HEADACHES due to Prevertebral Muscles and Retropharyngeal Tendonitis: Headaches often related to turning head upwards.

The prevertebral muscles and tendons are difficult to address and oftey interfere with healing and recovery.  They are frequently injured in whiplash injures and symptoms can linger for years or even decades.

"Headache attributed to retropharyngeal tendonitis" is classified by "The Third Classification of Headache Disorder, 3rd addition" 
Diagnosis Code 11.2.2

Raising of the eyes by tilting of the head can cause both referred pain, aching and headache.  These muscles and tendons extend over the top 3-4 vertebrae to the skull.   There is a frequent involvement of the upper cervicl complex.

While Neuromuscular Dental Orthotics address the majority of head and neck symptoms by  restoring structural and muscular balance NMD does not correct upper cervical vertebrae.

These can be addressed by specially trained osteopaths and chiropractors.  Atlas-Orthoganol chiropractors wok on the first vertebre (the Atlas) and the second vertebrae (the Axis) and their relation to the skull.   They deliver a precice adjustment to the upper cervical region.  NUCCA chiropractors address the same area utilizzing different techniques.  Both work well as does the osteopathic approach.

It is important to have a stable neuromuscular orthotic before doing the adjustment (on combination cases) and it is often necessary for a patient to have both adjustments on the same day.  Typically, the nuromuscular orthotic is corrected after the A/O adjustment.

I work closely with Dr Mark Freund on patients requiring upper cervical corrections.  https://www.northshoreatlas.com/atlas-orthogonal.

Addressing the fascial and muscular disorders of the prevertebral region is usually started by a very gradual passive gentle stretch with the patient laying on the floor with a very small towel roll under the shoulders allowing the head to extend and tip backwards.  If there is pain or discomfort the size of the towel roll is reduced.  Typically 20 minute sessions that also combine very slow diaphragmatic breathing will let these muscle release their taut bands and tension.  Overdoing the stretch impedes progress.

The scalene muscles are usually also involved in  creating problems but they can be addressed with ULF-TENS (Myomonitor), Spray and Stretch techniques, correction of paradoxical breathing issues and other physical modalities.

Sufficient Magnesium and calcium levels are important for muscle relaxation.
Feldenkrais and Alexander techniques work well in patients with these disorders as do Paul St John techniques.

All of these techniques work best with well balanced neuromuscular orthotics.  The Aqualizer appliance is a self balancing hydrostatic appliance that can also be extremely useful.  Italian studies show it relaxes muscles throughout the body.

I frequently have my patients walk and run up and down stairs in these appliances to let the body and spine unwind and the muscles relax prior to adjusting neuromuscular appliance.

Aqualizers are almost a necessity when having A/O adjustments for patients traveling from one office to another.

Cranial Manipulation is another instance where the Aqualizer is incredibly useful as a patient goes from cranial doctor to have his Neuromuscular Orthotic adjusted.

Dr Mark Freund also utilizes Cranial work.   https://www.northshoreatlas.com/cranial-suture-release

His Highland Park office is across the hall from my Highland Park office:
www.ThinkBetterLife.com

Prevertebral muscle and tendon issues can be very difficult and working with multiplle professionals is key to success.

Learn to Change Lives At ICCMO! TMJ, "The Great Imposter" Amazing Patient Testimonials Videos Describe How Neuromuscular Dental Treatment Can Eliminate Headaches, Migraines, Facial Pain and Neck Pain

Improved Quality of Life: These are actual patient testimonial videos of outstanding improvements in quality of life with Neuromuscular Treatment of TMJ and Pain Disorders. Hear about recovery from a patient a Mayo Clinic MD told her was hopeless.

THIS PRESS RELEASE WAS ORIGINALLY RELEASED ON 24/7 PRESS RELEASE

EVERY DENTIST WHO CARES ABOUT THE HEALTH AND WELFARE OF THEIR PATIENTS SHOULD LEARN ABOUT NEUROMUSCULAR DENTISTRY. CREATING HAPPIER HEALTHIER PATIENTS FREE FROM PAIN IS A NOBLE UNDERTAKING!

    Every patient with chronic pain and every physician, dentist and chiropracto truly interested in changing peoples lives should plan on attending the ICCMO Meeting from October 1-October 4, 2015 in San Diego at the Catamaran Resort and Spa.

Integrated TMD Treatments: Solving CranioMandibular Dysfunction Head to Toe
Visit https://www.regonline.com/builder/site/Default.aspx?EventID=1735252 to learn more about the event.

Visit the ICCMO website at: www.ICCMO.org

This year will be of special interest to chiropractors especially NUCCA and Atlas Orthoganol doctors, pain management physicians, physical therapists, sports physicians and more.

Patients who suffer from pain should encourage their doctors and especially dentists to attend.

Headaches and Migraines affect 25% of US households. At least 10% of the population suffers from chronic headaches. Dr Ira Shapira, a long time Highland Park resident founded I Hate Headaches.org to to help patients suffering from chronic migraines, sinus headaches, chronic daily headaches, tension headaches and TMJ headaches. Over 95% of all headache patients have Trigeminal Nerve mediated headaches. His premiere website www.ihateheadaches.org has helped thousands of patients understand how the Trigeminal Nerve and the structures it innervates are responsible for the majority of all headaches.

Many patients think that TMJ (TMD) disorders are only treated with splints. Dr Ira Shapira utilizes a multifaceted approach to giving patients quick and lasting relief from their chronic pain. He utilizes Diagnostic Neuromuscular Orthotics and has over 30 years experience in Neuromuscular Dentistry. He trained with Barney Jankelson the founder of this field and with Bob Jankelson, his son. In addition to utilizing Neuromuscular Dentistry he is one of only a handful of practitioners to utilize SPG Blocks (Sphenopalatine Ganglion Blocks), Trigger Point Injections and Spray and Stretch techniques to treat Myofascial Pain and Muscle pain from Fibromyalgia. He trained with Dr Janet Travell who wrote the book Myofacial Pain and Dysfunction: A Trigger Point Manual.

The ICCMO meeting is a must for doctors wanting to truly help their patients improve their quality of life. Dr Shapira is giving a course on the developmental aspects of TMD, Sleep Apnea and ADD and ADHD. Early pediatric key can allow us to grow healthier future generations.

According to the Migraine Research Foundation
"Children Suffer from Migraine Too

Migraine is very common in children - about 10% of school-age children suffer.
Half of all migraine sufferers have their first attack before the age of 12. Even infants can have migraines. Migraine has been reported in children as young as 18 months. 
Before puberty, boys suffer from migraine more often than girls. The mean age of onset for boys is 7, and for girls it is 11. As adolescence approaches, the incidence increases more rapidly in girls than in boys. This may be explained by changing estrogen levels. 
By the time they turn 17, as many as 8 percent of boys and 23 percent of girls have experienced a migraine.
The prognosis for children with migraine is variable. However, 60% of sufferers who had adolescent-onset migraine report ongoing migraines after age 30. The prognosis for boys tends to be better than for girls.

Many if not most of these problems canbe eliminated or reduced by early intervention according to Dr Shapira.

This link leads to a YouTube Channel of Think Better Life Patient Testimonial videos.
https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg

Everyone with chronic TMJ pain, migraines, neck pain or facial pain should view these videos.

The Website for Dr Shapira's new Highland Park office is www.thinkbetterlife.com.


According to the Migraine Research Foundation website:

"Migraine is an extraordinarily common disease that affects 36 million men, women and children in the United States. Almost everyone either knows someone who has suffered from migraine, or has struggled with migraine themselves. Nearly 1 in 4 U.S. households includes someone with migraine. Amazingly, over 10% of the population - including children - suffers from migraine. That's more than diabetes and asthma combined! About 18% of American women and 6% of men suffer from migraine. Migraine is most common during the peak productive years, between the ages of 25 and 55."

TMJ Disorders have been dubbed "The Great Imposter" because the majority of patients are misdiagnosed or only partially diagnosed by the medical community. The Trigeminal Nerve is frequently called "The Dentists Nerve" because it goes to the teeth, periodontal ligaments,, the sinuses, the tongue, the jaw joints and jaw muscles, as well as the tongue, the tensor of the ear drum, the muscle that opens and closes the eustacian tube and a major contribution to the autonomic nervous system. The Trigeminal Nerve also controls the blood flow to the anterior two thirds of the meninges of the brain, or in simple terms the Trigeminal nerve determines whether you will have migraines. The Trigeminal Nerves or Fifth Cranial Nerves is also the single largest contributor to Chronic Headaches and Migraine. Neuromuscular Dentistry is extremely effective in eliminating and treating migraines specifically because of the trigeminal nerve connection. Neuromuscular Dentistry is specifically directed towards eliminating trigeminal nerve nociception or painful input to the central nervous system.

What the majority of the medical community does not know is that TMJ or TemporoMandibular Disorders can have effects on almost every system in the body. The NHLBI or National Heart Lung and Blood Institute of the NIH published a report entitled CARDIOVASCULAR AND SLEEP-RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS that looked at the far reaching effects of TMJ disorders. The report recognizes the importance of "The masticatory apparatus is not only involved in chewing and swallowing but also in other critical tasks, including breathing and talking."

The NIH report also state, "TMD has been used to characterize a wide range of conditions diversely presented as pain in the face or jaw joint area, masticatory muscle pain, headaches, earaches, dizziness, limited mouth opening due to soft or hard tissue obstruction, TMJ clicking or popping sounds, excessive tooth wear and other complaints."

The report shows that 12% of the population suffers from TMD similar to the number suffering chronic headaches and migraines. The report has a major section on "The Craniofacial Complex and its Impact on Control of Upper Airway Resistance and Cardiopulmonary Function" The report covers the pathophysiology of sleep apnea which is implicated in morning headaches, fibromyalgia and Myofascial Pain and Dysfunction. It is now well established that oral appliances are a first line approach to treatment of sleep apnea and snoring for mild to moderate sleep apnea and an alternative to CPAP for severe sleep apnea.

The Autonomic portion of the Trigeminal Nerve is a key cause and cure for migraines and headaches. This is because of its innervation of the meninges of the brain and its control of blood flow to the brain. The SPG Block or Sphenopalatine Ganglion Block is sometimes considered a miracle cure for migranes. The popular book "Miracles on Park Ave" dealt specifically with the high efficacy of SPG Blocks in treating pain. The new MiRx protocol (http://www.mirxprotocol.com/) that has been show effective for preventing and treating migraines is actually just a different method of utilizing the SPG Block. Dr Shapira has been teaching utilization of the SPG Block to dentists and other healthcare professionals for many years.

Learn more about SPG Blocks @ http://chicago-headaches.blogspot.com and at www.thinkbetterlife.com.

The Mayo Clinic has also clearly stated the importance of the Trigeminal Nerve is headaches and Migraines "Although much about headaches still isn't understood, researchers think migraines may be caused by functional changes in the Trigeminal Nerve system, a major pain pathway in your nervous system, and by imbalances in brain chemicals, including serotonin, which plays a regulatory role for pain messages going through this pathway."

Mayo clinic also states, "During a headache, serotonin levels drop. Researchers believe this causes the Trigeminal Nerveto release substances called neuropeptides, which travel to your brain's outer covering (meninges). There they cause blood vessels to become dilated and inflamed. The result is headache pain."

These meninges are the Trigeminally innervated meninges discussed earlier and the serotonin and neuropeptides are the chemicals produced by nerve cells. These same chemicals are involved in TMJ, TMD and Migraines. The Trigeminal Nerve always utilizes these neurotransmitters not just for migraines.

Dr Shapira spent years doing research into sleep apnea and its connection to jaw position. His early research was done as a Visiting Assistant Professor in the 1980's at Rush Medical School in The Sleep Disorder clinic. He worked closely with Dr Rosalind Cartwright the acknowledged Mother of Dental Sleep Medicine. Dr Cartwright recruited Dr Shapira to return to Rush as an Asst Professor in the 1990's till early this century.

The connections between impaired nasopharyngeal breathing and development of ADD and ADHD in children was the topic of a recent lecture Dr Shapira gave in Buenos Aires, Argentina. The development of chronic TMJ disorders, headaches, migraines and postural distortions were all discussed at his lecture to members of ICCMO, The International College of CranioMandibular Orthopedics of which Dr Shapira is a Fellow and Secretary. Dr Shapira is a representative from ICCMO to the American Alliance of TMD Organizations and current Chair of the Alliance of TMD Organizations.

In the 1990's Dr Shapira was a star lecturer for the A4M, The American Academy of Anti-Aging Medicine where he presented his work on the effect of TMJ disorders across ones lifetime. Premature aging and loss of memory and even dementia and Altzheimers disease are part of the same ongoing problem. Sleep Apnea and snoring are types of TMJ disorders according to the National Heart Lung and Blood Institute of the NIH in their report: Cardiovascular and Sleep Related Consequences of Temporomandibular Disorders.

Dr Shapira has been utilizing a multifaceted approach toward relieving chronic pain associated with TMJ disorders for over 30 years and is now bringing his expertise to the North Shore Communities of Chicago. He created www.IHATECPAP.com which addressed Sleep Apnea and snoring and utilizing oral appliances to treat these problems. He also created www.ihateheadaches.org that focuses on many types of headaches and the role of Neuromuscular Dentistry in providing relief of these problems.

The DNA Appliance is offering a possible cure for sleep apnea and TMJ disorders by growing the jaws utilizing Epigenetic Orthodontics. Until recently it was believed these changes could only be accomplished through extensive surgical procedures.

Dr Shapira has also studied Cranial Suture Release techniques and Chirodontics. He inroduced these concepts to a Chiropracter who is his friend and colleague, Dr Mark Freund . Dr Freund has embraced these concepts in totality and has become an expert in these techniques through immersive studying both in the US and Internationally. His primary office is in Lindenhurst but he also sees Cranial patients in Gurnee in Dr Shapira's office www.delanydentalcare.com.

Dr Freund will be treating patients in Dr Shapira's Highland Park office. These techniques treat not only TMJ Dysfunction but also postural distortion such as forward head posture that leads to headaches and neck pain. These postural distortions can have negative effects throughout the entire body.

The NIH just reported over 25 million Americans suffer chronic pain or 11.2% of all Americans. See The Washington Post Story. http://www.washingtonpost.com/news/to-your-health/wp/2015/08/11/nih-m ... onic-pain/

Dr Ira L Shapira created the I HATE CPAP (www.ihatecpap.com) and I HATE HEADACHE (www.ihateheadaches.org) websites to help patients find help with these difficult medical disorders that medicine can frequently not treat adequately without a dental collaboration. Dr Shapira did research in the 1980's as a visiting assistant professor at Rush Medical School where he worked with Rosalind Cartwright PhD who is primarily responsible for the entire field of Dental Sleep Medicine. He also studied with Dr Barney Jankelson who created the initial concepts that neuromuscular dentistry still uses today and created a company Myotronics that is the leading manufacturer of instrumentation used by Neuromuscular Dentistry.

Dr Shapira is the current Chair, Alliance of TMD Organizations
http://www.tmdalliance.org/

Dr Shapira is a Diplomate of The American Board of Dental Sleep Medicine, a Diplomate of the American Academy of Pain Management, and a Fellow of the International College of CranioMandibular Orthopedics (ICCMO). He is a former national and International Regent of ICCMO, its current Secretary and the representative to the Alliance of TMD organizations or the TMD ALLIANCE has a general dental practice (http://www.delanydentalcare.com) in Gurnee, Il and has recently started Chicagoland Dental Sleep Medicine Associates with offices in Vernon Hills and Highland Park. Patients in Northern Illinois or southern Wisconsin can contact Dr Shapira by phone toll free at 1-8-NO-PAP-MASK OR 1-800-TM-JOINT or thru his websites at http://www.ihateheadaches.org or http://www.chicagoland.ihatecpap.com.

  

CHICAGO MIGRAINE CURE: Treatment and Prevention of Migraine Headaches

Migraines can be avoided, eliminated and cured with a combination of treatments designed to reduce noxious input into the Trigeminal nervous system.  It is universally accepted that migraines are mediated by the trigeminal input to the brain in conjunction with the trigeminal nerve control of blood flow to the anterior two thirds of the meninges of the brain.

There has long been a controversy whether migraine was a vascular headache or a neurogenic headache or a combination of the two.  Ther has never been a question over mediation of migraine by the trigeminal nerves.

Noxious input from the trigeminal nerve can be eliminated.  There is actually an appliance that has been FDA approved as a migraine preventive, the NTI -TSS appliance.  NTI-TSS stands for Nociceptive trigeminal inhibition tension suppression system.  It uses noxious input into the trigeminal nervous system to suppress bruxism.  The original appliance was Dr Peter Neff's  appliance that the NTI  concept was taken from.   There are many problems and risks associated with the NTI but there is a place for it in patients with migraines that occur in the night or upon awakening and who do not have sleep disordered berthing including apneas, hypopneas, RERAs, UARS, and/or snoring.

Patients with these problems should have their nocturnal breathing corrected which can often cure these same migraines.  The TAP appliance actually treats the breathing and simultaneously creates the same effect as the NTI simultaneously.

CURING MIGRAINES goes beyond the NTI and sleep disordered breathing to idealizing the cranial cervical physiology.  Neuromuscular Dentistry as part of a comprehensive program can cure many migraines by removing the noxious input to the CNS from the trigeminal nerve.  Correction of posture is important to eliminate myofascial pain and trigger points that also cause headaches.

Upper cervical spinal problems can also create migraines but the combination of neuromuscular dental orthotics and atlas orthoganol correction creates long term stability.

The first step is always diagnosis and trial reversible treatment.  A diagnostic neuromuscular orthotic shold always be the first step in neuromuscular treatment and prevention of migraines. Correction of upper cervical probles is easier when the orthotic is worn and adjustments hold better.  It is important to understand that changes to orthotic and upper cervical areas must be balanced carefully to achieve homeostasis.

Curing migraines depends on maintaining this homeostasis.  There are migraine triggers that are chemical in nature that must be controlled by diet and avoidance.  Many patients find that over time these migraine triggers have less effect.

There are no migraine cures that work for everyone but neuromuscular dentistry offers many patients near miraculous results.  The combination of neuromuscular dentistry with upper cervicsal stabilization is even more powerful.  SphenoPalatine Ganglion Blocks can be used on more difficult cases to turn off and prevent migraines.  These were discussed in a popular book "Miracles on Park Avenue".  In my office we teach patients to self administer SPG blocks with cotton tipped swabs and lidocaine delivery.   Learn more about treatment of headaches and migraines at
www.thinkbetterlife.com.

TMJ, TMD, Headaches, Migraines, Snoring and Sleep Apnea: FIND A NEUROMUSCULAR DENTIST

NEUROMUSCULAR DENTISTRY can offer incredibly quick relief for many patients suffering from TMJ disorders, Migraines and other issues.  It is ideal for finding the ideal physiologic position for dentistry and full mouth reconstructions.

In the Chicago area I have two locations for patients;

Highland Park, Il www.ThinkBetterLife.com

 Gurnee   www.DelanyDentalCare.com

I frequently see patients who travel long distances to see me in Chicago from the US and overseas.  I can make special arrangements for patients who want me to treat them personally, whether for TMJ pain, headaches, migraines, sleep disorders of cosmetic and reconstructive dentistry.

There are many areas across the country and from around the world where there are not neuromuscular doctors listed on my site.

I reccommend that patients seek out a Neuromuscular Dentist who belongs to ICCMO, The International College of CranioMandibular Orthopedics.

 FIND A NEUROMUSCULAR DENTIST

http://occlusiontmjauthority.com is the ICCMO site.  Patients can learn more about Neuromuscular Dentistry at that site.  I have just agreed to help write additional content for the site.

The find a dentist section is found at:
 http://occlusiontmjauthority.com/find-a-tmj-dentist-2/

Neuromuscular Dentistry is ideal for patients under Chiropractic care, especially patients who see a NUCCA Chiropracter or and A/O (Atlas/Orthoganol) Chiropracter.

POSTUROLOGY AND TMD (TMJ) DISORDERS: WHY THIS IS IMPORTANT TO PATIENTS WITH CHRONIC DAILY HEADACHES, MIGRAINES AND TENSION-TYPE HEADACHES.

THE JAW IS ESSENTIAL IN THE REGULATION OF NORMAL BODY POSTURE. THE SWALLOW SERVES AS A NEUROMUSCULAR RESETTING MECHANISM THAT CAN CORRECT OR CAUSE POSTURAL PROBLEMS THROUGHOUT THE ENTIRE BODY.

THERE ARE ONLY THREE MAJOR SET POINTS IN THE BODY FOR NEUROMUSCULARLY RESETTING POSTURE. ONE IS THE BITE WHEN WE SWALLOW APPROXIMATELY 2000 TIMES A DAY. THE SECOND IS OUR FEET /LEGS /HIPS WHEN WE STAND AND THE THIRD IS THE HIPS WHEN WE SIT.

THE QUADRANT THEOREM OF GUZAY EXPLAINS THE IMPORTANCE OF THE JAW TO FULL BODY POSTURE IN MATHEMATICAL AND ENGINEERING TERMS.

IT IS EASIER FOR THE LAY PERSON TO UNDERSTAND THE IMPORTANCE OF THE JAW BY IMAGINING STANDING ON THE DOCTORS SCALE. THE 100 POUND MARKER IS SET, THEN THE TEN POUND MARKER IS SET, AND FINALLY THE ONE POUND MARKER IS SET TILL THE SCALE PERFECTLY BALANCES.

THE PROBLEM IS THAT IF YOU MOVE THAT ONE POUND WEIGHT JUST A LITTLE TO THE RIGHT OR LEFT THE SCALE DOES NOT GO A LITTLE OUT OF BALANCE IT GOES "KLUNK" EITHER UP OR DOWN DEPENDING ON WHICH WAY YOU MOVED THE WEIGHT.

ION A SIMILAR MANNER THE JAW DOES THE SAME THING FOR HEAD POSITION AND WHOLE BODY POSTURE. PATIENTS WITH CHRONIC NECK, JAW OR HEADACHE PAIN COULD BE DESCRIBED AS HAVING BEEN "KLUNKED"

UNLIKE THE SCALE WHICH ONLY MOVES IN TWO DIRECTIONS THE JAW CAN BE DISPLACED ANTERIOR-POSTERIORLY, VERTICALLY TOO CLOSE OR TOO FAR APART (VERTICAL DIMENSION). SIDE TO SIDE OR OBLIQUELY. IT CAN ALSO BE TIPPED SIDE TO SIDE. FRONT TO BACK OR OBLIQUELY AND IT CAN BE ROTATED IN EITHER DIRECTION ON THE HORIZONTAL PLANE.

NEUROMUSCULAR DENTISTRY HAS THE TOOLS TO UNDERSTAND AND UNWIND THE POSTURAL ABBERATIONS AND ALLOW A RETURN TO A NORMAL PHYSIOLOGIC STATE. THIS IS WHERE HEALING CAN OCCUR ALLOWING LONG TERM RESOLUTION OF THE PATIENTS PROBLEMS.

THIS IS AN OVERSIMPLIFICATION BECAUSE ALL OF THE PROBLEMS IN JAW POSTURE ARE ALSO RELATED TO HEAD POSITION. AN EVALUATION OF THE ATLAS/AXIS RELATIONSHIP CAN BE INVALUABLE IN TREATING POSTURAL DISCREPANCIES,

THE FIRST STEP, FROM A NEUROMUSCULAR DENTISTRY APPOACH IS TO USE TECHNOLOGY TO MEASURE JAW POSITION AND FUNCTION AND TO DESIGN A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC THAT ALLOWS THE HEALING PROCESS TO BEGIN. AS HEALING OCCURS HEAD AND NECK POSTURE WILL CONTINUALLY CHANGE UNTIL A NEW HOMEOSTASIS IS REACHED.

FREQUENTLY, TOTAL POSTURA; CORRECTION MAY INVOLVE ORTHOTICS FOR SHOES OR EVEN FOR "BUTT LIFTS" FOR SITTING. THE PODIATRIST CAN SERVE AN IMPORTANT ROLE IN POSTUROLOGY AS CAN GAIT ANALYSIS. EVEN THE OPTICIAN CAN PROVIDE A VITAL LINK IN HEALING FOR PATIENTS WHOSE POSTURE IS ADVERSELY EFFECTED BY EYEGLASSES AND HOW WELL THEY FIT PATIENTS WORK AND LIFESTYLE FUNCTIONS. MASSAGE THERAPISTS AND EXERCISE THERAPISTS FREQUENTLY ALLOW COMPLETE HEALING AND HELP ESTABLISH A HEALTHY PHYSIOLOGY.

THE FOLLOWING PUBMED ABSTRACT FROM CRANIO DISCUSSES SOME OF THE POSTURAL ISSUES ON JUST THE FORWARD BACKWARD POSITION OF THE JAW. CLASS 2 IS BACKWARD POSITION, CLASS 3 IS FOWARD POSITION AND CLASS 1 IS NORMAL POSITION. THIS IS ONLY DISCUSSING SKELETAL POSITION HOWEVER AND NOT TRUE PHYSIOLOGIC POSITION THAT WOULD BE MESURED WITH NEUROMUSCULAR DENTAL MEASUREMENTS OF EMG AND MKG OR COMPUTERIZED MANDIBULAR SCAN.

Cranio. 2005 Jul;23(3):219-28.
Evaluation of cervical posture of children in skeletal class I, II, and III.
D'Attilio M, Caputi S, Epifania E, Festa F, Tecco S.
Source
Department of Orthodontics, University of Chieti, Italy.
Abstract
Previous studies on the relationship between morphological structure of the face and cervical posture have predominantly focused on vertical dimensions of the face. The aim of this study was to investigate whether there are significant differences in cervical posture in subjects with a different sagittal morphology of the face, i.e., a different skeletal class. One hundred twenty (120) children (60 males and 60 females, average age 9.5 yrs., SD+/-0.5) were admitted for orthodontic treatment. Selection criteria was: European ethnic origin, date of birth, considerable skeletal growth potential remaining and an absence of temporomandibular joint dysfunction (TMD). Lateral skull radiographs were taken in mirror position. Subjects were divided into three groups based on their skeletal class. The cephalometric tracings included postural variables. The most interesting findings were: 1. children in skeletal class III showed a significantly lower cervical lordosis angle (p<0.001) than the children in skeletal class I and skeletal class II; 2. children in skeletal class II showed a significantly higher extension of the head upon the spinal column compared to children in skeletal class I and skeletal class III (p<0.001 and p<0.01, respectively). This is probably because the lower part of their spinal column was straighter than those of subjects in skeletal class I and II (p<0.01 and p<0.001, respectively). Significant differences among the three groups were also observed in the inclination of maxillary and mandibular bases to the spinal column. The posture of the neck seems to be strongly associated with the sagittal as well as the vertical structure of the face.

PMID: 16128357 [PubMed - indexed for MEDLINE]

TMJ disorders, headaches and facial pain frequently involve cervical musculature. Acute pain relief is accomplished with cervical muscle injection

An article (pubmed abstract below) in the Journal of Orofacial Pain. "Treatment of acute orofacial pain with lower cervical intramuscular bupivacaine injections: a 1-year retrospective review of 114 patients." dicusses the use of cevical intramuscular injections to turn off acute pain in the ER. The study showed that 94% of patients had complete of partial relief with injection of a long acting anaesthetic.

There is a connection between the jaw and the neck that is incredibly important in the treatment of muscular headaches, facial pain, migraines, chronic daily headaches and TMJ disorders (TMD). The jaw acts as a counter-balance to the head and allows maintenance of head posture minimal excessive muscle adaptation. This is well described mathematically in engineering terms in the "Quadrant Theorem of Guzay". The jaw position is vital to body posture and abberations in jaw position can act as a descending disorder that can effect the entire body.

Forward head posture is frequently seen in TMJ and Headache patients. This forward posture cause exponential increases in muscle work just to maintain head posture.

Rcobado estimated that it takes double the muscle work from cervical muscles to low back for every centimeter of forward head posture, Three centimeters forward head posture would increase chronic muscle adaptation 8 fold (2X2X2=8) while a 5 centimeter forward head posture would increase it 32 times (2X2X2X2X2=32). The reason muscular injections work so well in relieving acute and chronic headaches and facial pain is that these muscles are grossly overworked in TMD patients.

Treating the muscles can give relief of acute pain but returning the system to a more normal physiologic state can give long term relief to patients.

A diagnostic neuromuscular orthotic allows the jaw to function in an ideal physiologic position. This allows gradual restoration of normal head posture and a return to normal physiologic function of the neck. I work closely with Atlas Orthogonal and/or NUCCA Chiropracters to correct the first two vertebrae early in treatment. These areas are especially prone to problems in TMD patients. As the foward head posture occurs the patient must rotate their head on the Atlas and Axis (first to vertebrae) to maintain sight lines. This is well explained by the Quadrant Theorem of Guzay which shows that the actual center of rotation for the jaw when both rotation and traslation movements are calculated is on the odontoid process of the Axis (2nd vertebrae)

Patients with TMD who are in car accidents never recover fully if their jaw issues are not addressed.

Posturology is the study of whole body posture. Posturology recognizes the importance of the jaw position. The normal swallow is a neuromuscular resetting procedure but most TMD patients have deviant or reversed swallows and are not even aware they swallow wrong. This can lead to GI problems but is primarily a structural problems that makes long term successful treatment of pain impossible without correction of neuromuscular jaw issues. A diagnostic orthotic allows patients to experience relief of head and neck pain prior to and permenant occlusal alterations.


J Orofac Pain. 2008 Winter;22(1):57-64.
Treatment of acute orofacial pain with lower cervical intramuscular bupivacaine injections: a 1-year retrospective review of 114 patients.
Mellick LB, Mellick GA.
Source
Department of Emergency Medicine, Medical College of Georgia, Augusta, Georgia, USA. lmellick@mcg.edu
Abstract
AIMS:
To describe 1 year's experience in treating orofacial pain with intramuscular injections of 0.5% bupivacaine bilateral to the spinous processes of the lower cervical vertebrae.

METHODS:
A retrospective review of 2,517 emergency department patients with discharge diagnoses of a variety of orofacial pain conditions and 771 patients who were coded as having had an anesthetic injection between June 30, 2003 and July 1, 2004 was performed. The records of all adult patients who had undergone paraspinous intramuscular injection with bupivacaine for the treatment of an orofacial pain condition were extracted from these 2 databases and included in this retrospective review. Pain relief was reported in 2 different ways: (1) patients (n = 114) were placed in 1 of 4 orofacial pain relief categories based on common clinical experience and face validity and (2) pain relief was calculated based on patients' (n = 71) ratings of their pain on a numerical descriptor scale before and after treatment.

RESULTS:
Lower cervical paraspinous intramuscular injections with bupivacaine were performed in 118 adult patients. Four charts were excluded from review because of missing or inadequate documentation. Pain relief (complete or clinical) occurred in 75 patients (66%), and partial orofacial pain relief in 32 patients (28%). No significant relief was reported in 7 patients (6%). Overall, some therapeutic response was reported in 107 of 114 patients (94%). Orofacial pain relief was rapid, with many patients reporting complete relief within 5 to 15 minutes.

CONCLUSION:
This is the first report of a large case series of emergency department patients whose orofacial pain conditions were treated with intramuscular injections of bupivacaine in the paraspinous muscles of the lower neck. The findings suggest that lower cervical paraspinous intramuscular injections with bupivacaine may prove to be a new therapeutic option for acute orofacial pain in the emergency department setting.

TMJ AND POSTURE: THE INTIMATE CONNECTION BETWEEN CHIROPRACTIC PROBLEMS AND TMJ DISORDERS (TMD) ARE CRITICAL.

PATIENTS LIVING WITH TMJ DISORDERS, CHIROPRACTIC DISORDERS, HEADACHES AND MIGRAINES are alll suffering from the same underlying disorders. It is well recognized that it is impossible to achieve long term successful treatment without addressing both the dental, TMJ and Trigeminal components in conjunction with with the Chiropractic aspects of care.

Atlas Orthoganal Chiropractic or NUCCA chiropractic focus on the first two vertebrae. Both are excellent techniques but I usually prefer working with A/O chiropracters as they take a more universal approach to care. Many NUCCA chiropracters think that they can correct everything even though research at the prestegious Las Vegas Institue has shown that NUCCA adjustments DO NOT HOLD when the Neuromuscular Dental Occlusion is not corrected. A/o Chiropracters tend to be mor inclusive in care.

Atlas Orthoganal Chiropactic focuses on the first two vertebrae, the Atlas and the Axis. According to the website http://www.atlasorthogonality.com/index.htm the website of the Roy W Sweat Foundation:

"Atlas Orthogonal (SCALE—Stereotactic Cervical ALignment methods) is a spinal healthcare program developed by Dr. Roy Sweat in the late 1960’s based on scientific and biomechanical procedures. Dr. Sweat is considered by many to be one of the world’s foremost authorities on the cervical spine. After years of extensive research he developed a non-invasive, precision instrument to restore structural integrity from cervical vertebral malposition. The percussion instrument achieves postural restoration without manipulation or surgery. This precision treatment reduces cervical spine misalignment and its related symptomatology."

I work with two excellent A/O Chiropracters Dr Mark Freund in Lindenhurst and Dr David Menner in Lake Villa. I have also worked with severl NUCCA Chiropracters.

The connection between the Trigeminovascular system, the masticatory apparatus and the TM Joints was best described by a series ofg patients called "The Quadrant Theorem of Guzay" that describes how the actual center of rotation of the mandible (lower jaw) after accounting for both rotation and translation is on the Odontoid Process of the Axis found within the confines of the Atlas. The head rests on the Atlas on two fcets and it was named for Atlas in Greek Mythology who held the world on his shoulders.

Yoy can consider A/o Chiropracters and NUCCA Chiropracters as a herois Atlas managing the balance of the head on the top of the cervical column.

The neuromuscular Dentist is the navigator who assures that the head stays balanced so Atlas Axis stability is retained. The two treatments are intimately connected.

There are many other important areas of treatment in the body but these TOP Blocks are most important for anyone with Headaches, Migraines, TMJ, TMD, Spinal Problems, Tension-Type Headaches, SUNCY, Chronic Daily Headaches and non-infectious Sinus Pain and Sinus Headaches.

Additional information on Neuromuscular Dentistry is available at: http://www.sleepandhealth.com/neuromuscular-dentistry and at Dr Shapira's Delany Dental Care Ltd website at: http://www.delanydentalcare.com/neuromuscular.html

Headaches since June, Back of head that last 1 1/2 days and end with throwing up.

Rachel: I have on going headaches since June. They are in the back area of the head and I usually have them for 1 day and half. Most of the time I end up throwing up

Dr Shapira response: Dear Rachel,

I assume that you have visited you physician to discuss your headaches due to the dramatic change. If nothing is found medically occipital headaches are frequently helped by a neuromuscular orthotic. Symptoms that you describe can also be caused by Atlas/Axis problems and you might want to consider seeing an Atlas Orthogonal or NUCCA chiropracter..

If the pain is primarily muscle ait may be easy to relieve utilizing Travell vapocoolant spray and stretch. Does the pain go away immediately after vomiting? When you vomit it causes instant but temporary release of closing jaw muscles.

It is always important to consider organic disease when a new type of headache occurs. Never assume that there is not an undrlying disease process. Neuromuscular Dentistry is probably one of the safest and most effective treatments for chronic headaches and migraines but when a new type of headache occurs it is important to rule out other medical causes.

Objective diagnosis is the key, you do not want to become a drug guinea pig diagnosed by serial drug experiments.

MRI for Migraine: Does dye matter? Neuromuscular Dentistry addresses the problem directly.

Cathy Jo:
Can an MRI with intravenous dye show different results than an MRI without dye. I have suffered from migraine headaches since the age of 5 (I am currently 42) and currently on disability because of the severity of my migraines. I did sustain an injury at the age of 5 and may have injuried my neck according to my mother. I do strongly believe this is the origin of my migraines, but an MRI without dye showed normal results. Would an MRI with dye show anything different?

Dr Shapira: Dear Cathy Jo,
n my experience an additional MRI with dye will rarely, if ever be productive. If it makes you feel better you can have one but I would suggest looking for an answer to your problem. I am enclosing contact information for a Neuromuscular Dentist,. I would appreciate your feedback..

If you were my patient I would suggest you try a neuromuscular diagnostic orthotic as a first step in diagnosis and treatment. If it is a neck injury that began your problem you may also require some cervical therapy, NUCCA Chiropractic and/or A/O Atlas -Orthogonal is frequently very effective when combined with a neuromuscular orthotic. It is important that you feel comfortable with your doctor and you should expect a consultation that takes at least 60-90 minutes. Your history is extremely important.

If you eliminate or substantially decrease the frequency an severity of migraines you can continue treatment. You might also want to try having a spenopalatine ganglion block as they often give incredible results. There is an excellent book "MIRACLES ON PARK AVENUE" that discusses SPG blocks in treating pain.

It is quite common for cervical problems an trigeminal problems and/or jaw problems to be related. The majority of patients have multiple muscle trigger points. Many times patients have severe and/or disabling headaches that are not acually migraines but just severe headaches. You did not give much detail in your letter. Details are extremely important in unraveling chronic pain problems.

New Developments in Migraine Treatment and how they relate to Neuromuscular Dentistry and Posturology

A recent article in Current Opinions in Neurology reviewed Migraine treatments. While it mentioned the use of medications such as Botox (onabotulinum toxin type A), triptans , Topiramate, gabapentin, petasites and tizanidine and a new nasal form of dihydroergotamine it also discussed risk factors associated with Temporo-mandibular (TMJ, TMD) disorders, sleep apnea and treatments like occipital nerve stimulators.

These are important aspects of Neuromuscular Dentistry which utilizes ultra-low frequency TENS to stimulate the Cranial Nerves V, VII and XI. This would create effects on occipital nerves as well. The use of Botox on cranial muscles shows that they are responsible for many migraines. Reducing pathological muscle activity is relatively easy utilizing a neuromuscular diagnostic orthotic. The occipital muscles respond to postural changes in the head position that have been well described by the Quadrant Theorem of Guzay. NUCCA and A/O (atlas Orthogonal) chiropractic are both extremely effective with chronic daily headaches and migraines however the adjustments do not hold without neuromuscular correction of the jaw position.

The use of medications to treat migraines is essential for some patients but the same therapeutic changes in brain chemistry can be accomplished for many patients by changing neural input to the brain via the Trigeminal nerve which (dentist's nerve) which also controls vascular headaches thru control of blood flow to the anterior two thirds of the meninges. The primary control of vascular flow to the brain is always affected by the health of the stomatognathic system. The blood flow to the brain from the internal carotid is also indirectly affected by jaw position and its effects on head posture and carotid blood flow.

The blood flow to the brain is provided by "The circle of Willis (also called the cerebral arterial circle, arterial circle of Willis or Willis Polygon) is a circle of arteries that supply blood to the brain. It is named after Thomas Willis (1621–1673), an English physician" (from Wikipedia) The arteries are "The circle of Willis comprises the following arteries:[2]
Anterior cerebral artery (left and right)
Anterior communicating artery
Internal carotid artery (left and right)
Posterior cerebral artery (left and right)
Posterior communicating artery (left and right)" and also the basilar artery and middle cerebral arteries, though they supply the brain, are not considered part of the circle of Willis. All of these are directly controlled by the Trigeminal Nerves or indirectly affected by head posture.

Neurologists agree that nearly all chronic daily headaches and migraines are controlled to a large extent by the Trigeminal Nerve. Correction of pathology in the oral systems changes the input to the brain and corrects autonomic functioning.

This study (below) qualifies TMD as risk factors but does not delve into how EMG spectral analysis of masticatory muscles could be used to define in a quantitative manner risks of migraines and chronic daily headaches.

Posturology may be considered a new field that combines and correlates many different specialties.

As defined by Wikipedia:
"Posturology is the scientific study of posture.
Posturology science involves comprehensive knowledge within every scientific specialization dealing with motor system as:
- biomechanics
- neurology
- antropology
- empbriology
And a good theoric and clinic knowledge of every function and aspect of anatomy that may directly or indirectly interface with motor system:
- otorhinolaringology
- dentistry
- angiology
- endocrinology
Posturology may take advantage of all instrumental resources that are already in use among those specialties but requires new protocols of measurement to be prototyped for either research and clinical use.
Posturology is aimed at setting up new evaluation methods to provide multi dimensional model of posture and it's variables, not neglecting resoureces such as patient's collaboration which, with adeguate rigour, may take advantage of the most accurate afference processing system: the patient's brain.
Posture is nowadays a challenge for scientific society as the discipline-oriented-approach of medicine organization does not comply with the functional-model of posture: a motor function implementation requires interdisciplinary perspective to be thoroughly evaluated and, so far, medicine does not provide a single figure with multi discipline skill.
Given the absence of scientific society interest in posture and the presence of obscure posturologist professionals, posturology is way far from from yielding scientific results, moreover, the current lack of scientific knowledge of posture and the growing ascertainment of relationship between diffused social deseases and the postural disorder, makes posturology research demand much more urgent than posturology clinic demand.
Posturology specialization, at present, is not scientifically aknowledged, but, if appropriately conceived, not only might overcome the lack of overview of the current scientific discipline-model approach but is the only way to provide the required functional-model approach to scientific research." (end wikipedia quote)


The following is taken from the posturology (http://www.posturology.eu/pages/acc2.htm) website:
"" What is responsible for these pathologies : the system thrown out-of-tune by the abnormal information signals it receives from the peripheral sensors : feet, eyes, teeth, skin etc.

The aim of posturology is to provide a treatment no longer based on the symptoms (pains) but on the causes, and one of reprogramming those out-of-tune sensors in the system.

The latest neurological research has shown that the control of the body’s spatial equilibrium does not depend exclusively on the internal ear, as was believed for a long time, but also on other sensors of the system, of which the feet and the eyes are the most important.

GOOD FEET, GOOD EYES

...These two elements constitute the primary inputs of the system, any disturbance due to ground-contact or of optical origin will have repercussions on the postural ensemble. These sensors being out-of-tune is extremely frequent, and most of the time is present without being noticed.

While feet and eyes provide the principal and most frequently encountered causes, there are others too that give rise to postural imbalance : certain types of scars, the manducatory system (teeth, muscles and articulations), the muscles etc.

GOOD TEETH ARE IMPORTANT

...Another neglected component of the sensorial system is the teeth, muscles and jaw articulation. Bad dental occlusion gives rise to neck-aches, head pains, dizziness, buzzing and evening and morning aches and pains."

The Sleep and Health Journal article on Neuromuscular Dentistry (http://www.sleepandhealth.com/neuromuscular-dentistry) explains many of the postural connections between the teeth, jaws, perioontal ligaments and how they ultimately effect and change total body function.

Curr Opin Neurol. 2010 Jun;23(3):254-8.
New therapeutic developments in chronic migraine.
Lovell BV, Marmura MJ.

Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. loveb9@gmail.com
Abstract
PURPOSE OF REVIEW: Chronic migraine is a common cause of chronic daily headache, which is often refractory to standard treatment. New research has increased our understanding of this disorder and its treatment. This review focuses on recent clinical trials and advances in our understanding of migraine pathophysiology. RECENT FINDINGS: Migraine research has traditionally focused on the more common episodic form of the disorder, but recent clinical trials have started to focus on chronic migraine or chronic daily headache. Topiramate, onabotulinum toxin type A, gabapentin, petasites and tizanidine are among the agents that appear to be effective in the treatment of chronic migraine. New acute medications including an inhaled form of dihydroergotamine will soon be available and neuromodulatory procedures such as occipital nerve stimulation may be effective for the most disabled patients. In the past few years, other studies have shed light on potential risk factors for chronic migraine such as medication-overuse headache, temporomandibular disorders, obstructive sleep apnea and obesity. SUMMARY: This review explains advances in the treatment of chronic migraine, a common disorder seen in neurological practice. These new advances in preventive treatment and a better understanding of its risk factors will allow clinicians to better identify individuals at greatest risk and prevent the development of chronic migraine.

PMID: 20442572 [PubMed - in process]

Article in Journal of American Osteopathic Association on role of trigeminal nerve in migraines. Why Osteopathy, Chiropractic, A/O and NUCCA work.

Osteopathic manipulation and Chiropractic manipulation both treat headaches by changing input into the trigeminal nerve much like neuromuscular dentistry does. The article states: " Pathologic findings in the neck constitute an accepted etiology or precipitant for headache. Osteopathic manipulative treatment may reduce pain input into the trigeminal nucleus caudalis, favorably altering neuromuscular-autonomic regulatory mechanisms to reduce discomfort from headache." The pathology in the neck is addressed to reduce pain (nociceptive) input into the trigeminal nucleus caudalis. The easiest and most direct method of reducing nociceptive input into the trigeminal nerve is a diagnostic orthotic followed by definitive long term treatment. The beauty of neuromuscular dentistry is that correcting the stomatognathic/ trigeminal system leads to auto correction of many neck problems.

The reason that NUCCA and A/O (atlas orthogonal) chiropractic is so effective when used in conjunction with a neuromuscular orthotic is that the chiropractic and/or osteopathic adjustments hold when the underlying masticatory pathology is adressed.



J Am Osteopath Assoc. 2007 Nov;107(10 Suppl 6):ES10-6.
Diagnosing and managing migraine headache.
Mueller LL.

University Headache Center, University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine, 42 E Laurel Rd, University Doctors Pavilion, Ste 1700, Stratford, NJ 08084-1354, USA. SOMPhysicians@umdnj.edu
Comment in:

J Am Osteopath Assoc. 2008 Apr;108(4):191; author reply 191, 214.
Headache is one of the chief complaints among patients visiting primary care physicians. Diagnosis begins with exclusion of secondary causes for headache. More than 90% of patients will have a primary-type headache, so diagnosis can often be completed without further testing. Although tension-type headaches are the most common kind of headache, patients with this type of headache rarely seek treatment unless occurrence is daily. Migraine, which affects more than 30 million people in the United States, is the most common headache diagnosis for which patients seek treatment. Migraine is a chronic, often inherited condition involving brain hypersensitivity and a lowered threshold for trigeminal-vascular activation. Intermittent debilitating attacks are characterized by autonomic, gastrointestinal, and neurologic symptoms. Migraine results in a marked decrease in a patient's quality of life, as measured by physical, mental, and social health-related instruments. Accurate assessment of a patient's disability will guide physicians in prescribing appropriate modes of therapy. However, migraine remains underdiagnosed, and patients with migraine remain undertreated. A comprehensive treatment approach to migraine may include nonpharmacologic measures, as well as abortive and prophylactic medications. Informing patients about realistic treatment expectations, possible delayed efficacy of medications, and avoidance of caffeine and overuse of medications is critical for successful outcomes. Management of migraine is a dynamic process, because headaches evolve over time and medication tachyphylaxis may occur, necessitating changes in therapy. Pathologic findings in the neck constitute an accepted etiology or precipitant for headache. Osteopathic manipulative treatment may reduce pain input into the trigeminal nucleus caudalis, favorably altering neuromuscular-autonomic regulatory mechanisms to reduce discomfort from headache.

PMID: 17986672 [PubMed - indexed for MEDLINE]

Posture correction,PPM Mouthguard, leg length and A/o or NUCCA Chiropractic

Slightly rewritten from an LVI forum post explaining to new neuromuscular dentists the importance of body posture and a few of the ways t can be addressed.

I had the supreme honor of studying with Janet Travell and watched her magically turn long legs into short legs and vice-versa. A trick I picked up from her 30 years ago was to correct the standing leg posture, have the patient walk and correct it again. I use paper towels as temporary orthotics in the shoe. I have the patient take short walks and the readjust the foot orthotic (paper towel). It is done easily by feeling the top of he hips with your finger tips and getting them at eye level (patients love having their doc on his knees) after several adjustments it will stabilize.

I take most of my bites standing so I will do this before taking bite or adj. The bite is essential but is not just a record of upper jaw to lower jaw, but rather a way to capture 3 dimensional body mechanics and jaw relatin simultaneously.

I teach the patient how to do this at home. They need a full length mirror and two marker spots on the top of the hip bone. They stand 4-5 feet back from the mirror and hang a black plumb line in the middle of the mirror and can self adj.their orthotics. Initially they will do this several times a day. I Rx they just buy several diffent Dr Scholl pads an self adj frequently. Sometimes the lift will switch sides more than once while the spine staightens itself.

The second trick is to also check the hip height in the sitting position. We use tushy orthotics to even height of hips sitting. It is crucial to know if the high side changes from sitting to standing because it corkscrews the spine and wreaks havoc on the bite. These are the patients whose Atlas is never stable. We send them for Atlas orthogonal adjustment with a leg correction, We have the leg length checked standing before they leave because it may need a change in the orthotic and we check the sitting orthotic because they are sitting in the car going from one office to the other. We frequently have them keep an aqualizer in their mouth or a coton roll as well so we get a/o aj without having it affected by the bite. It would be a whole lot easier if we could just cut the head off and just deal with the bite.

The patient does the same proceedure with the plumb line but sits on a hard flat chair. The patients keep their tushy orthotics in their car, desk chair, couch etc. For long term correction of structural hip deficiecy I have had patients, usually women have them made from bike pants that the pads are adjusted and "tummy control"

If a patient has a structurally short hip on one side sitting and leg length discrepancy on the other we are guaranteeing long term problems and dental failures in the mouth.

It is vital patients do their ascending correction 24/7 or it is the same effect of our orthotics not being left in. Corrections must be continuous.

When I have a patient and we do the pen test (I use cotton rolls easier to adj to improve results) we show them arm strength and balance with the correction then without. I then correct leg length with something under shoe and repeat the test. They get the same results. We then do a double correction to increae strength and balance more and the we blow them away because they lose strength and balance regardless if we take away the shoe lift or the bite correction. They now completely understand ascending/descending concepts.

Now all we have to worry abut is the AP position of spine from hips to head including pelvic tilt and hip rotation and balancing pecs and rhomboids and the effects on jaw relation.