Neck Pain

Have you Been Told You Have TMJ Disorder?

~ Dr. Robert Speirs DC ~ Leave a comment

Temporomandibular Disorder (TMD) is a term used to describe a group problems that cause pain in the temporomandibular joint, also called the TMJ. These problems can arise from the muscles around the joint, the disc within the joint or the bony portion of the joint itself. Imbalances between the muscles that open and close your jaw are the most common culprit.


Up to 25% of the population will suffer with TMD symptoms. Most patients are 20-50 years old and the condition is 2-3 times more common in females. Typical symptoms include: jaw clicking, limited mouth opening, possible jaw locking and pain. Chewing and eating usually make your symptoms more noticeable. TMD pain is generally described as an “ache” located in front of your ear canal but may also refer to other areas of your face, head, neck and shoulders. TMD patients often suffer from headaches.

TMD is more common in people who clench their jaw or grind their teeth, especially at night. Bad posture and emotional stress are contributors to this problem. You are three times more likely to suffer with TMD if you have been involved in a “whiplash” accident.

Conservative treatments, like those provided by our office, have been shown to be as effective as any surgery for most patients with TMD. Treatment is simple, focusing on “massaging” tightness out of the jaw muscles, restoring movement to any restricted joints (including your neck and upper back), and prescribing exercises to improve flexibility.

You should avoid aggravating activities like chewing gum or eating “rubbery” foods. Limit excessive talking. A custom fitted mouth guard may be prescribed to help minimize grinding & clenching and promote relaxation of your jaw muscles at night. Patients with night-time symptoms should avoid stressful activity before bedtime and try to sleep in a “neutral” position. In some cases, stress management techniques, like biofeedback, can assist you in learning how to relax your jaw muscles.

Why am I so dizzy after my whiplash?

~ Dr. Robert Speirs DC ~ Leave a comment

Migrane​

Whiplash, or better termed “Whiplash Associated Disorders” (WAD), is a condition that carries multiple signs and symptoms ranging from neck pain and stiffness to headache, confusion, ringing in the ears, and more. But can WAD cause dizziness? Let’s take a look!

Dizziness is a general term that is used rather loosely by the general population. We’ve all experienced dizziness from time-to-time that is considered “normal,” such as standing up too quickly or while experiencing a rough flight.

Often, dizziness and problems with balance go hand in hand. There are three main organs that control our balance: 1) the vestibular system (the inner ear); 2) the cerebellum (lies in the back of the head); and, 3) the dorsal columns (located in the back part of the spinal cord). In this article, we will primarily focus on the inner ear because, of the three, it’s unique for causing dizziness. Our vision also plays an important role in maintaining balance, as we tend to lose our balance much faster when we close our eyes.

It’s appropriate to first discuss the transient, usually short episode of “normal” lightheadedness associated with rising quickly. This is typically caused by a momentary drop in blood pressure, and hence, oxygen simply doesn’t reach the brain quick enough when moving from sitting to standing. Again, this is normal and termed “orthostatic hypotension” (OH).

However, OH can be exaggerated by colds, the flu, allergy flair-ups, when hyperventilating, or at times of increased stress or anxiety. OH is also associated with the use of tobacco, alcohol, and/or some medications. Bleeding can represent a more serious cause of OH such as with bleeding ulcers or some types of colitis, and less seriously, with menstruation.

The term BPPV or benign paroxysmal positional vertigo, has to do with the inner ear where our semicircular canals are located. The canals lie in three planes and give us a 3D, 360º perspective about where we are in space. The fluid flowing through these canals bends little hair-like projections, which are connected to sensory nerves that tell the brain about our spatial position. If the function of these canals is disturbed, it can mix-up the messages the brain receives, thus resulting in dizziness. Exercises are available on the Internet that can help with BPPV (look for Epley’s and Brandt-Daroff exercises).

DANGEROUS causes of dizziness include: HEART – fainting (passing out) accompanied by chest pain, shortness of breath, nausea, pain or pressure in the back, neck, jaw, upper belly, or in one or both arms, sudden weakness, and/or a fast or irregular heartbeat.

STROKE – sudden numbness, paralysis, or weakness in the face, arm, or leg, especially if only on one side of the body; drooling, slurred speech, short “black outs,” sudden visual changes, confusion/difficulty speaking, and/or a sudden and severe, “out of the ordinary” headache. CALL 911 (or the number for emergency services if you’re outside the Canada) if you suspect you may be having a heart attack or stroke!

Trigger points in the rhomboid muscles.

~ bryancobb ~ Leave a comment

This is another common muscle to get trigger points. It originates on the spinous processes of the T2-T5 vertebrae. It inserts on the medial border of the scapula. It’s main actions are to adduct the scapula pulling it back toward the spine, and to rotate the glenohumeral joint downward. This muscle also prevents wining of the scapula. This muscle is often overloaded by a sitting posture where the shoulders are rolled forward such as when using a computer. The Rhomboids are often weak and under trained in people. Trigger points in this muscle cause pain and ache in the upper back between the shoulder blade. Strength trading for this muscle is necessary to help prevent postural overload.

How can I calm down my WAD symptoms?

~ Dr. Robert Speirs DC ~ Leave a comment

Cervical Strain

​Whiplash is really a slang term for the rapid back and forth whipping of the head on the neck, usually associated with motor vehicle accidents. The title “Whiplash Associated Disorders”, or WAD, describes it best because it includes ALL of the MANY signs and symptoms of the disorder.

WAD basically comes in three sizes based on the degree of injury. A WAD I is present when there is pain but no physical examination findings; WAD II occurs when there are exam findings but no neurological loss (numbness or weakness); and WAD III includes loss of neurological function.  There is also a separate WAD level that includes fractures and dislocations (WAD IV).

There are many things that can be done by the patient to assist in the healing process for WAD. The first well-studied recommendation is to “continue with your usual activities.” Try to keep active and not change your routine. The good news is that WAD (especially types I and II) usually resolves without complication, and recovery is even more likely to occur if you don’t deviate much from your routine.

For those whose symptoms are more severe and/or not resolving, mobilization and manipulation of the neck and back are very effective treatment options. In addition to treatments you’d receive in a chiropractic office, there are MANY things you can do at home as “self-help strategies.” Some of these include (“PRICE”):

1)  PROTECT: Though it’s important to continue with your usual daily activities, this is dependent on both the degree of tissue injury and your pain tolerance. So do as many of your usual daily activities as possible, but AVOID those that result in a sharp, lancinating type of pain or those where recovery from the pain is delayed.  Therefore, this category may require modifying your ADLs (activities of daily living). A cervical collar (hard orsoft) should NOT to be used UNLESS you have an unstable injury (fracture or a grade III sprain).

2)  REST: Doing too much is like picking at a cut (which can delay healing) and doing too little can lead to a delayed healing response as well. Staying within reasonable pain boundaries is a good guide.

3) ICE > HEAT: Ice reduces swelling, and your doctor will typically recommend it over applying heat, especially on a recent injury. Heat draws fluids in, and while it may feel good, it can make your symptoms worse.

4)  COMPRESS: We can basically ignore this when referencing neck pain. This pertains better to wrapping an ankle, knee, wrist, or elbow with an elastic compression orthotic or brace.

5)  ELEVATE: This too is meant for the acute stages of an extremity injury like a foot or ankle.

Exercises unique for neck pain in the acute, subacute, and chronic stages of healing are perhaps the most important of the self-help approaches. In the ACUTE phase, try these…

1)  Range of Motion: Once again, stay within “reasonable pain boundaries” as you move your head forwards, backwards, side to side, and rotate left and right. These can be done either with or without LIGHT resistance applied using one or two fingers placed against your head. Limit the repetitions to three slow reps in each direction and emphasize the release of the movement.

2)  Chin/head Glides: Tuck in the chin (think of creating a double or triple chin) followed by poking the chin/head out.

In the SUBACUTE and CHRONIC phases of healing, the importance of strengthening the deep neck flexors cannot be over emphasized. Please refer to last week’s article for a description of this (see #3 of the 6 recommendations listed).

Trigger points in the trapezius muscle.

~ bryancobb ~ Leave a comment

The trapezius muscle is a large diamond shaped muscle in you mid/upper back and neck. This muscle is one of the most common sites where trigger points can form. This muscle originates on the Nuchal ligament and the spinous processes of C6-T12. It inserts on the spine of the scapula, the acromion process, and the distal clavicle. The upper fibres elevate the shoulder and rotate the glenoid fossa (shoulder socket) upward. The lower fibres assist this motion as well as help depress the shoulder. The middle fibres of this muscle strongly adduct the scapula. This muscle is susceptible to postural overload such as sitting at desk all day. Trigger points on the lateral upper edge refer into the lateral neck and temples, causing “tension neck ache”as well as headache pain.Trigger points in the middle and lower fibres refer pain into the posterior neck and shoulder.

How long does Whiplash last?

~ Dr. Robert Speirs DC ~ Leave a comment

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First, what is whiplash? It’s a lot of things, which is why the term WAD or Whiplash Associated Disorders has become the most common term for the main signs and symptoms associated with a whiplash injury. WAD is usually associated with a motor vehicle collision, but sports injuries, diving accidents, and falls are other common ways to sustain a WAD injury.

To answer the question of the month, in most cases, the recovery rate is high and favors those who resume their normal daily activities. The worse thing you can do when you sustain a WAD injury is to not do anything! Too much rest and inactivity leads to long-term disability. Of course, this must be balanced with the degree of injury, but even when the injury requires some “down time,” stay as active as possible during the healing phase.

Many people recover within a few days or weeks while a smaller percentage require months and about 10% may only partially recover. So what can be done to give you the best possible chance to fully recover as soon as possible?

During recovery, you can expect your condition to fluctuate in intensity so “listen” to your body, let it “guide” you during activity and exercise, and stay within “a reasonable boundary of pain” during your activity. Remember, your best chance for full recovery FAVORS continuing a normal lifestyle. Make reasonable modifications so you can work, socialize, and do your “normal” activities!

The KEY: Stay in control of your condition – DO NOT let it control you! Here are some tips:

1)  POSTURE CONTROL: Keep the weight of the head back by gliding your chin back until you “hit” a firm end-point. Then release it slightly so it’s comfortable—this is your NEW head position!

2)  FLEXIBILITY: Try this range of motion (ROM) exercise… Slowly flex your neck forwards and then backwards, then bend your neck to the left and then the right, and then rotate it to the left and to then to the right. THINK about each motion and avoid sharp, knife-like pain; a “good-hurt” is okay! Next, do the same thing with light (one-finger) resistance in BOTH directions. Try three slow reps four to six times a day!

3)  MUSCLE STRENGTH: Try pushing your head gently into your hand in the six directions listed above to provide a little resistance. Next, reach back with both hands or wrap a towel around your neck and pull forwards on the towel while you push the middle of your neck backwards into the towel doing the chin-tuck/glide maneuver (same as #1). Repeat three to five times slowly pushing, and more importantly, release the push slower! This is the MOST IMPORTANT of the strengthening exercises in most cases! Next, “squeeze” your shoulder blades together followed by spreading them as far apart as possible (repeat three to five times).

4)  PERIODIC BREAKS: Set a timer to remind yourself to do a stretch, get up and move, to tuck your chin inwards (#1) and do some of #2 and #3 every 30-60 minutes.

5)  LIFTING/CARRYING/WORK: Be SMART! Do not re-injure yourself. Change the way you handle yourself in your job, in the house, and while performing recreational activities.

6)  HOUSEHOLD ACTIVITIES: Use a dolly to move boxes and keep commonly used items within easy reach (not too high or low).

Be smart, stay educated, work within the range your body tells you is “safe” and most importantly, STAY IN CONTROL!!!

Trigger points in the Levator scapula

~ bryancobb ~ Leave a comment

The Levator scapula is a muscle in your neck that originates on the transverse processes of C1-C4 and inserts on the superior part of the medial border of the scapula. The primary actions of this muscle are to elevate the scapula and rotate the glenoid fossa downward. It also rotates the neck to the same side and assists in extension. When this muscle is tight it restricts neck rotation resulting in the classic “stiff neck”. With a forward head position the Levator is often stretched and over worked. To help combat this you must get the head back by releasing the anterior chest and neck muscles. Trigger points in this muscle refer pain into the angle of the neck and down the shoulder blade.

A Few Sleep Tips From Us To You

~ Dr. Robert Speirs DC ~ Leave a comment

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Your mattress and the position you sleep in may affect your spine.

✓ Choose a mattress that provides medium or firm support, such as a traditional coil spring or adjustable airbed. Avoid waterbeds, thick pillow tops and soft, sagging mattresses.
✓ Always sleep on your back with a pillow either underneath your knees or on your side with a pillow between your knees. Avoid sleeping on your stomach.
✓ Keep your neck and back covered while sleeping to avoid drafts that could cause potential muscle spasms.

Here are a couple of tips to help you get in and out of bed more comfortably:
✓ To lie down: Sit on the edge of the bed, pull your arms to your sides and tilt your body into the bed, maintaining the bend of your knees at 45 degrees. Finally, bring your feet into in a lying position or roll onto your back.
✓ To get up: From a side-lying position with your knees bent, push your body upright into a sitting position, swinging your legs over the edge of the bed as you rise.

If you find that you wake up sore then you may be suffering from any number of conditions that get worse overnight.

Workstation Ergonomics

~ Dr. Robert Speirs DC ~ Leave a comment

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Ergonomics is the science of adjusting your workstation to minimize strain in the following ways:

✓ Maintain proper body position and alignment while sitting at your desk – Hips, knees and elbows at 90 degrees, shoulders relaxed, feet flat on floor or footrest.
✓ Wrists should not be bent while at the keyboard. Forearms and wrists should not be leaning on a hard edge.
✓ Use audio equipment that keeps you from bending your neck (i.e., Bluetooth, speakerphones, headsets).
✓ Monitors should be visible without leaning or straining and the top line of type should be 15 degrees below eye level.
✓ Use a lumber roll for lower back support.
✓ Avoid sitting on anything that would create an imbalance or uneven pressure (like your wallet).
✓ Take a 10-second break every 20 minutes: Micro activities include: standing, walking, or moving your head in a “plus sign” fashion.
✓ Periodically, perform the “Brugger relief position” (See video below) -Position your body at the chair’s edge, feet pointed outward. Weight should be on your legs and your abdomen should be relaxed. Tilt your pelvis forward, lift your sternum, arch your back, drop your arms, and roll out your palms while squeezing your shoulders together. Take a few deep cleansing breaths.

Trigger points in the masseter muscle

~ bryancobb ~ Leave a comment

The masseter is the main muscle that moves your jaw. It originates on the zygomatic arch and maxilla, and inserts on the coronoid process and Ramus of the mandible. It’s actions are to elevate the mandible and close the jaw. The deep fibres of this muscle also retrude the mandible. This muscle commonly harbours trigger points as a result of teeth grinding. Trigger points in this muscle are often also associated with tmj dysfunction. Trigger points in the upper part of this muscle will refer pain to the upper molars and maxilla often felt as sinusitis. Trigger points in the lower portion of this muscle refer to the lower molars and temple. All trigger points can cause tooth sensitivity