Prolotherapy for Cervical and TMJoint (TMJ) Stability

A recent article (pubmed abstract below) on chronic neck pain should be of great interest to anyone suffering from chronic neck pain, cervicogenic headaches and / or TMJ (TMD).  It is well understood that there are postural implications to both of these disorders and that much of the pain is actually muscular in origin.  So what is the place of prolotherapy or proliferation therapy in treating cervical or TMJoint pain.

See my Highland Park website http://www.thinkbetterlife.com for more information on these topics.

The answer is in stability.  There are numerous functions of the muscles besides moving our body parts.  Muscle Splinting occurs when the muscles tighten to protect an injured joint.  This is a fantastic ability of muscles but when they do it for a long time they experience chronic muscle shortening and develop taut bands and/ or trigger points.  This is one possible  origin of a case of  Myofascial Pain and Dysfunction.  Too much of a good thing creates a problem.  The reason it is so important that the neck and jaw be treated together is for healing of ligament laxity.

I utilize Prolotherapy to tighten lax ligaments but we must also remove the repetitive strain injuries that create lax ligaments.

The following paragraphs by my friend Dr Mark Freund address the compilex relationship of jaw to neck.  Add in ligament laxity and the pot starts to boil.

How can my neck pain be TMJ Dysfunction?

Your jaw has a very powerful influence on the structure and posture of your body. Your body has an innate responsibility to preserve your teeth. Imagine if your bite was so far off that your teeth constantly met so poorly that you started to crack all your teeth and eventually lost all of them. You would most likely starve to death without repairs or dentures. Now imagine what your body does instinctively to preserve your teeth. First, your neck becomes distorted to ensure that your lower teeth and upper teeth meet properly. Next, you develop a new head position to preserve this bite. The lower part of your spine must compensate for the altered head position so you develop a postural abnormality which includes the muscles in the neck and back being strained to hold the head in the proper bite-preserving position. The long term pulling and postural changes result in the standard TMJ complaints: Cranial Distortions, Forward Head Posture, Headaches, Pain or tenderness in the face, jaw joint area, neck and shoulders, Difficulty chewing, Facial Swelling, Postural Distortions and Scoliosis.

These complaints are best address with the team approach involving interaction between a Dentist performing proper bite changes and a Chiropractor aligning the spine and manipulating the cranium into a neutral position. Dr. Mark Freund's approach to TMD (Temporal Mandibular Joint Dysfunction) is only shared by a small number of practitioners throughout the country due to the tremendous amount of education and study required. Dr. Freund practices the upper cervical technique called Atlas Orthogonal which is a very precise, specific gentle instrument adjustment of the top-most segment of the spine. This protocol does not involve hand manipulation of the neck and is extremely safe. Additionally Dr. Freund has undergone extensive education both domestic and internationally alongside Dental professionals, Physical Therapists, Doctors of Osteopathy and Chiropractors. The unique practice of making spinal corrections concurrent with bite changes is one of the most important elements of treating TMJ. Unfortunately not many practitioners are aware of this practice or its' importance.

Mark J. Freund, DC, BCAO

Natural Care Chiropractic, PC

847-265-0600

lindenhurstchiropractic.com

Open Orthop J. 2014 Oct 1;8:326-45. doi: 10.2174/1874325001408010326. eCollection 2014.

Chronic neck pain: making the connection between capsular ligament laxity and cervical instability.

Steilen D, Hauser R, Woldin B, Sawyer S.

Author information

Abstract

The use of conventional modalities for chronic neck pain remains debatable, primarily because most treatments have had limited success. We conducted a review of the literature published up to December 2013 on the diagnostic and treatment modalities of disorders related to chronic neck pain and concluded that, despite providing temporary relief of symptoms, these treatments do not address the specific problems of healing and are not likely to offer long-term cures. The objectives of this narrative review are to provide an overview of chronic neck pain as it relates to cervical instability, to describe the anatomical features of the cervical spine and the impact of capsular ligament laxity, to discuss the disorders causing chronic neck pain and their current treatments, and lastly, to present prolotherapy as a viable treatment option that heals injured ligaments, restores stability to the spine, and resolves chronic neck pain. The capsular ligaments are the main stabilizing structures of the facet joints in the cervical spine and have been implicated as a major source of chronic neck pain. Chronic neck pain often reflects a state of instability in the cervical spine and is a symptom common to a number of conditions described herein, including disc herniation, cervical spondylosis, whiplash injury and whiplash associated disorder, postconcussion syndrome, vertebrobasilar insufficiency, and Barré-Liéou syndrome. When the capsular ligaments are injured, they become elongated and exhibit laxity, which causes excessive movement of the cervical vertebrae. In the upper cervical spine (C0-C2), this can cause a number of other symptoms including, but not limited to, nerve irritation and vertebrobasilar insufficiency with associated vertigo, tinnitus, dizziness, facial pain, arm pain, and migraine headaches. In the lower cervical spine (C3-C7), this can cause muscle spasms, crepitation, and/or paresthesia in addition to chronic neck pain. In either case, the presence of excessive motion between two adjacent cervical vertebrae and these associated symptoms is described as cervical instability. Therefore, we propose that in many cases of chronic neck pain, the cause may be underlying joint instability due to capsular ligament laxity. Currently, curative treatment options for this type of cervical instability are inconclusive and inadequate. Based on clinical studies and experience with patients who have visited our chronic pain clinic with complaints of chronic neck pain, we contend that prolotherapy offers a potentially curative treatment option for chronic neck pain related to capsular ligament laxity and underlying cervical instability.

KEYWORDS:

Atlanto-axial joint; Barré- Liéou syndrome; C1-C2 facet joint; capsular ligament laxity; cervical instability; cervical radiculopathy; chronic neck pain; facet joints; post-concussion syndrome; prolotherapy; spondylosis; vertebrobasilar insufficiency; whiplash.

Headaches, Ear Pain, Mouth, Jaw and Tooth Pain related to TMJ, Whiplash and Unstable Atlas

Frank: What are the costs of treatment and is it covered by insurance? I have severely ground teeth. I clench a lot but mostly during day. 61 yrs old I do TMJ massage and that slightly helps. The headaches occur 4-10 times month. Headaches are inside my ears, above ears, in mouth and jaw and seem to sometimes be in the teeth and roof of mouth. I had whiplash injury. When I have atlas aligned it helps but does not stay in alignment.

Dr Shapira response: Insurance sometimes covers part of the cost but most insurance companies are worried primarily about shareholders and profits. Several years ago Chicago HMO agreed to pay 100% of the costs even though it was specifically excluded by their policy. Dr Mitchell Trubitt was the medical director after I showed him (trial of 6 patients) that covering TMJ disorders and neuromuscular dentistry saved them money. For many years I saw 15-25 new Chicago HMO patients patients a month and sometimes more. Success was incredible when cost was not an issue. Unfortunately United Health Care bought out Chicago HMO and they did not continue coverage. An article in Crano showed a 300% increase in medical costs in every field of medicine (except obstetrics) in patients with TMJ disorders.

As to your symptoms and treatment, I would suggest you have and examination and a diagnostic neuromuscular orthotic. It will protect your teeth from damage and address the myofascial pain it sounds like you are having.

Are you complete free of pain on your non-headache days or is the pain at more tolerable levels. Many patients "live" on drugs like ibuprofen and count headache days only when it doesn't work. The cost of living in pain is far greater than the cost of treatment. Chronic pain can suck the life out of you and the joy out of life.

The whiplash and Atlas are directly related to the jaw muscles and jaw joint and it is almost impossible to have a stable atlas / axis / craio articulation without correcting jaw position. The mandible acts like a counterbalance to the head and should be considered "the last vertebrae" which must be stabilized in a healthy position.

A diagnostic neuromuscular orthotic is the best way to determine if treatment will be effective. The orthotic is a reversible treatment that can be a life changer.

Frank: I'm in California? Is that a problem?

My headaches (or severe muscle pain in head neck teeth ears etc.) somedays is completely gone. But if I touch certain muscles they always feel like spasms and are very painful. Even 2 muscles on the side of my neck. Will it help to have all teeth capped to get them back to proper height? Will the cartilage that's wornoff ever grow back? Massage helps some I think? Cold laser helps quite a bit but I will have to do it forever. I no longer grind teeth,I just clench my jaw during the day even though my teeth aren't touching. I probably use 6-10 advil a month. But I use certain homeopathics and ice-cold therapy which are intermittent. ??????????????? I dream of a headache free pain free life.... Sometimes my headache so to speak is in my throat and in the teeth themselves and center of the ears. TKU Frank

Dr Shapira response: Frank, I don't think your pain is ever gone if the muscles are still painful to touch. It just means your pain level is below threshold but it takes a lot of energy to control pain and keep it below threshold. I term that energy "vital energy" it is the energy that makes you happy and lets you enjoy life rather than merely tolerate living. Do not start with having your teeth capped. What if it makes the pain worse. Start with a removable diagnostic neuromuscular orthotic that will let you treat the problem and evaluate success before making irreversible changes. Proceed with caps or other permanent correction only after controllling or eliminating pain to where you have a good quality of life. It is unlikely that cartilage that is totally gone will grow back but damaged cartilage can heal if it is given an ideal situation for healing.

Cold laser is safe but usually not long lasting. Trigger point injections tend to give more lasting results with hot trigger points in muscles. Spray and stretch can give amazing results. The pain patterns you describe are myofascial pain but that is just a guess without an exam.

California, is that a problem? I see long distance patients but to be successful I need several days intensive treatment to try to reach a relative homeostasis. My office can accomadate you but the first series of visits would be Monday thru Wednesday or Thursday and would require you arriving Sunday. Your original question about costs and insurance comes into play because the diagnostic stage of treatment including diagnostic orthotic, trigger points, etc may be an out of pocket expense. I would probably want to have my A/O chiropracter evaluate your Atlas after delivery of an appliance Monday afternoon.

Treatment is all about quality of life and relief of pain. There are no guarantees but my goal is to relieve as much pain as possible. I recently treated a woman who spent 50 years with a continuous headache and received total relief. I did do a reconstruction on that patient (wife of a physician) but only AFTER the pain was relieved.