By: Brian P. Kinmartin, PT, DPT, MTC, OCS, STC, CWcHP, Cert. DN
If you suffer from headaches, jaw pain, neck or facial pain it may be a very treatable condition. Two of the major body regions that contribute towards Cranio-Facial Pain include; The TMJ (Temporomandibular Joint) which is the joint formed between the temporal bone of the skull and the jawbone, and the sub-cranial region which includes the junction between your skull and the first two vertebra in your neck.
The TMJ are among some of the most frequently used joints in the human body. They allow us to talk, chew, yawn, swallow and even sneeze. Approximately 80 million people in the U.S. suffer from some form of TMJ disorder. Many people go to their dentist or orthodontist for treatment of the TMJ through dental work or the use of a dental appliance. This has been proven to be a very effective strategy, however another common factor contributing towards TMJ disorders that is often overlooked is the presence of neck and shoulder dysfunction. The muscles of the neck and shoulders are connected to the jaw, if you have stiffness or misalignment due to abnormal posturing in your neck or shoulders, it can directly affect both the position and the function of your jaw joints, causing irritation to one or both of the TMJ.
Both TMJ must work in coordination with each other in order to allow normal movements of the jaw to occur. The basic motions of the TMJ are to allow the jaw to open and close, protrude (move the bottom jaw forward), retract (move the bottom jaw backwards), and laterally move the jaw right and left. Normal opening of the jaw should be about 35-40 mm. A good test to determine normal opening is being able to fit 2 or 3 of your knuckles into your mouth. If you cannot open your mouth this wide, this may be contributing towards your headaches, facial and neck pain. Other symptoms that your jaw may be contributing towards your headache, neck or facial pain include "clicking" or "popping" when you open or close your jaw, tenderness on either side of the jaw where it meets your skull, or pain with opening, closing or chewing activities.
A few common causes of TMJ dysfunction may include; a trauma to the joint, including a blow to the jaw or head, excessive stress to the joint from gum chewing, fingernail biting, yawning, or grinding teeth, poor bite pattern or malocclusion, postural abnormalities especially due to a forward head posture, previous history of a whiplash injury.
The other main contributor towards Cranio-Facial pain is irritation or dysfunction to the sub-cranial region. A reduction in the space between the head and the first two cervical vertebra can result in a condition known as Occipital Neuralgia. This is a medical condition characterized by chronic pain in the upper neck, back of the head and behind the eyes. These areas of the head correspond to two nerves located in the back of the neck at the base of the skull, the greater and lesser occipital nerves. Compression to either one of these nerves as they penetrate the muscles high up in the neck just under the skull can contribute towards Cranio-Facial pain. This can be caused by any injury affecting the neck, such as whiplash, or poor posture and head position that develops gradually over time.
The main symptom of occipital neuralgia is chronic headache. Other symptoms may include; tenderness and pain at the base of the skull, in one or both sides, aching, burning, and throbbing pain that typically starts at the base of the head and radiates upwards into the scalp, pain behind the eye, sensitivity to light and tenderness throughout the scalp.
Treatment for patients that suffer from Cranio-Facial pain is usually a group effort of many health care providers working together to achieve the best patient outcome. Initial assessment and treatment of the TMJ portion of the dysfunction may include a consultation with a General Practitioner, Dentist, Orthodontist, Periodontist, or an Oral Surgeon. Initial assessment and treatment of the sub-cranial portion of this dysfunction may include a consultation with a General Practitioner or Pain Management Physician. Physical evaluation and treatment of both the TMJ and the sub-cranial region may include a referral by any of the physicians involved in the scope of care to a Physical Therapist that has experience and is qualified to treat both these regions. Physical Therapists are licensed health care professionals that specialize in human anatomy and mechanics, including evaluation, treatment and rehabilitation of the head, neck, spine and extremities. Once you are evaluated by a Physical Therapist and your condition is determined to be Cranio-Facial Pain, treatment for this condition will be a joint effort with your physicians with emphasize on restoration of normal facial and jaw mechanics and decompression of the occipital nerves through improving head position, posture and muscle flexibility and control.
For further information on this or other related topics you can contact Brian P. Kinmartin PT, PT, DPT, MTC, OCS, STC, CWcHP, Cert. DN, (Pawleys Island) (843) 235-0200, Richard A. Owens, PT, MS, OCS, Cert. SHT, CWcHP, Cert DN (Surfside) (843) 831-0163, Richard DeFalco, DPT, OCS, CSCS, CWcHP, Cert. DN (Myrtle Beach) (843) 839-1300, Richard A. Owens, PT, MS, OCS, Cert. SHT, CWcHP, Cert DN (Conway) (843) 733-3031, Richard DeFalco, DPT, OCS, CSCS, CWcHP, Cert. DN (Murrells Inlet) (843) 314-3224, at Professional Rehabilitation Services or visit our website at www.prsrehabservices.com where you can learn more about the company and even download a referral form for your physician to fill out. You can also call and schedule a FREE 15 minute consultation!