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Temporomandibular Joint Disorder

Temporomandibular joint disorder, or dysfunction, (TMD) is a common condition that limits the natural functions of the jaw, such as opening the mouth and chewing. It currently affects more than 10 million people in the United States. It is sometimes incorrectly referred to as simply “TMJ,” which represents the name of the joint itself.  The temporomandibular joint (TMJ) is a hinge joint that connects your jaw to your skull in front of your ear. The TMJ guides jaw movement and allows you to open and close your mouth and move it from side to side to talk, yawn, or chew.

What causes TMD?

TMD causes range from poor posture, chronic jaw clenching, and poor teeth alignment, to fracture or conditions such as lockjaw, where the muscles around the jaw spasm and reduce the opening of the mouth.

How Can a Physical Therapist Help?

Physical therapists can help people with TMD by easing pain, regaining normal jaw movement, and lessening daily stress on the jaw. A physical therapist will select individualized treatments that work best to improve your symptoms. Treatments can include posture education, manual therapy, trigger point dry needling, pain modalities, and strengthening exercises. If you think you have symptoms associated with temporomandibular joint disorder, contact your physical therapist!

Resources:

Manipulation

There has been much discussion concerning manipulation as a method of treatment. Alternative medicine providers, chiropractors, use this method for treatment to promote health by releasing tensioned nerve tissue from vertebrae that have ‘subluxed’. This adjustment is meant to relieve the nerve tension and impaired neural impulses can resume their normal function. Claims that impinged nerve tissue that can cause anything from asthma to colic to chronic disease can be relieved by manipulation are less then genuine. 

Nerve tissue, that are either contained in the spinal canal or exiting through a foramina- a recessed passageway in bone, pass along messages to and from the spinal cord to muscles and a host of sensors in skin and joints. Obstruction of neural tissue can occur from serious vertebral disc herniation or other peripheral injury such as injured bone, muscle, and connective tissue.

Fans of manipulation often state the immediate relief they get from this procedure, this relief is from a phenomena known as cavitation. Cavitation is the passage of a vapor though a liquid medium to an area of lower pressure. In a manipulation, the patient experiences a popping sensation and a mechanical receptor in the joint is stimulated. This stimulation imparts a relaxation response which is fed back through the spinal cord to the brain and back down sensory nerves called efferents that all is well.

Manipulation has been shown to be an effective method for back problems within 30 days of incident, as per the Agency for Healthcare Research and Quality. However, some practitioners use this as a method for health maintenance and that it must be a regularly repeated in order to stay ‘healthy’. There has been no substantial evidence to support this idea.

We can't stop time. But with the right type and amount of physical activity, we can help stave off many age-related health problems and live life to its fullest. Physical therapists are movement experts who can help you optimize quality of life through prescribed exercise, hands-on care, and patient education.

Here are 9 things physical therapists want you to know to age well:

1. Chronic pain doesn't have to be the boss of you.

According to the Centers for Disease Control and Prevention (CDC), in 2016, an estimated 20.4% (50 million) US adults experienced chronic pain, contributing to indirect medical costs, lost work time, and wages. Physical therapist-supervised exercise, mobility, and pain management treatment plans can ease pain while moving and at rest, improving your overall quality of life.

2. You can get stronger when you're older.

Research shows improvements in strength and physical function are possible in your 60s, 70s, and even 80s and older, with an appropriate exercise program. Progressive resistance training, in which muscles are exercised against resistance that gets more difficult as strength improves, has been shown to prevent frailty.

3. You may not need surgery or medication for low back pain.

Low back pain is often overtreated with surgery and medications despite a wealth of evidence demonstrating physical therapy can be an effective alternative—and with much less risk.

4. You can lower your risk of diabetes with exercise.

Nearly 30 million Americans have diabetes, and only 21 million know they have it. Obesity and physical inactivity can put you at risk for this disease. But a regular appropriate physical activity routine is one of the best ways to prevent, and manage, type 2 diabetes.

5. Exercise can help you avoid falls—and keep your independence.

About 1 in 4 US older adults fall each year. Despite this statistic falling is not a normal part of aging, and you can reduce your risk of falls. A physical therapist can help assess your risk, design an individualized prevention plan to include exercises and balance training, address underlying medical conditions, and more.

6. Your bones want you to exercise.

Osteoporosis or weak bones affects more than half of Americans over the age of 50. Exercises that keep you on your feet like walking, jogging, or dancing, and resistance exercises, such as weightlifting, can improve bone strength or reduce bone loss.

7. Your heart wants you to exercise.

Heart disease is the number 1 cause of death in the US. Exercise is one of the top ways of preventing it and other cardiovascular diseases. Research shows that if you already have heart disease, appropriate exercise can improve your health.

8. Your brain wants you to exercise.

Physically active people—even later in life—are less likely to develop memory problems or Alzheimer's disease, a condition affecting more than 40% of people over the age of 85.

9. You don't "just have to live with" bladder leakage.

More than 13 million women and men in the US have bladder leakage. Don't spend years relying on pads or rushing to the bathroom. Learn more about treatment from a physical therapist.

Craniofacial Therapy

Craniofacial therapy is a manual therapy technique used by physical therapists to mobilize neural tissue found within the skull.  The basic tenant behind craniofacial therapy is that the skull is essentially a pressurized vessel in which blood and cerebrospinal fluid exerts outward pressure.  The point of this therapy is to redirect pressure thorough accessory movements of the skull plates and facial bones to mobilize neural tissue and relieve symptoms.

Sometimes you can see the results of this pressure vessel phenomena in facial asymmetries of people you may have seen. One side of the jaw may be longer than the other, an eye may be higher or lower than the other, a cheek bone may be higher or lower. This does not necessarily indicate an immediate problem, but neurodevelopmental problems may develop in the young and jaw or hearing problems can occur in adults.

As a result of this stress-transducer system, neural tissue can become trapped, producing pain, headaches and even vertigo. This can happen in the part which holds the brain known as the neurocranium and the anterior facial bones, the viscerocranium. The therapist then evaluates the accessory movements of the facial or skull bones for immobility and therapy is directed to changing the abnormal accessory movement, thus releasing trapped nerve tissue. In the case of facial asymmetries, they may become less noticeable.

September 26, 2019: When Jen Bambrough was 19 years old, she did not think much of the car accident she was in. It was basically a fender bender, and she initially seemed none the worse for wear. Over time, though, a physical toll revealed itself. The young woman experienced chronic pain that limited her activities and compromised her quality of life. Because the root of her pain couldn’t be readily detected, however, she faced skepticism in the medical community and experienced misdiagnoses.

Sadly, that’s not unusual. Headlines and studies say it all: In 2017, the magazine The Atlantic ran an interview with a leading bioethicist titled, “The Long History of Discrimination in Pain Medicine.” Four years earlier, the peer-reviewed journal Pain Management Nursing published a broad narrative review on the impact of disbelief toward patients with chronic pain.

In this episode of Move Forward Radio, Jen discusses how she became a strong self-advocate and gained a considerable measure of relief from her pain. She also talks about how physical therapy is an essential piece of the pain management puzzle. She even pursued a career as a physical therapist to help ensure others don’t endure what she did.

Since earning her doctor of physical therapy degree and license as a physical therapist in the state of Tennessee, Jen has been involved in efforts to raise awareness of the benefits of physical therapy through the American Physical Therapy Association, and even attended a congressional briefing to speak to members of the House of Representatives. She and her husband live in Chattanooga and enjoy an outdoor lifestyle of rock climbing, hiking, stand-up paddleboarding, and yoga.

Here is a link to a 16 minute podcast about Jen’s story:

https://aptacasts.com/2019/09/25/physical-therapy-an-important-piece-of-the-pain-management-puzzle/ 

What is Cervical Radiculopathy?

Cervical radiculopathy occurs when a nerve root coming off the spinal cord becomes compressed. The compression can occur for various reasons. In younger people, it may occur when a cervical disc herniates due to trauma. In older individuals, it commonly occurs spontaneously as a result of arthritis or decreased disc height in the neck region.

When the spinal nerves are impinged, they cannot properly send messages to the muscles from the brain, nor receive proper sensation from the specific arm location the nerve travels. Everywhere the spinal nerve travels will be affected. That is why a pinched nerve in the neck can cause pain, weakness, and loss of sensation in the arm, even though the pinch is in the cervical region.

How Does it Feel?

Symptoms of cervical radiculopathy vary depending on the nerve root involved, and commonly occur on the same side of the body as the affected nerve. The symptoms may include:

Pain in the neck, shoulder blade, shoulder, upper chest, or arm, with pain possibly radiating into the fingers following the path of the involved nerve root.

Pain described as "sharp" or "pins-and-needles" or “popping sensation” in cervical region.

General dull ache or numbness anywhere along the pathway of the nerve.

Weakness in the shoulder, arm, or hand.

Pain that worsens with certain neck movements.

Pain that improves when the arm is lifted over and behind the head (relieving tension on the spinal nerve).

How Is It Diagnosed?

The most accurate diagnosis is done by magnetic resonance imaging (MRI) or electromyography (EMG). An MRI can show soft tissues, including the spinal cord and nerve roots. This test can determine what is causing the compression on the nerves, including disc bulges or disc herniation. An EMG measures the nerve and muscle function. This test can tell how well your spinal nerves are communicating to your muscles.

How Can a Physical Therapist Help?

Your physical therapist will develop an individual treatment plan based on the findings of your initial evaluation. The treatment plan may include:

Pain Management. The first goal is to reduce the pain and inflammation in the area. Ice packs and rest help within the first few days. A cervical contoured pillow may be recommended to properly support the neck, and allow you to sleep more comfortably.

Manual Therapy. Your physical therapist may use manual therapy techniques to relieve pressure in the cervical (neck) region. This procedure can provide immediate relief of pain and numbness radiating into the arm. Gentle massage may also be performed on the muscles of the cervical spine and scapular (shoulder blade) region. This technique helps the muscles relax and improves circulation to the area, promoting healing and pain relief.

Posture Education. Your physical therapist may suggest adjustments to your workstation and work habits, to promote good posture to protect your neck. In the early stages of recovery this may mean sitting only 15 to 20 minutes at a time.

Range-of-Motion Exercises. Your physical therapist will teach you gentle cervical mobility exercises to relieve your symptoms, and allow you to return to normal movement. In the beginning stages of recovery, it is important that none of these exercises increase the pain radiating down into your arm. If you spend many hours sitting at a desk during your workday, your neck may become stiff. Your therapist will teach you neck stretches to take pressure off of your neck from extended periods of sitting, to help improve your mobility.

Strengthening Exercises. Your physical therapist will help you determine which muscle groups need to be strengthened based on which spinal nerves are involved in your particular case. 

Functional Training. As your symptoms improve, your physical therapist will work on functional exercises to help you return to your job, sport, or other daily activities. For example, if your job duties require overhead reaching, pushing, pulling, and long periods of sitting, you will be taught ways to perform these tasks to reduce undue stress to the neck.

Benign Paroxysmal Positional Vertigo (BPPV)

Every year, millions of people in the United States develop vertigo, a sensation that you or your surroundings are spinning. The sensation can be very disturbing and may increase the risk of falling. If you've been diagnosed with benign paroxysmal positional vertigo (BPPV), you're not alone—at least 9 out of every 100 older adults are affected, making it one of the most common types of episodic vertigo. The good news is that BPPV is treatable. Your physical therapist will use unique tests to confirm vertigo, and use special exercises and maneuvers to help.

What is BPPV?

Benign paroxysmal positional vertigo is a common inner-ear problem affecting the vestibular system, a system used to maintain balance. BPPV causes short periods of dizziness when your head is moved in certain positions, relative to gravity. Benign means that this disorder is not life threatening, and generally, the disorder is not progressive. Paroxysmal means that the vertigo (spinning sensation) occurs suddenly. Positional means that the vertigo is triggered by changes in head position, most commonly when lying down, turning over in bed, or looking up. This dizzy or spinning sensation is called vertigo. Vertigo symptoms can last from seconds to a couple of minutes at a time. Vertigo episodes can occur frequently for weeks or months.

How Can a Physical Therapist Help?

Fortunately, most people can recover from BPPV with the help of a physical therapist. Your physical therapist will assess your vestibular system function, and choose an appropriate intervention to improve your symptoms. The treatment for BPPV usually consists of very specific head and neck maneuvers, performed by your physical therapist. If you think you may have symptoms associated with BPPV, please contact your physical therapist!

Words that harm: Degenerative Disc Disease

Imagine this common scenario: you develop a case of low back pain and it doesn’t go away after a couple of weeks. You decide to see your primary care provider, who calls for standard X-rays. When the results come back your doctor diagnoses you with “degenerative disc disease.” 

What runs through your mind when you hear this term? 

Disease. 

No one wants to be diagnosed with a disease, especially when it’s in your spine. How scary does that sound? This may lead you to seek injections, medications or even surgical management to “fix” the problem. 

In actuality, degenerative disc disease is NOT a disease but rather a normal aging process, much like gray hair or wrinkles. Every human spine undergoes some degree of degeneration with age, the vast majority of which does not correlate with pain. A recent study found that 37% of people in their 20s who didn’t have symptoms showed some degree of degeneration through their discs. This increased to 96% in asymptomatic people in their 80s. Remember, all people in this studies did not have pain and spinal changes were found incidentally. 

As a physical therapist, I see a lot of people who hear radiological diagnoses as a reason for people’s back pain. These terms create a lot of fear and mismanagement of what we know to be a normal aging process. In reality, degenerative disc disease may or may not be causing your back pain but is likely creating confusion and fear. 

The American Academy of Orthopedic Manual Physical Therapists (AAOMPT) has taken the official stance that the medical community drop this misleading term. “The majority of spinal pain is self-limiting and can be managed appropriately without the need for medications or risky procedures (injection, surgery, etc.). For those individuals who do need care, AAOMPT supports and encourages early physical therapy interventions with known effectiveness instead of high-risk procedures and medication, and strongly recommends that clinicians avoid using the diagnosis of degenerative disc disease. Orthopedic Manual Physical Therapists are frontline providers for patients with low back pain who can provide early evidence-based low risk noninvasive care that empowers the patient to successfully manage their back pain.” 

From Pregnancy to Menopause: 4 Ways Physical Therapy Helps Women’s Health

When you think of physical therapy, what comes to mind? You might think of treatment for replacement surgeries or sports-related injuries. But what about women’s health?

Here are four common ways that physical therapists (PTs) treat women’s health:

1. Childbearing

Supporting the weight of the baby, hormone changes, and lack of core strength can affect a woman during pregnancy. Many women assume these are permanent changes they must learn to cope with in the long-term. But that’s not true. PTs can help with many related issues, including:

Body mechanics and flexibility

Safe exercise plans before and after childbirth

Improving the function of pelvic muscles

Incontinence

2. Gastroenterological and urological conditions

Conditions that fall under these categories, such as bowel incontinence and constipation, are often ones that women do not feel comfortable discussing or may not even know that these issues can be treated. Women’s health PTs have specialized education and expertise and frequently help women with these issues.

3. Pelvic floor dysfunction and gynecological conditions

Pelvic organ prolapse, pelvic pain, and pain with sexual intercourse are some of the issues that many women deal with silently. PTs can help with solutions that often do not involve surgery or long-term use of prescription medications.

4. Menopause

Menopause can mean significant changes for a woman, including weight gain, insomnia, and hot flashes. PTs can design an aerobic exercise plan to help with those effects while also improving strength and balance, which in turn helps with building muscle and maintaining bone density.

Multiple sclerosis (MS) is a condition that affects the body’s central nervous system (CNS). By the latest estimates, over 2.5 million people worldwide have MS.

It’s a disorder that causes your body’s immune system to attack myelin, a coating that insulates some of your nerve fibers. This process is known as demyelination. When myelin is damaged or destroyed, it affects the nerve impulses traveling to and from the brain and spinal cord, causing a wide variety of symptoms in MS.

MS affects your brain, spinal cord, and optic nerves in your brain resulting in symptoms such as:

Trouble walking

Feeling tired

Muscle weakness or spasms

Numbness and tingling

Blurred or double vision

Poor bladder or bowel control

Pain

Depression

Problems focusing or remembering

Physical therapy treatments for multiple sclerosis

However, with Physical Therapy there are ways around all of this through proper treatments. Physical therapists can help through exercises like stretching to ease muscle spasms and figuring out your limitations as far as what you can do in life.

Physical therapists can be very helpful for patients with MS. Treatment for MS may include:

MS medication — disease modifying drugs

Medication to manage symptoms

Occupational therapy can help you make adaptations to make everyday tasks easier

Self-management techniques such as learning to pace yourself

Aids, assistive devices and equipment

A speech therapist to help you if you have trouble with speech

Stress management techniques

Talking therapies for depression

Diet

Exercise

Vitamin D — which dampens overactive immune responses and also protects brain cells

If you are someone you know has been diagnosed with MS call us at Wind City Physical Therapy to get relief from your symptoms.

Physical Therapy for Falls

Falls can diminish your ability to lead an active and independent life. About one third of people over the age of 65 and almost half of people over the age of 80 will fall at least once this year. Falls cause everything from scrapes and bruises to broken arms, and 95% of hip fractures. Falls lead to more than 700,000 hospitalizations per year with medical costs exceeding $30 billion. Research shows that the dangerous consequences of a fall can be prevented with the help of a physical therapist.

Risk Factors for a Fall

The more risk factors you have, the greater your risk. The factors associated with the greatest fall risk are:

A history of previous falls

Balance problems

Leg muscle weakness

Vision problems

Taking more than four medications or psychoactive medications

Difficulty with walking

How Physical Therapy Can Help

If you are worried about falling or if you recently had a fall, your physical therapist can help! First, your physical therapist will conduct a thorough assessment of your fall risk. Based on the results, they will design an individualized exercise program to improve your balance and strength. A physical therapist can also educate you about the medical risk factors linked to falls, and help you make your home as safe as possible. If you are concerned you have an increased risk for falling, please contact your physical therapist!

Resources:

http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=85726fb6-14c4-4c16-9a4c-3736dceac9f0#HowCanPhysicalTherapistHelp

I signed up to do a 72-hour adventure race in Florida in February. This is very exciting, especially since I am training in Wyoming, for a race in a warm, humid climate. Oh well, what’s a girl to do when she likes to challenge herself with athletic endeavors. As I thought about some fun ways to train, snowshoeing kept rising to the top of the list.  

During the winter season, it’s important to keep exercising—even though it’s cold. Snowshoeing allows you to relax and take in the sights, or power through and get a good cardio workout in.  Snowshoeing is one of the simplest ways to get out and explore the beautifully snow-blanketed landscape that abounds in Wyoming. Casper has an amazing system of groomed, partially groomed and ungroomed trails so you can snowshoe to your heart’s content.

Like running, snowshoeing can be enjoyed in solitude or as a group activity. People of all ages can enjoy the sport together—the learning curve of snowshoeing is much less steep than that of skiing or snowboarding.

Here are the basics for your first-time snowshoeing:

Snowshoes: Before you go out and have fun on the trails, you’ll want to make sure that you have the right snowshoes. There are different types of snowshoes depending on the terrain - Recreational, Backcountry, and Racing. Recreational shoes are best for families and beginners. Backcountry shoes are built for just that, and work for people who blaze their own trails. Racing shoes are for those athletes looking to diversify their winter training on snowshoe trails.  Rental snowshoes are inexpensive and easy to find, and there’s no expert training needed to start — just put one foot in front of the other.

Wear suitable boots and socks: The good news is that snowshoes adjust to fit pretty much any type of boot or shoe. So, your main concern is to wear something that keeps your feet comfortably warm and dry. Insulated, waterproof winter boots with thick soles and rubber or leather uppers are ideal, but sturdy waterproof leather hiking boots can also work. Wool or synthetic socks that wick sweat is a must—carry an extra pair in case yours get soaked.

Dress in (non-cotton) layers: As always when exercising outdoors, dress in layers so you can adjust your clothing to suit your activity level and the weather. Avoid cotton because it can get soaked and chill you, and instead choose synthetics or wool styles because they wick moisture and retain warmth even when wet. Note: Cross-country ski clothing is designed for aerobic winter activity, and can do double-duty as snowshoe clothing.

Base layer: Choose a lightweight or mid-weight base layer based on the temperature forecast and your activity level. A zippered top lets you vent as you heat up and zip up for warmth during rest stops.

Mid layer: Soft-shell jackets and pants make good insulating mid-layers because they retain heat when wet, move freely and breathe as you exercise. Polyester fleece mid-layers can also work in a pinch.

Outer layer: For your outer layer, choose a waterproof, breathable shell jacket and pants to help keep you dry, and fend off wind. Pit zips are a good idea for added ventilation because you’ll be working up a sweat and you don’t want to overheat.

Hat and gloves/mittens:  Keep your head and hands covered to prevent loss of body heat and to protect from sunburn. A wool or synthetic hat, headband or balaclava retains heat during cold, blustery days; a wide-brimmed hat or a ball cap can shade your eyes on sunny days. Waterproof ski gloves or mittens are a must to keep your hands dry and warm. You can also combine waterproof/breathable shells with wool liners or light fleece gloves. In milder conditions, glove liners may be all you need, but have a backup waterproof pair with you, just in case.

Bring adjustable poles with snow baskets (optional, but recommended)

Sunglasses and sunscreen will protect you from UV rays, which are more intense when reflected off of snow, and can cause both sunburns and snow blindness.

Gaiters keep snow out of your boots. For deep powder, you need a high style with waterproof/breathable fabric.

Snowshoe Trail Etiquette

To ensure all winter sports enthusiasts have a great time, here are a few snowshoeing tips. When you are snowshoeing:

Do your research before choosing a trail or heading into the backcountry to ensure you’re prepared. Trails may have restrictions on certain winter sports, uses, and pets. Additionally, backcountry areas may have seasonal closures or safety restrictions.

Follow Leave No Trace principles whether on a trail or in the backcountry. If you bring it in, pack it out.

It’s okay to go off-trail when snowshoeing. Just be mindful to choose areas with ample snowfall and avoid areas where plants are peeking out of the snow to preserve vegetation.

Avoid stepping on ski or machine-made tracks with your snowshoes. Instead, walk next to the tracks or break your own trail.

The faster hiker always has the right of way. Step to the side if faster hikers are behind you.  Allow the downhill hiker/skier proceed first.

Consider and understand your limits.

In relation to planning ahead, there is nothing wrong with a half-hour hike – planned 15 minutes out and 15 minutes back. Shorter hikes are great, especially if you are trying out new snowshoes or are unsure of your endurance level.

By starting slowly and planning for short routes, you can build up your level of adventure once you gain confidence and ability. It’s important to listen to your body and plan your snowshoeing adventure in accordance with any injuries or illnesses as well.

Hydration is not just for summer sports.

While hydration is a keyword connected to many summer activities, and while most hikers would never head out on an adventure without a bottle of water, the same consideration is not given to winter activities and it should be.

Just because you don’t feel as thirsty when the weather is cold, that doesn’t mean your body isn’t using and losing water. Cold, dry air will work to dehydrate you more quickly and you will still sweat under your layers, even if you don’t feel hot.