A recent article (pubmed abstract below) on chronic neck pain should be of great interest to anyone suffering from chronic neck pain, cervicogenic headaches and / or TMJ (TMD). It is well understood that there are postural implications to both of these disorders and that much of the pain is actually muscular in origin. So what is the place of prolotherapy or proliferation therapy in treating cervical or TMJoint pain.
See my Highland Park website http://www.thinkbetterlife.com for more information on these topics.
The answer is in stability. There are numerous functions of the muscles besides moving our body parts. Muscle Splinting occurs when the muscles tighten to protect an injured joint. This is a fantastic ability of muscles but when they do it for a long time they experience chronic muscle shortening and develop taut bands and/ or trigger points. This is one possible origin of a case of Myofascial Pain and Dysfunction. Too much of a good thing creates a problem. The reason it is so important that the neck and jaw be treated together is for healing of ligament laxity.
I utilize Prolotherapy to tighten lax ligaments but we must also remove the repetitive strain injuries that create lax ligaments.
The following paragraphs by my friend Dr Mark Freund address the compilex relationship of jaw to neck. Add in ligament laxity and the pot starts to boil.
How can my neck pain be TMJ Dysfunction?
Your jaw has a very powerful influence on the structure and posture of your body. Your body has an innate responsibility to preserve your teeth. Imagine if your bite was so far off that your teeth constantly met so poorly that you started to crack all your teeth and eventually lost all of them. You would most likely starve to death without repairs or dentures. Now imagine what your body does instinctively to preserve your teeth. First, your neck becomes distorted to ensure that your lower teeth and upper teeth meet properly. Next, you develop a new head position to preserve this bite. The lower part of your spine must compensate for the altered head position so you develop a postural abnormality which includes the muscles in the neck and back being strained to hold the head in the proper bite-preserving position. The long term pulling and postural changes result in the standard TMJ complaints: Cranial Distortions, Forward Head Posture, Headaches, Pain or tenderness in the face, jaw joint area, neck and shoulders, Difficulty chewing, Facial Swelling, Postural Distortions and Scoliosis.
These complaints are best address with the team approach involving interaction between a Dentist performing proper bite changes and a Chiropractor aligning the spine and manipulating the cranium into a neutral position. Dr. Mark Freund's approach to TMD (Temporal Mandibular Joint Dysfunction) is only shared by a small number of practitioners throughout the country due to the tremendous amount of education and study required. Dr. Freund practices the upper cervical technique called Atlas Orthogonal which is a very precise, specific gentle instrument adjustment of the top-most segment of the spine. This protocol does not involve hand manipulation of the neck and is extremely safe. Additionally Dr. Freund has undergone extensive education both domestic and internationally alongside Dental professionals, Physical Therapists, Doctors of Osteopathy and Chiropractors. The unique practice of making spinal corrections concurrent with bite changes is one of the most important elements of treating TMJ. Unfortunately not many practitioners are aware of this practice or its' importance.
Mark J. Freund, DC, BCAO
Natural Care Chiropractic, PC
Open Orthop J. 2014 Oct 1;8:326-45. doi: 10.2174/1874325001408010326. eCollection 2014.
Chronic neck pain: making the connection between capsular ligament laxity and cervical instability.
The use of conventional modalities for chronic neck pain remains debatable, primarily because most treatments have had limited success. We conducted a review of the literature published up to December 2013 on the diagnostic and treatment modalities of disorders related to chronic neck pain and concluded that, despite providing temporary relief of symptoms, these treatments do not address the specific problems of healing and are not likely to offer long-term cures. The objectives of this narrative review are to provide an overview of chronic neck pain as it relates to cervical instability, to describe the anatomical features of the cervical spine and the impact of capsular ligament laxity, to discuss the disorders causing chronic neck pain and their current treatments, and lastly, to present prolotherapy as a viable treatment option that heals injured ligaments, restores stability to the spine, and resolves chronic neck pain. The capsular ligaments are the main stabilizing structures of the facet joints in the cervical spine and have been implicated as a major source of chronic neck pain. Chronic neck pain often reflects a state of instability in the cervical spine and is a symptom common to a number of conditions described herein, including disc herniation, cervical spondylosis, whiplash injury and whiplash associated disorder, postconcussion syndrome, vertebrobasilar insufficiency, and Barré-Liéou syndrome. When the capsular ligaments are injured, they become elongated and exhibit laxity, which causes excessive movement of the cervical vertebrae. In the upper cervical spine (C0-C2), this can cause a number of other symptoms including, but not limited to, nerve irritation and vertebrobasilar insufficiency with associated vertigo, tinnitus, dizziness, facial pain, arm pain, and migraine headaches. In the lower cervical spine (C3-C7), this can cause muscle spasms, crepitation, and/or paresthesia in addition to chronic neck pain. In either case, the presence of excessive motion between two adjacent cervical vertebrae and these associated symptoms is described as cervical instability. Therefore, we propose that in many cases of chronic neck pain, the cause may be underlying joint instability due to capsular ligament laxity. Currently, curative treatment options for this type of cervical instability are inconclusive and inadequate. Based on clinical studies and experience with patients who have visited our chronic pain clinic with complaints of chronic neck pain, we contend that prolotherapy offers a potentially curative treatment option for chronic neck pain related to capsular ligament laxity and underlying cervical instability.
Atlanto-axial joint; Barré- Liéou syndrome; C1-C2 facet joint; capsular ligament laxity; cervical instability; cervical radiculopathy; chronic neck pain; facet joints; post-concussion syndrome; prolotherapy; spondylosis; vertebrobasilar insufficiency; whiplash.