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Q & A: How to Choose the Right Pillow

Q.  How in the world do you find the right pillow?  I have tried so many, and none of them are comfortable.  They are all hurting my neck!  Could you please share some tips on what I should be looking for in a pillow?  Thanks!  -Aimey

A.  Great question, Aimey!  Finding the right pillow is arguably just as difficult as finding the right bed.  Neither process tends to be easy.  A poorly fitted pillow can be a big problem as it can often lead to many potential issues such as neck pain, headaches, and poor sleep.  Ideally, you will find a pillow that works best for your needs.

A properly fitted pillow can help address the following issues:

So how do you actually choose the right pillow?  Follow this 5-step process to narrow down the choices in order choose a comfortable pillow that best fits your preferences.

Step One

The first step to choosing the right pillow is to determine your preferred sleeping position.  Are you a side sleeper, back sleeper or stomach sleeper?  This doesn’t mean that you don’t move around.  Determine what position you spend the majority of your time in when sleeping in bed.

Step Two

Once you have determined which position you sleep in the most, choose the general shape and thickness of the pillow. This is important because you want the pillow to support your neck and head.  We are all different shapes and sizes.  Depending on the shape and anatomy of your upper back, neck, and head, the pillow shape and size vary.

As a rule of thumb, a person who sleeps on his/her side will need a slightly thicker pillow.  This is also true if a person has a larger kyphosis of the thoracic spine–meaning that the shoulders are more rounded, and the upper back has also started rounding.  This causes the head to move forward so that the head, neck, and shoulders are not in a neutral position.  In this case, you will also need a thicker pillow.

Thicker pillows that prop your head up more can also be helpful in reducing snoring and even acid reflux.  For acid reflux, it may be more beneficial to slightly tilt the entire bed up 5-10 degrees so that your head is higher than your feet.  A thicker pillow may also be helpful to prop your head up if you are suffering from a head cold as you may breathe a little better if your nose is stuffy.

In general, you want a pillow that allows for the proper positioning for the neck so that your neck and head remain in the most neutral position possible.  The pillow should assist your neck in keeping its natural curvature.  This is critical for anyone suffering from neck pain and tension type headaches.

Side sleepers need a little more thickness to insure that your head is supported in a neutral position while back sleepers will want a thinner pillow.  Depending on your neck, you may actually want a small cushion or roll used right along the neck to give extra support.

Step Three

Choose the shape of the pillow.  There are many different kinds and shapes of pillows.  There is the traditional shaped pillow.  Nowadays, you can find a pillow in almost every shape.  The idea is to find the shape that accommodates your personal sleeping style.

For me, I have a pillow that is shaped as a rectangle but the sides are thicker than the middle.  The two different width neck rolls on top and bottom provide a custom fit for my neck.  It’s like having a flat pillow when I sleep on my back, yet support when I sleep on my side.  This particular design allows my neck to stay in a neutral position whether I am on my back or side sleeping.

Step Four

Choose your filling.  There are many different types of fillings available.  Each one is designed to address a certain need regarding shape and comfort as well as for personal preferences or medical necessity.  The type of filling is also important to consider when you are deciding if you want a firmer or softer pillow.  This is mostly preference as long as you stick to the rule that on average you want your head and neck to remain in a neutral position.  However, if you have a larger thoracic kyphosis or other medical reason you may need your head more propped up.

Types of fillings include but aren’t limited to:

  • Down or feather pillows made from the inner plumage of geese or ducks
  • Wool
  • Cotton
  • Latex
  • Memory foam

If you experience any allergy related issues, first consider the pillow’s filling or fabric to make the appropriate choice for you.

Step Five

In this final step, you have determined your typical sleeping position, which allowed you to choose the proper style, shape, and fit for your head and neck.  You want to keep your head and neck in a neutral position if possible.  You have decided on the type of filling and basic firmness level.  Now it’s time to trial different pillows to determine your personal preference and to actually find a brand/style that most directly fits and accommodates for all of your needs.

It’s always best to actually lay down and trial a pillow before buying it.  Lay with the pillow as if you are actually going to sleep.  Place it and yourself in your typical sleeping position.  Does it address all of your needs?  Is it comfortable?

If you can’t lay down with it, then even finding a wall to mimic lying down may be beneficial.

Typically, you will need to sleep with a new pillow for several nights before determining whether or not the pillow will work out.  If you wake up with neck pain, headaches or have any other breathing or sleeping difficulties associated with the pillow, then throw that pillow on the guest bed and try the 5-step process again.

Thanks for the question, Aimey!  Finding the right pillow that fits your particular body shape and needs can be a challenge.  When you find the right one, you will be rewarded with restful and rejuvenating sleep which will be well worth it.

Do you have any tips or tricks to share when choosing the right pillow?  Please leave your comments below. 

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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BeastNet Podcast Recap: Ben and Ted

In this podcast interview with Mike James (host of the BeastNet Podcast) and Ted Kielley (friend and Physical Therapy client), we discuss injury rehabilitation and what you need to do practically and mindset-wise to get back to obstacle course racing events (like the Spartan).  We also discuss the importance of teaming up with medical providers who actually understand your specific sport or lifestyle and how to find medical providers that can help you along the way.  Finally, we discuss best practices in preventing injury as a person ages to insure longevity as an Obstacle Course Race (OCR) athlete and how to age well in general.  Listen to the podcast

Disclaimer:  This blog post and podcast are not meant to replace the advice of your doctor/health care provider, or speak to the condition of one particular person but rather give general advice.

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Does Kinesiological Tape Really Work?

I was first introduced to Kinesiological (Kinesio) style taping during a continuing education class in 2005.  Since then, this style of taping has exploded in the mainstream with athletes and celebrities alike wearing it.  Research on this modality was initially scant.  Today there are over 540 published studies with even more antidotal testimony!  Although the research is ongoing and published regularly, I get asked all the time about what can you use Kinesiological tape for and how exactly it works.  I will review three theories on how Kinesiological tape actually works and the different reasons for using it.

Kinesiological Taping For Achilles Tendinitis

How does Kinesiological Tape Work?

  • Sensory Theory (also known as the Gate Control Theory) – The basic premise of this theory is that the Kinesiological tape, when applied to the skin, activates sensory receptors present on the skin. These receptors relay information to/from the brain.  Since the sensory receptors are faster than other types of receptors (such as pain) the brain reacts to the sensory information first.  This can lead to altered movement patterns and awareness to the area.  It can also allow for decreased sensations of pain.  This theory is similar as to why we think topical analgesics (such as Biofreeze) work as well as why transcutaneous electrical nerve stimulation (TENS units) can reduce pain.
  • Circulatory Theory – The basic premise of this theory is that the when the Kinesiological tape is applied with little tension it forms convolutions in the skin. These convolutions create channels and reduce pressure within the tissues, lymph system, and circulatory system which aids in blood and lymphatic flow.
  • Muscle Activation Theory – The premise of this theory is that when the Kinesiological tape is applied at different levels of tension on the skin over the muscles and tissues, the Kinesiological tape can either mechanically or neurological increase or decrease muscle activation via a nervous system response.

Presently the truth behind Kinesiological taping is that we really don’t know exactly how or why it works.  Based on my clinical experience, I believe that the Kinesiological tape interacts with the body’s tissues in different ways depending on how and where the Kinesiological tape is applied.  Depending on how the Kinesiological tape is utilized, any one or combination of the three theories is likely correct.

Research states that Kinesiological style taping is at least as effective as other minimal interventions for musculoskeletal pain which may include topical analgesics like Arnica montana (Arnica Rub) or Biofreeze.

Research has also shown that taping can reduce pain acutely within first week of injury and possibly even in cases of pain which has been present for as long as three to four weeks (or longer).

Research concludes that there are some improvements in muscle and joint range of motion (ROM) and a reduction of pain.  However, because the improvement isn’t significant or long standing it shouldn’t be used as a standalone intervention.  Kinesiological taping is best used in combination with other interventions (such as manual therapy based techniques and exercise) which have been proven to affect outcomes over the long-term.

When Kinesiological tape is used in conjunction with other treatments, it may help speed up the recovery as the Kinesiological tape can allow for other techniques to be utilized more effectively due to the loss of pain, swelling or easing of movements.

Although there have been hundreds of research studies performed, the effectiveness of Kinesiological tape is still questioned primarily due to issues with research design.  Many of the taping applications are based on theory and not science.  Since there isn’t a consistent application pattern, the research studies aren’t comparing the same techniques over large enough patient populations to show a true effect.  In addition, researchers still need to quantify how much tension is actually being used and the actual Kinesiological taping technique being used versus other types of techniques or interventions.

Unfortunately, without better quality research it’s unclear if the results shown in many of the studies are due to an actual effect or through placebo.  For now, none of the studies show significant benefits regarding long-term pain alleviation or improved strength or range of motion (ROM).  So for now, the main conclusion is that Kinesiological taping should be used only as a short-term treatment in combination with other treatments.  I personally use Kinesiological tape, and I often find that my clients experience success with specific tape applications for different conditions.

What do you use Kinesiological Tape for?

  • Reduce pain
  • Reduce swelling and edema
  • Support muscles and joints
  • Reduce muscle tension
  • Increase strength
  • Improve performance
  • Enhance or correct movement patterns through stimulation of sensory receptors
  • Provide compression
  • Enhance healing by slightly lifting skin away from sore or injured tissues to improve blood flow and lymphatic drainage
  • Support injured joints and muscles without impeding range of motion (ROM)

There are dozens of companies’ now manufacturing Kinesiological style tape.  There are many high quality tapes being manufactured with all kinds of colors, designs, and variations in adhesive quality and elasticity.  Personally, my favorite brands are based on price point and actual use.  This includes ease of application and how long the Kinesiological tape actual stays on.  The brands I use most include:  Kinesio Tape, RockTape, Thera-Band Kinesiology tape, Spider tape, and KT TAPE.  Although there are many more brands available, I have not personally used them.

There are many different applications Kinesiological taping can be used for.  Like any treatment modality, it can work wonders for one person and do nothing for another, but should we really be surprised?  Many of our most popular pharmaceuticals are no different.  Kinesiological taping has the benefit of rarely having significant side effects.  There are rarely side effects to utilizing this style of tape as the products utilized tend to be very hypoallergenic.  Occasional skin irritation has been the only noted side effect I have known of in my clinical experience.  In order to avoid skin related issues (including application and removal tips), please refer to Skin Care with Taping.

I have found success with utilizing Kinesiological taping as an adjunct treatment strategy and as part of a complete treatment approach.  If you are interested in specific applications for different conditions, please see the following in which I demonstrate different taping techniques.

Step-by-step guides:

Kinesiological Taping for Osgood-Schlatter Disease

Kinesiological Taping for Patellar Femoral Pain Syndrome

Kinesiological Taping for Shin Splints

Video:

How to Apply Kinesiological Tape When Treating Achilles Tendinitis

Books with step-by-step guides specific for ankle sprains and low back pain:

The Physical Therapy Advisor’s Guide to Treating Ankle Sprains and Strains

The Physical Therapy Advisor’s Guide to Treating Low Back Pain During Activity and Exercise

Have you tried using Kinesiological taping before?  If so, what was your experience like, and did it help you?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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How to Prevent and Treat Osteoporosis

There are many best practice guidelines for treatment of osteoporosis.  In many ways the treatment is quite straight forward and taking steps to prevent it is critical for health aging.  The sooner one starts the process, the better!  Regardless of age or severity of the condition, it’s never too late to start.  In most cases of osteoporosis, bone loss tends to be gradual.  Bone density tends to peak in a person’s mid-twenties and worsens as a person ages.  Statics conclude that in individuals over 50, one in two women and one in eight men will have an osteoporosis related fracture within their lifetime.

Osteopenia and osteoporosis can occur for many different reasons, but the most common reasons include:

  • Females are more likely to experience bone loss.
  • Certain ethnic groups.  White Anglo-Saxons are more likely to develop these conditions.
  • Prior family history.
  • Medication side effects.
  • Lack of proper nutrition, including vitamin deficits such as low Vitamin D3 levels.
  • Hormonal dysregulation.
  • Lack of weight bearing exercise.
  • Being bed bound.  Studies conclude that completely immobilized bones can lose up to 15% of mineral density within three months.
  • Lack of resistance exercise.
  • Certain genetic disorders.

Prevention and Treatment Strategies for Osteopenia and Osteoporosis:

Start Early 

As we age, our bones will normally start losing some bone density and flexibility.  (They become more rigid.)  It’s important to work on optimizing bone density early in life.  Bone density is best developed under 30 years of age, but it can be improved or at least slowed down at any age.

There are also studies that indicate pregnancy may also help to improve bone density.  This assumes a healthy diet with adequate calcium levels is consumed during the pregnancy and while breastfeeding. 

Weight Training

Weight training (particularly barbell training) loads the skeleton progressively over time, which can decrease bone loss and increase bone mineral density.  It also positively affects hormones, such as human growth hormone (HGH) and testosterone, needed to improve bone density and muscle strength.  Barbell training is the most effective method due to the progressive load on the skeletal system, and the muscle pull being exerted on the bone, which also stimulates bone formation.

Resistance training (other than through barbell training) can also be beneficial.  You can resistance train by utilizing strong elastic bands and cords or even machine weights.  This allows variations of pushing or pulling exercises that exert a force on the muscle, which stimulates muscle and bone development as well as optimizes vital hormone function.  Depending on the type of exercise, the resistance bands can mimic skeletal loading.

The key to maintaining and improving bone density is always axial skeletal loading and the associated pull of muscles against the bone during activity (particularly, strenuous activity).  Examples of such exercises include squats, lunges, and dead lifts.

Weight Bearing Activities

This refers to any activity, such as walking, jogging, hiking, climbing stairs, and dancing performed against gravity.  Biking and swimming are examples of exercises that are not weight bearing and therefore, they are not as beneficial for bone development.

Vitamin D3

Vitamin D3 is critical to the absorption of calcium, through the intestinal wall, which is important for bone health.  Although calcium is a critical component of bone health, I cannot recommend extra supplementation because of the potential cardiac risks to over supplementation.  A healthy varied diet will typically supply adequate calcium levels (assuming that adequate magnesium and Vitamin D3 levels are present for absorption and that you are avoiding drinking soda).  Vitamin D3 is also a critical nutrient in maintaining a healthy immune system.

Increase Your Intake of Vitamin K1 and K2

Research indicates that Vitamin K can help to reduce bone loss by helping the body regulate osteoclast function within the bone.  An osteoclast is a type of bone cell that breaks down bone tissue.  These very important cells are integral in maintaining proper bone density and insuring an appropriate amount of calcium in the blood stream.  Without adequate calcium, many critical cell functions can be affected, including heart function.  Both Vitamin K1 and K2 have been proven to reduce the risk of fractures, including hip and vertebral.

Vitamin K, found in green leafy vegetables, has anti-coagulation benefits.  If you take blood thinning medications, your physician will need to know how much you consume on a regular basis so your medication can be properly dosed.

Avoid Soda

Excessive soda intake (particularly diet soda) has been linked to poor bone density.  The exact cause isn’t entirely clear.  Many theorize that the acidic nature of the soda along with the chemicals and additives cause increased osteoclast activity in the bones.  This releases more calcium into the blood stream in order to help fight the negative effects of soda consumption.  It is clear that too much soda is bad for your health and bones.

Magnesium

Magnesium is a critical component of bone health and health in general.  Magnesium helps the body to regulate calcium levels.  This has a positive effect on bone health and also has been proven to reduce the risk of kidney stones.  Many also use magnesium as a sleep and recovery aid.  When consumed at night it can be beneficial for improved sleep.  Magnesium can also reduce muscle soreness, cramps, and/or spasms.  You can take Mag Glycinate in pill form or by eating foods higher in magnesium such as spinach, artichokes, and dates.

Most people are deficient in the amount of magnesium they consume on a regular basis.  It is often recommended to start supplementation with a beginning dose of 200 mg (before bedtime) and increasing the dose in 100 mg intervals as needed.  I would caution you that taking too much magnesium can lead to diarrhea.  Mag Glycinate in its oral form is the most highly absorbable.

Stop Smoking

If you smoke, please stop.  It not only affects your bone density, but it has negative effects on every other body system.  It also increases your risk of cancer and heart disease.

Eat Healthy

Do not eat anything that comes in a package.  A diet with proper vitamins and minerals is not only imperative to preventing osteoporosis, but it is the key to preventing most disease and illness.  Most of our food should be from low sugar fruits and vegetables as well as protein and healthy fats (primarily from plant sources such as avocados and coconut or olive oil).  Any animal fat should be from organic and grass fed animals.  Your body tissue needs nutrients to be able to perform at a high level.

Avoid processed food as much as possible.  Limit sugary food and add more protein and healthy fat in your diet.  Maintaining a diet with adequate healthy fats is essential in providing the nutrients to support all hormone function in the body as well as support the brain and nervous system.  Adequate protein intake is necessary to support muscle health and development.  A healthy diet equates to healthy bones.

In order to prevent or alleviate osteoporosis and osteopenia, implement weight bearing exercise and resistance training; a lifestyle free of smoking and alcohol; and regular bone density screenings.  Maintain a balanced diet rich in calcium, Vitamin D3, Vitamin K, and magnesium.  It’s never too late to implement these strategies as you maintain a healthy lifestyle.  For additional information, please refer to Q & A: How to Self-Treat Osteopenia and Q & A: Which Type of Imaging to Use.

Which strategies can you implement in order to prevent and self-treat osteopenia and/or osteoporosis?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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7 Tips to Quickly become Heat Acclimated for Your Race

Running and exercising in warmer weather tends to be more taxing on your body and requires more energy to remain cool.

Most running experts suggest performance impairments of between 1.6% and 3% in marathon times for every 10 degrees above 55 degrees Fahrenheit.  The exact ideal temperature (approximately 45-55 degrees Fahrenheit) is debatable and based also on humidity.

When you’re not acclimatized to running in heat, it takes even more effort to keep your running pace.  This increases your risk of muscle cramping, bonking (hitting the wall), and/or being unable to maintain your goal pace (which leads to a longer finishing time).  Continue Reading

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Q & A: Thoracic Spinous Process Fracture

Q.  I have been diagnosed with a T-6 spinous process fracture.  I have been prescribed a thoracolumbar brace for 12 weeks.  If it takes away the pain, I’m willing to try it.  What do you think generally of braces?  I like swimming, walking, Pilates, and yoga.  All of that is out right now except the walking.  I have osteoporosis and compression fractures at T-6/7 and T-11/12.  I would love your insight on healing time or ability to get back to the activities I love.  I was encouraged to read the Q & A on the teenager who had the C-7 spinous process fracture, but my story is quite a bit different.  Thank you!  -Mary 

(Please note that the original question was much more detailed and personal, so it was truncated.  The name has been changed for privacy.)

A.  Thanks for the great question!  For general discussion purposes, I will address the following topics:  bracing; healing and recovery times; osteoporosis; and treatment.

Bracing

Lumbar and thoracic braces can be appropriate and necessary tools for the right circumstances.  Corset style braces and/or more rigid style bracing are typically prescribed for either of the following two reasons:  to stabilize an injury site that the physician is concerned that movement may compromise healing or safety or to stabilize an area in the hope of reducing pain.  In this particular case, a brace was likely prescribed for both reasons.

There are many potential down sides to wearing a brace.  It can be uncomfortable and inconvenient to wear.  More concerning, bracing can lead to over dependence and the loss of important muscle stabilization strength.  This is why an appropriate exercise program should be maintained while wearing the brace.  Once you’re cleared to wean from the brace and taper back into normal activities, you can progress into a more targeted and comprehensive exercise plan.

Healing and Recovery Times

Whether or not a spinous process will heal depends on the severity of the fracture.  Is it a small fracture with the bones still attached (basically a crack) or was the spinous process separated from the vertebrae?  If the two pieces were separated, then it is likely they will not heal back like a normal fracture.  The bone will not re-attach itself back to vertebrae.  When this occurs, it’s known as a non-union.  Scar tissue and fascia will surround the injury site and in most cases, form a solid fibrous pseudo-union between the two pieces of bone.

In most cases, there aren’t any deleterious effects from the injury and healing process.  Like bone healing, this process typically takes 6 to 8 weeks for most individuals.  It can take longer based on other factors:  age; nutritional status; smoking; and other conditions such as osteoporosis or diabetes.  Even certain medications, such as NSAIDs, may impede bone healing.  Speak to your physician and pharmacist about any and all medications and supplements you are taking.

(In Mary’s particular case, there may be other compounding factors or the fractures were quite severe since the expected time frame for healing is 12 weeks.)

Compression fractures will likely take about the same amount of time to heal.  If the bone is slightly collapsed, it will not recover its previous shape.  It will remain slightly more wedge shaped.

Osteoporosis

Although bracing is often a necessary part of the recovery, it will likely weaken the surrounding musculature.  A strong core and adequate stability of the muscle around the trunk are important components to one’s recovery as well as prevention for ongoing issues (particularly in cases of compression fractures).

Be proactive in dealing with your osteoporosis.  Otherwise, you will likely continue to experience fractures and other issues.  There are medications that can help, but they all have significant potential risks.

Proper nutrition and weight training are components to managing osteoporosis.  Please refer to Why Astronauts Resistance Train and So Should You.

In addition, I recommend Sara Meeks’ book, Walk Tall! An Exercise Program for the Prevention & Treatment of Back Pain, Osteoporosis and the Postural Changes of Aging.

Treatment

Nutrition is very important for healing.  Consult with a functional medicine practitioner to dial in your nutrition and address any potential nutrient deficits or nutrient absorption issues.  Also, refer to Why You Won’t Heal – Poor Nutrition.

I recommend starting with a walking program that includes a gradual taper up to at least 3 miles per day.  Once you’re medically cleared to exercise again, find a physical therapist (PT) that specializes in osteoporosis management.  The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area.

A PT can help you initiate a comprehensive core stabilization program along with weight training.  In many cases, a core stabilization program can be initiated around the 6 to 8 week mark, but it depends on when your physician clears you to return to exercise other than walking.

Prior to initiating a full strength training routine, begin by initially focusing on your back extension strength (which will address the spinous process fractures as well as the compression fractures).  Any rehabilitation program should be slow and steady.  Start well before the 12 week period unless there are medical contraindications for doing so based on your particular situation.

Healing times vary tremendously.  It’s based on the severity of the injuries and your individual health status.  With poor bone health or other co-morbidities, it could be prolonged.  Full healing may take 4 months or so.

With these types of injuries, pain is always highly variable.  It can vary from a couple of weeks to 4-6 months.  Pain will typically slowly decline as the healing process progresses.  The early inflammatory process that was initiated after the injury will progress through an acute to more subacute phase.  Wearing the brace usually helps with early pain management.

Thankfully, this type of injury usually results in a full return to function without many long-term deleterious effects.  The key is to allow adequate healing time, and then slowly and strategically progress back into full activity.

Have you ever suffered from a thoracic spinous process fracture?  Please share your story below. 

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

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What to do about TMJ Pain

Pain in your jaw or side of your head is often associated with temporomandibular joint syndrome which is also known as TMJ pain.  It’s often referred to as TMJD or temporomandibular joint disorder.  The causes of TMJ pain can be highly variable and are often multifactorial.  Pain can be mild to very severe.  Learn how to recognize the symptoms of TMJ pain and how to determine the possible cause so that you can implement simple treatment techniques.

Symptoms can include:

  • Pain in your jaw near the ear
  • Clicking or locking of the jaw
  • Pain can be on one side or both
  • Pain in the ear, face or neck
  • Pain while chewing (particularly, more difficult to chew food such as meat or raw vegetables like celery)
  • Headache pain

Potential Causes and/or Risk Factors for TMJ Pain:

  • Direct trauma, where the jaw was directly injured
  • Grinding your teeth
  • TMJ can develop rather quickly if there are other precipitating factors.  For example, if you were to eat a series of meals that required excessive and difficult chewing.
  • Over extending the jaw
  • Hypermobility (in the jaw or in general) which allows for excessive movement in the temporomandibular joint
  • Postural dysfunction (poor posture)
  • Muscle spasms within the muscles of mastication or the chewing muscles
  • Cervical mal-alignments
  • Rheumatoid arthritis
  • Osteoarthritis
  • Certain connective tissue diseases

Although TMJ is diagnosed in both men and women, it appears to be more prevalent in women.  This may be due to gender differences as women tend to have more laxity and movement in joints than men.  It may be due to a combination of other anatomical and genetic differences.

Treatment for TMJ Pain

In most cases, a combination of interventions from your dentist and from a physical therapist (PT) is the best approach.  The most important aspect of treatment is to determine which factors lead to the pain originally.  Was there one direct causative factor, such as trauma, or is the pain associated with multiple risk factors?  Due to the multifactorial nature of TMJ, often multiple treatment interventions are needed.

It’s important to have a thorough dental examination to determine if there are any specific tooth or jaw alignment issues.  The dentist can also take an X-ray of the jaw to help confirm that the diagnosis of TMJ is in fact orthopaedic in nature and not related to something more serious (such as an infection or abscessed tooth).  If grinding or clinching your teeth at night is associated with the pain, then the dentist can make a night splint.

From a physical therapy standpoint, it’s important to not only to address the TMJ joint, but also the head, neck, and spine.  Any muscle pain or dysfunction issue can be treated with massage and soft tissue mobilization.  The treatment may be intraorally to gain access to some of the deep muscle of mastication or may include addressing muscles on the outside of the head, neck, and face.  Proper cervical vertebral movement will also be checked and any cervical dysfunction should be addressed.

General treatment strategies for TMJ pain include:

  • Night splints.
  • Use of NSAIDs, such as Ibuprofen, to address pain and inflammation.
  • Ice to address pain and inflammation of the joint.  I recommend icing no more than 3-5 minutes at a time because the joint is small and superficial.
  • Massage.  Many trigger points and muscle spasms will refer pain into the head and/or jaw.  Since the likely areas of dysfunction are either cervical or intraoral, it’s best to contact a physical therapist or bodyworker that is specifically trained to treat this condition.  Massage techniques range from a light relaxing massage to a deep tissue massage or utilization of acupressure points.
  • Exercise.  A primary treatment modality and prevention technique is exercise.  This can be broken down into two primary areas: jaw mobility and cervical dysfunction. 
    • Specific exercises to address jaw mobility:  In this exercise, you will hold your tongue at the roof of your mouth and slowly open your jaw.  Only open as far as you can while keeping the tongue at the roof of the mouth and stopping before any clicking or grinding.  It’s best to perform this exercise while looking in a mirror to insure symmetry of your mouth when opening and closing it.
    • Specific exercises to address cervical dysfunction (if present):  Often TMJ pain is associated with a cervical related issue.  I often have my clients perform this cervical retraction exercise.  Sit up straight, and retract your chin straight back with your mouth lightly closed with your tongue resting on the top of your mouth.  Repeat 10-20 times.

  • Focus on your posture.  Poor posture is a bane of modern society.  The most common example of poor posture is a forward head with rounded shoulders.  This causes excessive muscular tension throughout the cervical spine, upper trapezius region, and mid-thoracic area which will directly affect the positioning of the jaw.  Proper posture allows for the optimal alignment of your spine, head, and jaw.  This is particularly important when eating.  Poor posture is almost always associated with muscle knots and trigger points.  Subscribe to my e-mail list to gain immediate access to my FREE resources including My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain.  It’s a downloadable .pdf file with my recommended stretches and exercises to address posture.  These simple exercises (with complete instructions and photos) will help you to improve poor posture and can be performed at home.
  • Acupuncture.  I am personally a big fan of acupuncture.  It’s very useful in treating all kinds of medical conditions.  It can be particularly effective in treating headaches, TMJ pain from muscle trigger points, muscle cramps, spasms, and pain as it addresses the issues on multiple layers.  Acupuncture directly stimulates the muscle by affecting the nervous system response to the muscle while producing a general sense of well-being and relaxation.
  • Relaxation.  TMJ associated pain is often a condition associated with individuals with a high amount of emotional stress.  This is likely due to associated jaw clinching.  It’s important to address the underlying emotional stress that maybe contributing to the condition.  This may include counseling, deep breathing techniques or performing my recommended stretches and exercises for neck and shoulder pain to generally help alleviate tension.  The importance of addressing any and all contributing factors (including any psychological factors or emotional stress) cannot be overstated.
  • Speak with your Physical Therapist, Physician, and/or Dentist.  If you are suffering with TMJ pain, there are options.  Please speak to your medical provider to determine if other causes are contributing to the problem.  In severe cases, there are a myriad of surgical procedures that can be attempted to address the issue.  The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area.  In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to hear your dentist and/or physician’s opinion as well).

Although TMJ pain can be difficult to manage, don’t give up hope!  Most TMJ pain can be cured or effectively managed with proper care and by addressing the likely causative factors.  Begin by implementing one or two of these treatment tips, and then assess how well they worked for you.  If the technique helped, continue with it and then implement another strategy.

Have you ever experienced TMJ pain?  If so, which treatments strategies have worked the best for you?  Please share below. 

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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How YOU Can Benefit from Physical Therapy

I can’t tell you how many times someone will ask me what I do for a living, and upon hearing that I am a physical therapist, he or she will immediately divulge his/her complex personal medical history about a health issue or describe some past experience with a physical therapist (PT).  The stories are usually exceedingly positive or as one may expect, very negative and unfortunate.  This in no way upsets me to hear about one’s personal experiences or medical history.  However, it is concerning that so many people live with chronic aches and pains and (apparently) aren’t able to resolve the problem.  I can’t promise that physical therapy is the panacea of all cures for what ails you, but I have seen it work miracles in people’s lives.  The most amazing thing is the diversity of people I have had the privilege to interact with and help!

Often the answer or treatment plan for a person’s particular issue is not what is expected.  For example, a common complaint is shoulder pain.  Many people struggle to lift overhead properly and often have shoulder pain.  This pain is typically from what is known as shoulder impingement syndrome leading to tendonitis of the rotator cuff.

There are many “standard” treatments for this ailment depending on the medical practitioner you ask.  For example, a physician is likely to offer pain medications (and possibly an anti-inflammatory medication); advice on icing and taking it easy; and if particularly progressive, a physician may even provide a hand out regarding elastic band exercises.  Some physical therapists would likely offer similar advice, such as icing and elastic band exercises to strengthen a muscle group known as the rotator cuff muscles.  (The rotator cuff is a group of four muscles that are important in the movement and stability of the shoulder.)

Time and time again, after a thorough examination of the client, I understand why the shoulder is hurting.  The person has no thoracic mobility likely due from: years of poor posture; office work; washing dishes; taking care of children; or sitting watching TV for hours.  Maybe these activities have led to a very rigid and immobile thoracic spine.

Poor thoracic mobility is a big deal when it comes to shoulder mobility.  The shoulder joint is made up of the scapula (shoulder blade) and humerus (the arm bone to the elbow).  The shoulder blade and the thoracic spine also make a type of joint.  If the thoracic spine is stiff, the shoulder blade is unable to rotate correctly–affecting the way the ball of the humerus spins in the socket of the shoulder blade.  This leads to impingement of the rotator cuff and biceps tendon which causes pain.  If you don’t treat the lack of thoracic mobility, it will be very difficult to ever resolve the shoulder pain.

This real and all too common example of why a person develops shoulder pain is to illustrate why seeing a physical therapist is so valuable.  How would a person know the real cause of the shoulder pain if he or she didn’t ask a physical therapist?  The answer is that he or she wouldn’t know.  Unfortunately, he or she would likely go round and round from one treatment to the next without fully recovering or understanding the real reason why the pain developed in the first place.

Worse yet, as the shoulder pain worsens so does one’s ability to function and his/her quality of life.  In an older adult, this so often begins a downward spiral away from healthy aging and toward an abnormal aging process.  This same example is seen in many of the most common orthopaedic complaints from foot and ankle pain to knee or low back pain.

The dichotomy of the human body is that it is very simple and fragile, yet a complex and robust machine!  The body is truly remarkable and full of surprises.  Many of the most common aches and pains a person may have can be described in a similar scenario like mentioned above.

Physical therapy can help!  Some issues are not so black and white.  Many issues are like peeling an onion with many layers to the problem.  I believe it is crucial to have a physical therapist on your team to help you live a long, happy life performing the activities that you want for as long as you want!

Age is relative, and movement is the key to healthy living.  The goal for health aging is to improve health span, which means the length of time that a person is healthy and thriving in his or her life and not just alive.  Physical therapy can help with healthy aging by improving health span and assisting in a more successful aging process.  We are all capable of successfully aging if we are intentional about the process. 

Physical therapists can help you improve, restore or maintain your ability to move and function in your daily life.  As a physical therapist, I help people participate in life, whatever that may be for each individual.  To learn more about physical therapists, visit the American Physical Therapy Association (APTA).

How Can Physical Therapy Benefit You?

  • Assist in recovery from a surgery (assisting in complete recovery and integration back into daily life or sport)
  • Assist in recovery from a stroke or heart attack
  • Assist in improving strength or endurance after an illness or prolonged inactivity
  • Assist in improving balance and walking ability to prevent falls
  • Maintain independence
  • Pain management including low back pain, shoulder pain, hip or knee pain and/or arthritis pain
  • Improve athletic performance by optimizing movement patterns
  • Health and injury prevention in sport and in life (work or play)

Physical therapists can help guide you through any array of recovery or rehabilitation: return to work, sport, running, and CrossFit.  Whatever your desired activity may be, a physical therapist can help you get moving and “living” again!  Fundamentally, movement is life!

If you’re interested in learning more about how physical therapy can help you to age successfully and improve your health span, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!

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How to Avoid Overtraining as a Long Distance Runner

http://marathontrainingacademy.com/how-to-avoid-overtraining-as-a-long-distance-runner

Marathon Training Academy

May 30, 2018

In this podcast interview with Angie Spencer (RN and Certified Running Coach) and Trevor Spencer (co-host of the Marathon Training Academy Podcast), we discuss Overtraining Syndrome (OTS) and how it differs from an overuse injury, the top mistakes we see runners make in regards to training and recovery, and answer questions from runners.

In this episode, we speak with Dr. Ben Shatto about overtraining, which is a leading cause of injury and burnout in long distance runners.  Listen to the podcast

Disclaimer:  This blog post and podcast are not meant to replace the advice of your doctor/health care provider, or speak to the condition of one particular person but rather give general advice.

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Why You need an annual Physical Therapy (PT) Evaluation

As we age, most of us hope to experience a lifestyle that is fun, rewarding, and meaningful.  Maintaining mobility and independence are fundamental components to aging well.  Unfortunately, too many older adults in the United States experience chronic disease, illness, and debility.  Some of the most common chronic illnesses facing older adults (such as heart disease, diabetes, obesity, pulmonary diseases, and neurological disorders) are sadly considered a normal part of the aging process, when in fact they are not.

Although chronic disease, illness, and debility are common in today’s society, it’s not part of a normal aging process.  The normal aging process should allow you to maintain your most basic mobility and independence until the end of life.  To insure this happens, it’s critical to be proactive about the aging process.

Physical therapy can be an important and integral component to aging well.  As a physical therapist (PT), I’m a strong advocate for all older adults to see a physical therapist at least one time per year for a movement and functional screening examination.  This is an opportunity to develop an exercise and training prescription to address any new physical issues or impairments that are starting to occur.  A PT can help to establish a preventative training program that allows you to identify any areas of concern (such as decreasing balance, accelerated loss of muscle or bone mass).

Many of the most common chronic illnesses or impairments start off as somewhat minor annoyances.  However, when left untreated, they can develop into debilitating and life changing impairments.

For example, a case of knee pain left untreated can progress and slowly limit your function.  This can eventually lead to severe muscle weakness, ongoing chronic pain, and the loss of your ability to perform even the most basic tasks (such as standing up from a chair or toilet and walking independently).

Now imagine if your knee pain was proactively dealt with.  During your PT evaluation, you work with your PT to develop an individualized exercise and stretching prescription.  Upon implementation, your knee pain resolves!  Now you have a preventative training program to decrease your risk of developing knee pain again.  In addition, you’re set up for success in continuing your healthy and active lifestyle as part of aging well.

A yearly PT evaluation, including the opportunity to develop an individualized training program, is essential in order to address any physical impairment early in the process.  Taking a proactive stance to address noted physical impairments is a critical step in insuring a health aging process while maintaining mobility and independence which is vital to age well. 

If you’re interested in learning more about how physical therapy can help you to age successfully and improve your health span, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!