagonals from bottom left, top right, bottom right and top left.
3. Breath out as remove pressure
4. Repeat each direction 5 times, 5 times per day
A: Pressure to the right
B: Pressure to the left
C: Pressure up to ceiling
D: Pressure toward neck
E: Pressure diagonally back toward left ear
F: Pressure diagonally toward right ear
Mandibular Stabilisation Phase 2
Jaw position: teeth one knuckle widths apart
Directions
1. Relax, maintain good posture and awareness of breath
2. Place knuckle of index finger between to and bottom teeth
3. Remove it, keeping teeth separated on knuckle width apart
4. Place tongue on roof of mouth ( Clucking position)
5. Apply gentle pressure to the lower jaw as shown in photographs A-F in Mandibular stabilisation phase 1
6. Breathe in hold breath and pressure on jaw for 2 seconds
7. Repeat 5 times, 5 times per day
Mandibular Stabilisation Phase 3
Jaw position: Teeth two knuckle widths apart
Repeat as above – End goal is to do exercises above with three knuckles width apart.
Like many people the answer may be right behind you! Few of us, however can talk about this which is a shame, as it yields clues about diet, gastrointestinal health, stress, even anxiety levels. As a child I was anxious. Every morning my Mum arrived with 2 tablespoons of milk of magnesia, one tablespoon of cod liver oil and a glass of hot ribena. This was followed by a bowl of cooked prunes! No wonder I am not a “morning person!” My sister and I dreaded the questions “Have you had at least 3 poops this week, girls?” This lead to a fascination whether “the pieces” floated or how many there were! Mum always said to be a good ‘poopy monster’ you had to see a shape like a banana, not sheep pellets!
On a more serious note, one of the most common gastrointestinal complaints is chronic constipation. Daily repetitive straining leads to a weak pelvic floor. Why? The pelvic floor is a hammock of muscles that supports the intestines, the bladder and the uterus and if repeatedly strained, when trying to void sitting on a modern-day western toilet, the downward pressure stretches and weakens the Pudendal nerve, responsible for bladder control. In addition the toilet design may increase the risk of Irritable Bowel Syndrome and colon cancer.
Oncologists have observed that 80% of colon cancers occur in the caecum and the sigmoid colon, the two areas that are not fully evacuated in the sitting posture. X-rays taken to see the internal mechanics of voiding in a squat versus sitting position confirmed that food was shown to pass easier in the squat position. In other words the anal canal is kinked like a garden hose when seated on the “Throne!”
This causes fecal stagnation and probably explains why colon cancer is the second leading cause of cancer deaths in the United States. In traditional Asian and African cultures where squatting is the norm, colon cancer is virtually unknown!
To prevent constipation: Exercise daily, walking and do squats, eat more fibre, raspberries, papaya, cantaloupe, and /or apples. and drink plenty of fluid! Try to “Practice squatting daily”.
This is not new, once a week at boarding school matron decided that everyone in our dormitory had to balance on the rim of the toilet in our bare feet. Needless to say this position led to much hilarity and I fell in the bowl and spent 15 minutes out in the cold dark corridor with my nose against the wall facing a wee circle. If I moved an inch I had to stand longer. To this day if I see someone with a bulls eye tattoo, I make a beeline for it and try to stick my nose in it!
When I saw this headline the other day it made me smile: ”Police station toilets stolen, cops have nothing to go on!” …Maybe this was not a bad thing!
• Does your child look like this?
• Are you always nagging your child’s about the way he/she eats?
• Does he/she often swallow foods whole or ‘inhale’ their food?
It could be Orofacial Myofunctional Disorder (OMD) which like TMD, (Temporomandibular Disorder) is often misdiagnosed, ignored and the implications not fully understood.
Failure to nurse/latch on can be due to OMD. This is often commonly referred to as “tongue thrust” because the tongue functions against or between the front or side teeth during swallowing rather than lifting up into the palate (roof of the mouth). This disorder is generally accompanied by inappropriate function of the muscles of the tongue, lips jaw and face. There is frequently a low forward resting posture of the tongue and open lips.
The basic problem is related to abnormal orofacial function and postures. Just as controlled forces of the orthodontic appliances (braces) can move teeth, the abnormal functions and postures related to OMD can influence the development of dental malocclusion (incorrectly positioned teeth, an improper bite relationship between the teeth in the upper and lower arches, or a malformation of the bone of the dental arches). During the act of swallowing, the tongue is thrust against and /or between the teeth. This is called a tongue thrust swallow.
Myofunctional therapy can make all the difference for your child’s future because it often restores normal processes of dental eruption. It can also aid in the retention of bite/ cosmetic appearance following orthodontic treatment.
Living in Neolithic bodies, trying to adapt to a constantly changing environment, we all feel the effects physically and mentally (positively or negatively). The latter can result in any of the following: cardiovascular disease, strokes, cancer, musculoskeletal chronic pain & depression.
The glue of life for me has always been to share fun and laughter with my family and friends. 25 years ago, I came across what I call, my ‘Bible of Fun’- The Super Colossal Book of Puzzles, Tricks and Games.
I have used this book to organize parties over the years where I encourage people to participate in different team activities, after a few drinks of ‘Dutch’ courage first which is required by some more than others. Little did they realize that even though they felt anxious, their participation and letting go, having fun, research shows, and I believe, will have extended their lives!
In addition, it has given everyone a gift that keeps on giving, as stories are retold and timeless memories unite us all forever in laughter.
I believe that when we live on the edge, challenge our own comfort zone, take a risk, and adapt to change… then we grow, find our purpose and happiness in life
Making time for fun has always been a priority for my family and recently I organized a 60th birthday party for my husband.
I invited friends and family to arrive dressed in characteristics/hobbies/jobs or ages of the ‘birthday boy’. (I find that if I make people dress up in costume, they find it easier to socialize and laugh more.) To set the tone a stuffed Simon was sitting in a lawn chair waiting to greet his guests.
Everyone was divided into 8 teams of 6. A designated captain organized their team doing 10 minute activities which that night were lasso golf, putting, wine tasting and ‘You can STILL dance’, led by my Zumba instructor, Inna. To see what Zumba is all about go to www.zumbavancouver.com. Dancing is a great way to get fit, and tone up your laugh lines! Fun and music is so infectious everyone was soon jiggling and wiggling body parts they had not felt for years.
My girlfriend Ann, summed up the evening up with this rhyme:
We are back in Vancouver for some birthday fun, Yikes! Simon’s now 60 -no longer a young gun, 50 close friends, all dressed in drag, Came by for the evening wondering what’s in Cathy’s Party bag! It was tasting wine, weird games of golf and Zumba with Inna - now that was a treat! Turns out that Brock’s team A was the one to beat - So thanks for the party being 60 ain’t bad Such a good time by all, was had!
They say that before 40, your face and body is genetic after that it’s your own fault. Can I ask all of you “Do you want laughlines or faultlines?” as you age?
I ask numerous questions about birth to the present day, and I hear similar stories which are consistently linked to specific head shapes, anatomy and life events.
Viola Frymann said “Musculoskeletal strains on the newborn during delivery can cause problems throughout life. Recognizing and treating these dysfunctions in the immediate postpartum period is one of the most important phases of preventive medicine.”
Real story – This is one of the most severe examples I have encountered of how craniofacial anatomy can affect someone’s life dramatically. A young lady, age 27 walked into my office last year, having already been through open heart surgery for heart and breathing issues! I was the first person who looked inside her mouth and at her bite as part of a general history taking, and made a possible connection between her narrow palate, and her ongoing and unresolved heart problems. A “light bulb went on her head” when she suddenly understood how her symptoms might be related to this area. Her husband worked with Down’s children who among other anatomical dysfunctions have an extremely narrow palate, heart and breathing issues! She had seen over 23 specialists, and been treated by many health care professionals with a variety of approaches including surgery to solve her issues with no change in symptoms. As a result had become unable to exercise and it was a struggle to enjoy life. Prognosis given by the heart specialist was poor.
Birth history- Anatomy of the cranium – The relationship between the sphenoid, occiput and temporal bones appear consistently to be most significant in my opinion. Clinically, a patient with a narrow head, asymmetrical face/nasal area, a narrow palate and tongue dysfunction will often have chosen similar lifestyle.
Due to the narrow sinus/facial area, the airway and breathing through both nostrils equally, is compromised (unknown to the caregivers and patients often into adulthood). This can result in following history:
1. Feeding issues or colic because the stuffy nose makes nursing difficult and the mum, feeling inadequate gives up breastfeeding because the baby gets too exhausted and cranky. If the baby does persevere and nurses, they can only manage to latch on for short intervals. This can result in a very hungry, angry baby gulping down milk and air resulting in gastric issues or projectile vomit! (Current thinking is that for good jaw development and airway the baby needs to breast feed for 6 months)
2. Facial distortion at birth, colicky baby, feeding and speech problems. The worst symptoms seem to arise when the baby is subjected to a long hard labour, forceps, being a twin in the early years, OR/and a body trauma particularly, if it involves the pelvis and/or head.
3. Childhood/teenager postures- forward head posture/ head tilt & short leg. Personally, I was always told to stop “slouching” at boarding school and was made to walk around with a book on my head for half and hour as punishment! This was very difficult for me to do with my asymmetrical head shape. The teachers assumed I was being defiant when I couldn’t do it! In those days, the punishment for defiance was the ‘strap’ and I felt mystified and helpless!
4. Childhood behaviours: ADD, snoring, tongue posturing, poor sleep patterns, often labelled a “clumsy” child. Thumb and finger sucking.
5. Sports injuries to head, neck & body can contributing factor
6. Childhood issues: one sided vision problems, asymmetrical spinal curves, blocked Eustachian tube, asymmetrical wax build up, earaches which then have tubes surgically implanted.
7. Tonsil/adenoids removal, often happens
8. Sensitivities / allergies often present
9. Airway difficulties: As a child/ young adult they will intuitively pick an anaerobic sport like hockey, basket ball, volleyball, anything where the body does not have to move fast and breathe deeply for too long… “They often have exercise induced asthma.” Being unable to breathe equally through both nostrils due to narrow craniofacial features, (this can be seen on Xray and area is often operated on). Muscle overuse in the Masseter and Pterygoid muscles in my experience are more susceptible to sinusitis and adaptive posture. Body’s natural coping habits: Thumb & finger sucking, (perhaps to fix a narrow or asymmetrical palate). My oldest patient age 18 was still ‘thumb sucking’.
10. Orthodontic work to straighten or correct malocclusion
11. Stressful conditions at home and school.
Summary: The more combinations of these a child has, there is a potential to have the worst TMD issues as an adult because the body develops layers of adaptive strategies and symptoms. Birth trauma and long labours, been in a car accident, Orthodontic work to straighten or align teeth, narrow palate, dysfunctional tongue and speech issues, allergies, asymmetries in head at birth (mild and severe), body and face, snoring, eye, ear & breathing problems, early childhood & prolonged adult stress.
Here are my thoughts on how to fix the problem: A comprehensive osteopathic approach with precise, gentle, restorative manipulative therapy can help these children immeasurably. The general level of well-being, as well as neurological function, will significantly improve. Adjunct therapies, such as visual and auditory perceptual training, tutoring and a well-balanced diet of whole, natural foods, perhaps with carefully selected supplements, will then be far more effective.
Structural dysfunction resulting from birth trauma can be corrected early so that neurological development progresses satisfactorily. Then academic, behavioural and developmental problems can be averted by establishing or restoring optimal anatomic-physiologic integrity. Therapeutic measures can teach a child how to use the body efficiently. When you have your next baby, have an osteopathic physician evaluate and treat you, the mother, during pregnancy in order to reduce any possible complications during labour and then provide a though evaluation of your baby during the newborn period. This is the essence of prevention.
Resources:
1. North Shore massage therapist: Brenda Pulvermacher 604 986 9355 at www.OceanWellness.ca
3. Kamloops BC Claudia Scrivener, MSPT, Registered Physiotherapist; 250-377-7675; HANDS ON HEALTH SUITE 103 – TUDOR VILLAGE
1315 SUMMIT DR.
KAMLOOPS, B.C.
V2C 5R9
Email: handsonhealth.brian@telus.net
The following information is taken from The International Rehabilitation Medicine Association on Myofascial Pain Syndromes.
Why muscle hurt! The body has 500 muscles which makes up half of our body weight. Being the motors of the body they work with and against gravity together with the cartilage, ligaments and intervertebral discs they also serve as mechanical shock absorbers. Each one can be subjected to acute or chronic strain and develop myofascial trigger points and have own characteristic patterns of referred pain.
Definition of Trigger point (TP) A myofascial TP is defined as a “hyperirritable spot, usually within a taut band of muscle or in the muscle fascia, that is painful on compression and can give rise to characteristic patterns of referred pain and tenderness.
Incidence – A meaningful interpretation of incidence must distinguish between ACTIVE TPS that cause pain, either at rest or in relation to muscular activity and LATENT TPS. A latent TP may show all the diagnostic features of an active TP except that it causes pain only when the TP is palpated. The recognition and management of TPS is part of Physiotherapists training.
Recognition - Pain is dull, intense or aching and variable from hour to hour or day to day. Pain intensity strongly related to posture and muscular activity. Pain relates to the use of one muscle group and as such has specific referral pattern
Differential diagnosis – Referred pain of muscular origin can be confused with neurological pain or of a rheumatic/inflammatory origin which can be felt unrelated to muscular activity. Neurological pain is often associated with loss of or change in sensation and deficits that match a peripheral nerve or root distribution. Physiotherapist are trained to assess these differences.
Emotions like anxiety, anger, fear and frustration facilitates the development and perpetuation of myofascial TPS and intensifies the suffering caused by pain; psychological stress in turn is augmented by the uncertainties and limitations imposed by persistent pain, the cause of which is obscure and which can responds poorly and not quickly enough for our overwhelmed, stressed lifestyle.
Stretch and Massage the Scalenes!
The number of neck muscles, including the upper trapezius, sternomastoid, splenii and suboccipitals muscles, refer pain strongly to the head.
These muscles are frequently responsible for Tension headaches. Masticatory muscles are likely cause of head aches felt side of the head (often first thing in the morning), facial and jaw area, also earaches and toothaches.
Ever had pain referring to the front, sides and back of the shoulder regions as well as down to the index finger? The TPS in the 3 scalenes muscles can be responsible which are on either side of your neck. They also allow blood to flow into your arm and can lead to a number of problems. Ex: Thoracic Outlet Syndrome. Ever wonder why you sometimes get pain/ weakness/ numbness or tingling fingers at night in ring and pinkie fingers or wedding ring doesn’t fit in the morning? I had a patient once who thought he was having a heart attack because of Scalene TPS!
Scalene Massage
Upper Neck Exercise
Deep massage and slow mindful stretching with breathing can effectively remove symptoms…
Watch the videos on YouTube. Upper Neck Exercise and the Scalene Massage.
TMD is often misunderstood as CHVS SABERS Approach to Management
Follow the SABERS approach:
S is sleep
A is awareness of arousal level (increased cortisol levels), How emotions, exercise, excitement and posture affects breathing
B is breathing
E is exercise
R is rest
S is self esteem.
By addressing all these aspects of a patient’s life the treatment is more likely to be successful.
Sleep – Do you know that sufferers of CHVS will complain: “I have nightmares and vivid dreams, my sheets are always tangled up in legs and my sleeping patterns are awful”.
Sleep in fetal position with spine straight, teeth apart, tongue on palate, nasal breathing and employing deep abdominal respiratory patterns. Support jaw with the front of the pillow.
A warm bath before bed can help to relax the body
Resist TV flipping channels instead read a complex boring “how to” book to lull you off to sleep!
Arousal level of respiratory system- TALK TEST- if you can talk to someone while exercising, this is correct level of exercise because abdominal or lateral costal breathing can be maintained as well as nasal breathing This prevents the people from working above their anaerobic threshold which stresses the body and increase the arousal level (increased cortisol levels)
Breathing – What is good breathing? The cornerstone of this treatment is to practice deep abdominal breathing frequently. Practice TTTT… tongue on palate, teeth apart, lips together, shoulders ‘high beaming’ everyone and stand on the balls of your feet. I have a naughty jingle to remember this “Tongue, teeth, tits and toes lips together breathing slow!”
NOTE: The tongue tip should always be up on the palate even when standing and sitting. Say the letter “n” to know if your tongue is in the right place
Practice every hour on the hour to take time to breathe 10 breaths slowly. Initially putting red stickers at your computer, on mirror in the car or sign “Just breathe” These all act as a reminder to breathe properly!
If this is hard hold the breath for 2-3 seconds anywhere in breathing cycle then do alternate nostril breathing
(December’s newsletter)
How does doctor know if symptoms are caused by HVS?
50-70% patients visiting specialists are habitual over breathers. It may be difficult to pick up the problem because blood gases fluctuate in CHVS. A simple 12 breath test can be performed. The patient is asked to stand and take 12 RAPID breaths, which many sufferers are amazed to find reproduces exactly their distressing symptoms!
Have you heard people say “I thought I was dying… having a heart attack” but when I went to emergency I felt better and the doctor could find nothing wrong. In all three types of chest pain below, many stresses (physical, social and emotional) may combine with hyperventilation to bring it on. Often these stresses are not found in the security of the doctor’s rooms.
There are 3 types of chest pain associated with HVS:
Sharp pains felt while breathing in from pressure on the diaphragm from a bloated stomach, caused by “air gulping”, which results in spasm of the diaphragm and pain.
Dull aching pain with chest wall soreness, most often after exercise. This is due to overuse of intercostals, and accessory muscles, which tire easily and hurt.
Heavy pain behind the breast bone radiating to the neck and arms. This happens when the blood supply to the heart muscle itself is reduced by HVS stress/anxiety, and spasms of the coronary arteries.
Exercise – Do you find yourself saying “I can’t do yoga. It’s too slow. I feel too agitated. It’s torture to lie there and breathe!”
Hyper ventilators will often feel the urge to sigh, yawn (often seen at the beginning of a yoga /Pilates class) or ‘air gulp’. The body will try to loop back to hyperventilation.
In the book Hyperventilation Syndrome (HVS) by physiotherapist Dinah Bradley she says that, “There are 3 muscle groups used for breathing: Diaphragm, intercostals/ chest and the accessory muscles. In normal breathing 70-80% of the work of respiration is done by; the diaphragm (which is the most energy efficient and relaxing way to breathe); the intercostals which attach between each rib lifting them sideways, do 20-30% of the work and lastly the accessory muscles which include the shoulder and neck area. The body will overwork this area during extreme exercise, and STRESS. Chronic Hyper Ventilators, who tend to reverse this ratio using 80 % of effort in neck/shoulder area will as a result, feel pain in this region and can be one of the causes of headaches.”
Rest – Try to have 8 hours of sleep per night to help combat fatigue, and decrease arousal levels. Research shows this will also help control high blood pressure and improve overall health and feeling of well being.
If a patient comes into a doctor’s office with excessive daytime sleepiness, depression, and excessive fatigue! Cognitive impairment, un-refreshing sleep, frequent awakenings, and chronic pain, this could be many things. Symptoms are often treated with medication.
you suffer from the above symptoms, ask your health care professional to send you for investigations to evaluate sleep disordered breathing, and intake & absorption of Oxygen
Quick test to feel effects of poor prolonged breathing can be felt when trying to breathe through a regular/or coffee straw with tissue in both nostrils and walking up a flight of stairs. Please only try this if no previous medical condition. One starts to feel chest tightness, light headedness, unable to focus. A patient tried this. Only then did he understand that poor breathing could be affecting his heart and blood pressure as well as mind.
There are a number of conservative measures that are recommended to treat UARS, Learn from kids. They sleep more, take work seriously but selves lightly, play often and live in moment.
If you’re found to have obstructive sleep apnea, the best way to treat this condition is via what’s called a Continuous Positive Airway Pressure machine, or CPAP. This is a small device that acts as an air pump which blows some positive gentle air pressure through your nose and it stents your airway open so you don’t stop breathing at night. When used effectively, it works. You wake up feeling much more refreshed; have much more energy and all the medical problems start to get better. One of the problems with CPAP, however, is that people just don’t like to use it, but with good counselling and proper follow-up from clinic staff and the equipment people that administer the device, many people can do well with this device.
First, take this test and notice how your body reacts to stress.
ANATOMY: The name is derived from the two bones which form the 
divides the joint into two cavities, each of which is furnished with a 
Joint mobilization
The Ladies sat in the gardens of the hotel underneath palm trees and sunny skies. The tables were decorated in multicoloured fabric held together with fresh flowers and the centrepiece was a multicoloured dotted teapot. Color coded daisies arranged on a vertical oasis came out of its centre. We all wore straw hats decorated with flowers, boas, and gloves and nibbled on sandwiches shaped like card deck suits. As they sipped on champagne and orange juice, they listened to my stories, I had them tell stories using something I learned at Improv classes, then they joined me dance away our worries to Salsa music. 
Mandibular Stabilisation Phase 3 
On a more serious note, one of the most common gastrointestinal complaints is chronic constipation. Daily repetitive straining leads to a weak pelvic floor. Why? The pelvic floor is a hammock of muscles that supports the intestines, the bladder and the uterus and if repeatedly strained, when trying to void sitting on a modern-day western toilet, the downward pressure stretches and weakens the Pudendal nerve, responsible for bladder control. In addition the toilet design may increase the risk of Irritable Bowel Syndrome and colon cancer.
retold and timeless memories unite us all forever in laughter.
Birth history- Anatomy of the cranium – The relationship between the sphenoid, occiput and temporal bones appear consistently to be most significant in my opinion. Clinically, a patient with a narrow head, asymmetrical face/nasal area, a narrow palate and tongue dysfunction will often have chosen similar lifestyle.
Why muscle hurt! The body has 500 muscles which makes up half of our body weight. Being the motors of the body they work with and against gravity together with the cartilage, ligaments and intervertebral discs they also serve as mechanical shock absorbers. Each one can be subjected to acute or chronic strain and develop myofascial trigger points and have own characteristic patterns of referred pain.
