Dear Readers,

As we approach age 40, one of the subtle, inevitable changes we experience is shrinking muscles and weaker joints. Since males on average have a higher percentage of muscle mass, the changes are more noticeable: less strength in the gym; it’s harder walking up stairs and harder to run. Shrinking leg muscles and loss of speed and agility are what cause great athletes like Michael Jordan and Joe Montana to call it quits.

What should this mean to you?

It means that if you want those future plans you have in mind to become a reality, you need to take care of your body today because it is changing, which demands certain adjustments in your daily routine to compensate. I know people whose life changed dramatically after blowing out a disc in their back. While injuries like this eventually heal, they often result in a percent loss of function and chronic pain. Those who got surgery didn’t fare much better most of the time, as surgery disrupts nature’s design.

With that, allow me to be one of your resources to help you improve and maintain your musculoskeletal health. Even if you currently don’t have pain or limited mobility, I hope you stick around because: (1) prevention is the best cure for disease; (2) your situation can change any day; and (3) you might discover something from one of my videos or articles that you can share with a friend who is in pain, and possibly save him/her from unnecessary suffering.

Products. I’d like to be transparent about this, so let me explain. But first — did you notice the Pain and Injury Doctor logo?   A quick glance and it looks like the Red Cross symbol. Look closer, and the logo is actually four arrow pointing inwards. Each one represents a component of self-care for musculoskeletal health:

1 – diet and nutrition
2 – rehabilitative exercise
3 – manual therapy
4 – home modalities

(The four arrows form a small person with arms and legs extended (X) to symbolize maximum flexibility).

PainandInjuryDoctor.com falls under telemedicine; a broad term that encompasses aspects of health care delivered over the internet.  You’ve probably heard of sites like WebMD, ShareCare and Mayo Clinic.  These are more than websites; they are a form of telemedicine.   They enable individuals like you to research symptoms, drug names, diseases and medical terms used by your doctor and get fast answers.

With PID, you get guidance on how to self-manage common, non-emergency forms of musculoskeletal conditions such as low back pain, neck pain, tendonitis and shoulder stiffness.  Yes, there are tons of videos on YouTube on this; some good and some not-so-good.   My intent is to explain the cause of common musculoskeletal conditions in simple terms, and special strategies I developed to get relief, even permanent relief, that involve the four components mentioned above.

The Big Idea of PID is that yes, you can cure common presentations of musculoskeletal pain faster than waiting it out by doing home rehabilitation.  I’ll share with you videos of the techniques I prescribed to patients when I was in practice, and still personally use to get relief when needed.  Some of these techniques involve using equipment.  Yes, I do sell them on my site PulsedEMF.com.  It’s obviously up to you to purchase them, and if you decide to do so, where to buy them.  My job is to show and explain what I believe will bring the best, fastest results in relieving pain but the action is up to you.  Rest assured, the products on my site are the select few out of nearly a hundred that I have tested over my 20 years in practice that I’ve seen actually work on pain sufferers.  In fact, I have many of these products lying around my home that I use regularly to treat friends and family.  They all have scientific and/or clinical evidence to back them up.  Think of them as investments in your health and quality of life.

I truly believe this is just the tip of the telemedicine iceberg, and greater things are yet to come as technology advances.  I believe that virtual assistants like Alexa, in the near future, will be able to project a hologram demonstration of exercises to do for a bulging disc; or be able to accurately diagnose a condition by scanning your body and reading your vital signs, right in your living room.

In the meantime, I welcome you to keep visiting The Pain and Injury Doctor online.  I am in the process of producing self-rehab video guides for the 15 most common presentations of musculoskeltal pain I’ve come across.  The ones for Low Back Pain and Fibromyalgia and Insomnia are completed.  Next up is Neck Pain.  Please share on social media, as there is a good chance someone you know can benefit from these free rehab videos.  They are taking longer than anticipated to produce, partly because of the Covid pandemic, and partly because of my high quality standards.  But when they are complete, I hope for these videos to help millions of pain sufferers across the world; especially those who do not have access to a doctor.

Also in the meantime, I plan to release more articles and YouTube videos on managing pain.  Some of the topics coming up include what to do about foot weakness and pain; a great, inexpensive home recipe for joint health; and a factor that might be affecting your health that you probably don’t know about.

Till then, take care, and stay vigilant until the pandemic is declared over.

Dr. Perez

P.S. You can ask me a question any time on my FaceBook page, or you can use the form at the bottom of the PID home page.

Did you know that by natural design, the human body is optimized for STANDING and WALKING, not sitting and lying down?

The evidence is longer and stronger legs for standing and walking compared to the arms.  Your femur, tibia and fibula (leg bones) are longer and thicker than their counterparts; respectively the humerus, ulna and radius bones of the arm.  Millions of years of evolution made our species homo sapiens develop this bi-pedal frame in order to survive and thrive.  No other animal as far as we know has a frame like ours.

But there’s a problem:  the bipedal design of man evolved during a time when there were no desks, computers and automobiles whose operation is better suited for sitting.  Back then, there was only rough terrain to walk for miles in order to seek shelter and food.  There was fast prey to subdue by foot in order to not starve.

Fast forward to today:  just about all occupations these days involve using a laptop.  White collar jobs, and increasingly blue collar jobs require sitting at a desk.  Sitting is required for operating airplanes, trucks, and cars.   To add to the problem, food is plentiful; overall less nutritious and higher in calories — no need to walk that much (expend calories) to get it while it packs on the pounds.  Humans are much heavier than they were millions of years ago, on average, and it’s not due to muscle.  This makes standing less tolerable, and makes sitting feel better on our feet.

So the combination of frequent sitting and weight gain, which places more pressure on your joints, is a harmful combination that leads to pain and injury, affecting tens of millions of people.  Osteoarthritis is the gradual degeneration of the joints, particularly the weight-bearing joints (hips, knees, feet, lumbar spine) and it is hastened with obesity and sedentary living.

Here are the detrimental things that happen in your body when you sit for prolonged periods throughout the day:

• The pressure to your lumbar discs increases.  Sitting removes back support from your legs, pelvis and abdominal muscles, which contract less when you sit.
• Your postural muscles turn off somewhat, and as a result you burn less calories.  Some studies connect this to a rise in bad cholesterol levels in the blood.
• When you bend your neck to look at a monitor screen while sitting, it creates forward head posture.  This strains the neck and upper shoulder muscles, and compresses the neck vertebrae; hastening osteoarthritis in the cervical spine.  It can even cause tension headaches.

Sitting is an  inescapable part of life.  The key is to compensate for it by standing and walking when you can.  Neutralize its effects.  There are many ways to do this while living a modern lifestyle:  walk to work, walk during lunch breaks, take the stairs instead of escalator, and do 15-minute workouts right in your office or work area, to name a few.

Drs. Brent and Tiffany Caplan, integrative medicine practitioners based in Ventura, California recommend the following simple stretches to do to counteract sitting:

Let’s talk about creep. No, I am not talking about a person unwelcomely staring at you all night from across the bar. I am talking about a constant load of stress applied to soft tissues (muscles, ligaments, fascia, discs) over an extended period of time resulting in a progressive deformation of those soft tissues. This can lead to muscles or ligaments changing their functional resting length and adaptively shorten or lengthen. These imbalances will lead to degeneration of your spine and will also set you up for future injuries. Creep to your intervertebral discs, the cushion between each spinal segment, may cause them to deform eventually leading to a herniated disc.

A common position that we are constantly in, as working professionals or students, is sitting. The sitting position, especially if in a poor slouched posture, puts an overload of strain in your neck, mid back, and lower back. It may also affect how well you are breathing. Poor respiration will lead to a decrease in oxygen supply to your body and brain!

So now that we know about creep and sitting how do we prevent it? The answer is simple. You should not sit for more than 20 minutes without taking a micro-break. These include Brügger’s relief position and the standing overhead arm reach. No pain should be felt during these movements. These movements are beneficial if you have any back or neck pain or want to support your spine and prevent any degeneration or future injury.

Brügger’s relief position:

• Do while standing or sitting on the edge of your seat.
• Relax arms at side and turn palms outward, spread fingers, bring shoulders down and back, tuck your chin (attempting to make a double chin, not looking down but straight ahead).
• Now exhale repeatedly as if trying to make a candle flame flicker but not go out. Be aware to make sure you are stomach breathing and not chest breathing. (To test this put one hand on your chest and one hand on your stomach. You should feel your stomach rising up and down as your inhale and exhale but your chest should remain still).

Do this for 10 seconds every 20 minutes.

Standing overhead arm reach:

Stand up and gently raise both arms above your head with palms facing forward and elbows slightly bent.

• Take a deep breath in through your nose and hold the breath while reaching up as high as you comfortably can (a stretch should be felt in your lower back).
• Hold for a couple seconds then release the breath through your mouth and go back to the starting position.

Do 10 repetitions every 20 minutes.

Now you’re done and your micro-break only lasted 30 seconds, totaling a mere 1.5 minutes per hour, to maintain your health and prevent spinal injuries.

Dr. Brent Caplan & Dr. Tiffany Caplan
Central Coast Center for Integrative Health
1730 S Victoria Avenue, Ste 230
Ventura CA 93003

The human body has magnificent intelligence to monitor, maintain, and repair itself 24/7.  These complex, biological functions are the result of millions of years of evolution and of course play a major role in the survival and thriving of our species.

But even nature has its faults.  When it comes to injury repair, the body’s repair mechanisms can inadvertently create a new set of problems.

When you sustain tissue damage, whether from sudden trauma such as spraining your ankle or gradual trauma such as a cumulative/repetitive tendinous strain or joint wear and tear, your body initiates a cascade of events to heal the injured tissue.

First, clotting factors appear and thicken the blood to stop any bleeding (hemostasis).  This is a complex chain reaction that involves many types of substances, each with a specific role.  Some clotting factors make blood vessel walls more permeable, allowing fluids to exit around the area and accumulate into the extracellular (outside the cells) spaces.   This is why edema, or swelling occurs following an injury.  The purpose of swelling to quarantine the injury site by creating a wall of pressure around it.  The swelling also contains noxious substances (“the inflammatory soup”) such as substance p and arachidonic acid that produce pain and therefore discourage movement, protecting against further damage.

While this is happening, cells called fibroblasts start laying down a net of protein fibers called fibrin around the damaged tissue, which could be skin, muscle, bone or organ.

This fibrous net catches red blood cells, which stack up and form a fibrous blood clot, plugging damaged blood vessels and filling in the space formed by the injury.  The fibrous clot gradually contracts, hardens and pulls damaged tissues together.  The blood clot material eventually thins out, falls off, and may even be picked off by the person.  Underneath, the reparative collagen fibers remain, forming what we call scar tissue.

You can observe this process if the injury is superficial such as a gash in the skin, but this process also happens in ligament, tendon, muscle and bone tissue injuries where there is no damage to the skin above.  If it was a paper cut, you may not see a scar, but if it was a gash/laceration, when it finally heals you will see a scar.

Upon close inspection, the scar is lighter in color, feels harder, and is raised.  Now imagine this scar tissue in the ligaments and tendons of a healed sprained ankle, knee or shoulder where there is movement and proximity to other structures such as bone, muscle, bursae, and nerves.

Unlike the scar tissue of a skin gash, which does not take much physical stress to it, ligaments and tendons by nature are subject to frequent movement and stress (bearing a load).  They are components of all joints in your body, and the function of joints is movement and generating force.  So, excess scar tissue in deeper muscle, ligaments and tendons present potential problems, described next.

Going back to the repair process, as the fibroblasts continue to lay down strands of collagen, they do so in a random, criss-crossed pattern forming the scar tissue.  It’s tough and dense, which is good for repairing, but can also pose a problem in a couple of ways.

First, the criss-cross pattern of scar tissue makes it less elastic (stretchable).  So after it heals, and the area is later subject to substantial stress, the scar tissue will give, and you’ll have a re-injury.  This explains why boxers easily get flesh cuts after getting hit in the right spot—it’s an area of scar tissue from a previous cut that “broke” upon absorbing stress forces.  Fibrosis is a term that describes pathological scar tissue; i.e. abnormal scar tissue deposition that causes disease/dysfunction such as pain and restricted movement.

Second, the very dense nature of scar tissue can cause pain receptors to bunch up around it, as they cannot penetrate it.  This makes the injury site sensitive after healing completes, and contributes to the pain becoming chronic (recurring).  Small, focalized areas of pain are called trigger points, as they can trigger pain in other areas when pressed.

Third, scar tissue build up constricts blood vessels, which compromises waste removal from the area and inhibit oxygen delivery to the area.  In some cases, this results in chronic, low-grade inflammation, which contributes to pain sensation.

Fourth, the body may try to stabilize scar tissue by calcifying it.  Calcium ions in the blood deposit on the scar tissue, hardening it and making it have rougher edges, which can cause restricted and painful movement.  This is common in chronic shoulder injuries.

The bottom line is that scar tissue is essential to healing, but due to the aforementioned reasons it may also lead to pain chronicity, whether it is an acute onset sprain/strain injury; a cumulative strain such as tennis elbow; or pain from tissue degeneration such as hip osteoarthritis.

So how does one fix chronic pain caused by excess scar tissue build up?

The Ideal Approach to Ensure Proper Soft Tissue Healing, Minimize Scar Tissue and Prevent Chronicity

The best defense is a good offense:  immediately after an injury, follow the standard methods of treatment:  apply cold directly to the area; add some compression, elevate the area if possible to help prevent excessive swelling/edema, and rest the injured area for at least two days.  If the pain is unbearable, you can take over-the-counter anti-inflammatory medications (non-steroidal anti-inflammatories like Tylenol and Ibuprofen) but I recommend trying to just stick with ice if you can, and tough it out.

As the acuteness subsides, you can introduce passive movement of the injured area.  This stresses the ligaments and tendons just enough which causes the fibroblasts to lay down the scar tissue collagen fibers in a more organized fashion, which will result in better healing/ quality of healed structures.

Then, perhaps on the third day do active movements of the injured area, then a week later, active-resistance movements (weights, resistance bands, swimming pool) to stress the structures in a controlled fashion, encouraging quality remodeling of scar tissue.  You may need assistance from a rehab specialist to gauge how much resistance to use, and when.

And finally and ideally, your injury will be 100% healed, without loss of strength or range-of-motion.

What to Try if You Did Not Rehabilitate Your Injury Properly and Have Chronic Pain and/or Stiffness

But what if you didn’t do all of this, and now your pain is chronic, a year after the injury or onset of pain?  Scar tissue could be the main culprit:  limiting mobility, getting re-injured, attracting pain-sensing nerve endings (forming trigger points), and constricting arterial, venous and lymph flow to and from the injury site causing chronic, low-grade inflammation.

Will heat do the job?  Heat such as that delivered by a hotpack vasodilates blood vessels close to the skin.  If you use an infrared heat lamp, you could treat deeper areas such as the hip.  This may help your chronic injury feel better, as more circulation means more oxygen, nutrients, proteins and other substances that benefit cells.  But heat doesn’t do much to that hard, rigid scar tissue.  Heat offers temporary relief.

Will electrical stim (TENS) help?  Devices like TENS that deliver an electrical current to the skin transcutaneously (through the skin) can be helpful in temporarily reducing pain perception, but they do nothing to address scar tissue.

Will pulsed EMF help?  Pulsed EMF uses magnetic fields to generate pulses of electromagnetic energy.  PEMF has been used since the 1950s to help heal broken bones.  Scientists know that biological tissue reacts to electromagnetic fields.  They affect cell membrane permeability and gene expression, which can have beneficial effects such as reducing inflammation and synthesizing functional proteins.  PEMF may make chronic pain feel better, but it does not have any therapeutic effect on scar tissue itself.

Will therapeutic ultrasound help scar tissue?  Ultrasound (not the kind used for imaging) is the delivery of high frequency sound waves through the body to generate heat.  Ultrasound is popular for treating deep joint structures, particularly the shoulder (glenohumeral joint), hip and knee joints.   Unlike topically-applied heat, ultrasound heats from the inside of the body.  Sound, physically, is reverberating pressure waves traveling through a medium.  When the ultrasound waves pass through the skin and strike something of higher density; i.e. tendons, ligaments or bone, it generates heat, just as rubbing your skin really hard will generate heat.  The pressure waves of the ultrasound may be strong enough to loosen some of the scar tissue fibers as well, making it a good choice for treating chronic joint pain.

Will massage therapy help?  It can, depending on the nature of the scar tissue.  It’s most effective in reducing fibrosis if started during the sub-acute phase, and continuing past the remodeling phase of tissue healing.   Massage is known for its soothing/relaxing effect, but it is also appropriate for soft tissue injuries, particularly myofascial release/ trigger point release, deep tissue massage, instrument-assisted soft tissue therapy, and Active Release technique.  These methods are more accurately described as “soft tissue mobilization” techniques and involve placing pressure into areas of scar tissue to break them up, stretch them as they are being laid down by fibroblasts, or to separate scar tissue adhesions—points where scar tissue binds to other structures.

There is another modality that is not well-known to most people that has a high success rate in treating chronic tendinopathies due to scar tissue fibrosis: extracorporeal shockwave therapy (ESWT), or shockwave for short.  Shockwave uses pulsed, high energy acoustic (sound) waves delivered right through the skin to physically break apart/ thin out underlying scar tissue.  You may have heard of how doctors can dissolve kidney stones using a machine that sends waves through the skin all the way to the kidney stone, without surgery, called lithotripsy.   This is precisely extracorporeal (meaning “outside the body”) shockwave therapy.

Shockwave treatment is often described as “ultrasound on steroids” since it uses sound pressure waves, but at a lower frequency and higher energy.   Think of thunder, clapping hands, and a jet breaking the sound barrier.

When a shockwave enters living tissue and encounters changes in tissue density or impedance (such as from fat to muscle) it will either be reflected, refracted, transmitted or dissipated just like any other wave.   According to the site Shockwave Therapy Education, energy is released at these interfaces of different impedance values, creating compression and shear loads on the surface of the material with the greater impedance (mostly scar tissue, tendons, and ligaments), like very tiny explosions.

The energy released by shockwaves causes microtrauma (tissue destruction), which triggers the reparative process:  new blood vessels form (neovascularization) and fibroblasts secrete collagen fibers in a more organized fashion, replacing the old, disorganized scar tissue.  Blood flow improves, and the old, chronic injury undergoes new healing and heals more completely the second time around.   The restructuring of collagen fibers results in less nociceptors than when fibrosis was present, and the result, after a brief soreness following the microtrauma, is less pain.

Conditions Extracorporeal Shockwave Therapy is used to treat include:

• Plantar fascitis
• Epicondylitis
• Trochanteric bursitis
• Dupruyten’s contracture
• Carpal tunnel syndrome
• Achilles, patellar and other tendinopathies
• Post surgical scar tissue fibrosis

Below are video fluoroscopy images of ESWT breaking apart a calcaneous (heel) bone spur:

 

TYPES OF SHOCKWAVE MACHINES

There are two, main types of shockwave machines, ballistic and piezoelectric.  In a ballistic machine, a small pellet is accelerated back and forth inside a metal tube by strong electromagnets or by compressed air.  When the pellet strikes inside the end of the metal tube (strikeplate), it produces a radial shockwave.  This type of shockwave is considered low-energy, as the shockwave dissipates and expands radially as it enters and travels through tissue.

A piezoelectric machine uses an array of tiny crystals at the end of a concave treatment head.  An electric current is passed through the crystals, which causes them to quickly expand and contract, generating pulsed acoustic pressure waves.  A silicone cone attachment is affixed to the treatment head to conduct, focus and direct the shockwaves produced by the tiny crystals.

The shape of the cone attachment and the output voltage determine the depth to which the soundwave travel.  Piezoelectric machines are considered high-energy, as the acoustic wave is focused into a small area and does not dissipate much.  These machines therefore are used with more caution.

BOTTOM LINE:

Scar tissue is like biological “glue” the body uses to repair injuries to itself, but it can cause problems long after the injury heals.  Scar tissue fibrosis is a mass of hardened protein strands laid down haphazardly by fibroblasts at the injury site.   It is often a factor in chronic musculoskeletal pain.  It develops in injuries, such as shoulder and knee strains, and is worse if the injury is not properly treated/ rehabilitated.  Scar tissue perpetuates chronic pain by inhibiting proper movement of soft tissue structures– tendons, ligaments, fascia and muscles, which can cause abrasion to adjacent tissues; inhibit vascular flow to the area; and cause sensory nerve endings to bunch together.  Extracorporeal Shockwave Therapy (ESWT) is a treatment that uses high-energy pressure waves to break down scar tissue fibrosis so that new, organized fibers can replace it; abrasion and congestion are reduced, and movement and strength are improved.  It is a highly-effective modality for tendinopathies and similar musculoskeletal diseases, with some studies finding an 80% success rate.

For more a more in-depth explanation of how extracorporeal shockwave therapy works, watch my interview with Dr. Ulyss Bidkaram, a chiropractor who uses ESWT in his practice:

REFERENCES:

Shockwave Education

http://www.shockwavetherapy.education/index.php/theory/biological-effects

Angela Notarnicola and Biagio Moretti. The biological effects of extracorporeal shock wave therapy (eswt) on tendon tissue.  Muscles Ligaments Tendons J. 2012 Jan-Mar; 2(1): 33–37.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3666498/

Semra Aktürk,1,* Arzu Kaya, et al.  Comparision of the effectiveness of ESWT and ultrasound treatments in myofascial pain syndrome: randomized, sham-controlled study, J Phys Ther Sci. 2018 Mar; 30(3): 448–453.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5857456/

Image credits:

https://www.biodermis.com/what-are-the-stages-of-wound-healing-s/221.htm

http://www.shockwavetherapy.education/index.php/theory/biological-effects

https://www.verywellhealth.com/what-is-rice-190446

https://www.pediagenosis.com/2019/10/exercises-for-range-of-motion-and.html

https://www.verywellhealth.com/what-is-rice-190446

 

I think we’ve all had an incident of one-sided jaw pain at some point, where it’s difficult to open and close the jaw without experiencing sharp pain. I’m not referring to chronic TMJ pain related to malocclusion (called TMD—temporomandibular joint dysfunction); I’m referring to those isolated incidents that happen to everyone on occasion. This condition can be caused by chewing hard/tough food requiring stronger than usual jaw muscle contraction; chewing a large piece of food on one side of your jaw; teeth grinding, and of course trauma to the jaw such as from boxing and other contact sports. The TMJ can also be misaligned from rear-end collision car accidents (acceleration-deceleration), as the force of impact is enough to violently hyper extend and flex the TMJ. Some cases of sudden onset TMJ pain self-resolve, but in other cases it can last for weeks, which can obviously be a nuisance as chewing food becomes uncomfortable.

The jaw, or temporomandibular joint is classified as a synovial, condylar joint. Joints are named after the two bones that comprise it, so the TMJ is formed by the articulation of the mandibular fossa (depression/pit) of the left and right temporal bones of the skull and the left and right condylar heads of the mandible (lower jaw), hence temporomandibular joint. It could have been named the “mandibulotemporal joint,” or MTJ, but someone long ago decided temporomandibular sounded better.

TMJ movement is very complex, involving flexion, extension, rotation, translation and oblique movements. These movements are accomplished by varying- magnitude, combined contractions of the temporalis, masseter, medial pterygoid and lateral ptergoid muscles controlled by the central nervous system, including nuclei in the brainstem. So, the simple act of chewing is neurologically complex; perhaps the most complex out of all the joints in the body.

Synovial means that the joint is encapsulated by ligaments and has an inner tissue lining called synovium that produces synovial fluid, a clear viscous fluid that reduces friction in the joint, very much like how motor oil reduces friction between a car engine’s cylinders and pistons. Not all joints are synovial, such as the acromioclavicular (AC) joint of the shoulder which is a fibrous joint; only the joints that are tasked to move frequently and have a comparatively larger range of motion i.e. knees, hips, shoulders, fingers, etc. The TMJ also has an articular disc, a thin slip of tissue that sits between the mandibular heads and temporal bone that provides cushioning/ shock absorption.  Since the TMJ is a heavily used joint, nature added this extra protection.  Just imagine the number of times the TMJ extends and flexes (opens and closes) in a typical day, from talking and eating!

So what is going on when you have one-sided jaw pain when you previously didn’t? The answer is that the jaw is slightly misaligned and the resultant, abnormal movement is pulling excessively on the soft tissues of the affected side and/or the condyle is pressing against the mandibular fossa excessively, firing surrounding nerve endings. Muscle spasm reflex of any of the aforementioned jaw movement muscles may also be contributing to the pain by maintaining the misalignment in place. TMJ misalignment is typically subtle and not usually visible, but sometimes you can see it if you open your mouth in front of a mirror. If you notice your mouth opening forms a tilted oval shape as opposed to an even oval shape, it means your mandible is deviating to one side due to TMJ misalignment. Usually, the mandible deviates to the same side of the misalignment/jaw pain, but not always.

To restore alignment and balance to your TMJ, try this:

Relax your jaw. This may sound easy, but for some people, especially those who subconsciously tend to clench their jaw, it is not. Just concentrate on your jaw and facial muscles, commanding them to let go. Your mandible should drop slightly so that your teeth are not touching at all.

Next, with your jaw still relaxed, using the palm of your hand on the side opposite to the painful side of your jaw, tap the opposite side of the jaw (the side of the jaw bone, not directly on the joint itself) firmly three times. Pause for ten seconds, then do it again. Wait for a couple more seconds, and see if you notice reduced pain. If pain is less, it means the TMJ settled back into alignment and the pain should start to go away and should be gone in about an hour or two. If not, tap obliquely at an upward angle towards the affected joint, then re-evaluate. If you notice the pain lessens, then that’s it—just wait a little longer, and the pain will disappear and your jaw will be back to normal.

If there is no change, try this: with your jaw still relaxed place your hand to the sides of your face with the tips of your index fingers directly on top of the protuberances of the condylar heads of the mandible and your thumbs cradling the back of the jaw bone (ramus). Alternately press gently inwards with your index fingers for a total of six times (three on each side). Then, using your thumbs gently pull the jaw forward three times. You can also gently push your jaw side to side alternating sides, three times per side.  I need to emphasize that you must keep your jaw totally relaxed while you do this; otherwise it may not work.

Watch this video where I demonstrate these simple moves:

If you find that you get one-sided TMJ pain quite often, you may have malocclusion of your bite.  Make sure to see your dentist/ orthodontist.

Sometimes TMJ can trigger headaches.  If you have both, fixing the TMJ misalignment is likely to fix your headaches.

 

Humans are a bi-pedal animal:  the only in existence as far as we know.   Sure, bears, primates and a few other animals are capable of standing on their hind legs and walking, but it is not their natural gait.  So, feel special that you belong in this class of animals!

There are many studies, particularly in the field of evolutionary biology that theorize why homo sapiens evolved to be bi-pedal, and the impact of the resulting evolutionary changes in our design.  For one, being bi-pedal allowed our eyes to see further down the plains.   Our species evolved to favor intelligence at the expense of strength and agility, so we needed a survival adaptation to give us an edge over things like saber- toothed tigers and other beasts.  Being bi-pedal allowed homo-sapiens to see over the thicket, and give him enough time to evade faster-running predators.

Thank you nature, right?

Well, being bi-pedal comes with disadvantages; disadvantages that magnified as man’s intelligence grew and allowed him to invent things such as chairs, desks and heavy furniture.  Being bi-pedal frees up the forelimbs, or arms, to carry things.  Heavy things.   This is why low back pain is one of the leading causes of chronic pain and disability.  You don’t see dogs or horses get low back pain much unless they are in their final years.  This is because as a qudra-ped they can’t pick up heavy things of course, and there is little axial force on their spinal column joints and discs, which lie in a horizontal plane.

When in a bi-pedal state– standing, walking, running– the spine does a wonderful job balancing the muscles of the limbs and torso.  It is the anchor point and nexus of the major muscles of the body.  When working/moving properly, the spine instantly adapts to changing loads (bending, twisting, carrying and releasing weight).  When not, injury then pain results, and you get sidelined for a while.  Blown discs, strained back muscles and even stress fractures can happen when the spine is not properly aligned and physically & neurologically conditioned– common in those who are overweight, sedentary, sit hours and hours every day, do heavy lifting at work and have a bad diet and other adverse & unhealthy lifestyle habits.

So does that mean you should spend more time in a recliner?  No.  Even though the bi-pedal standing position puts the most pressure on your back and weight-bearing joints, for most people it still is preferred over sitting because your body was naturally designed for standing, walking, jumping, crawling, stooping and all the various movements that are required to navigate a primitive terrain.  The muscles become more toned and responsive, you burn more calories, and your organs work better in the standing position.

I understand that most people prefer to sit when they can.   If your body isn’t well conditioned, standing puts a lot of pressure to the feet, knees, hips, low back, and even shoulders (from the weight of heavy arms).  Sit down, and that pressure is instantly relieved.  But if sitting becomes your preference, and you avoid walking and exercising then you are in danger of cutting your life span short.  Many studies show that exercise and regular, moderate physical activity are a positive correlation variable to life expectancy.  If you remove that variable, your life expectancy, at least statistically, drops.  So if you get comfortable sitting and avoiding exercise, it gets more difficult mentally and physically to start up again.  The more you put exercise off, the less likely you are ever to do it.

So, what should you do if you are in the sedentary camp?  If you have pain or discomfort in any of your weight bearing joints?

The first thing I recommend you do is to convince yourself you need to get moving.  Regularly.  And don’t be too hard on yourself.  I’m not talking about suddenly going to the gym 3x/week for one hour workouts.  No, start gradually.

In fact, once you make the decision to start exercising again, don’t do anything major for at least a month.  Instead, spend that time learning how to eat healthy.  Swap the junk food and eating out for wholesome, nutrient-dense food prepared at home; about 85% plant, 15% animal protein (or vegetable).  Drop the concentrated carbs (grains–breads, pasta, crackers etc., sugar, and even fruit juice, unless it’s diluted).  Replace them with greens, whole fruits, nuts and seeds, and water.  Clean, naturally-occurring, unadulterated, unrefined, untreated food from the Earth.  Grass fed and pastured meat only, in small portions (8 oz. day max).

If you have pain, try self-rehabilitating.  There are many exercise programs, orthopedic exercisers and home use therapy devices like the home infrared lamp, red light/laser, lumbar traction and PEMF to name a few, to help you overcome them.  Combined with a healthy diet like previously mentioned, you stand a very good chance of curing yourself or significantly lowering your pain.

By the end of the month, you are ready to get going.  Start with speed walking with hand weights, about 3 miles.  Do this for a week or two.  Then, move up to light jogging and light, home exercise.  Again, don’t be too hard on yourself.  Go at a pace that you can handle.  You can choose a treadmill in the gym, if you prefer.  I’d say a good mile pace would be a nine-minute mile or better, to get the best cardio benefit.  Aim for 2-3 miles max.

On some days, lift heavy weights.  But, I highly recommend you get at least one session with a professional personal trainer at your local gym.  Let the trainer show you basic strengthening exercises, and most importantly proper form.  You want to make sure you don’t hurt yourself.

Oh, and lastly:  if you must sit down for prolonged periods every day due to your job, check out this article for prolonged sitters.   It’s got my recommendations for those who sit at a desk all day, or sit in a car/truck all day.  These things can literally save you from spinal surgery years down the road!

Remember, the human body has a preference for being in the bi-pedal position most of the time when you are not sleeping.  You must do all you can to move in a way that naturally accommodates the design of your body.  Modern living has wreaked havoc on the body and resulted in countless of cases of chronic, musculoskeletal pain throughout the developed world; do what you can to prevent yourself from being a statistic.

Dr. Dan

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