What Causes Sciatic Pain, Disc Herniation, and Disc Bulges?

Bad Back? Sciatica? Disc Problems?

Learn more: watch the video or read the transcript below.

Transcript of Video:
What Causes Sciatic Pain, Disc Herniation, and Disc Bulges?

I’m Dr. Shawn Phelan. I am here today from Wake Forest Chiropractic in Wake Forest, North Carolina, to talk with you about disc herniation and bulges and sciatica, which is a condition that can be caused by these conditions.

Many of the patients who come to Wake Forest Chiropractic have these conditions, and we thought it would be beneficial of them and you to understand more about them. This knowledge will help you to understand the treatments that may be suggested to you by us or your local practitioner.

"Spinal Cord"

Figure 1

Let’s start with this diagram (see Figure 1) of the vertebrae, spinal column, spinal cord, and discs. In simple terms, vertebrae are really not much more than a couple of blocks of bone stacked upon each other, which is what creates our spinal column.  The vertebrae are separated by discs (intervertebral discs). The job of the disc is to absorb shock and provide us with stability. Behind the vertebrae and discs is the spinal cord which runs from the brain down to the upper to mid lumbar spine area. Just in front of the spinal cord and right next to the intervertebral disc is the spinal nerve. The spinal nerve leaves the spinal cord and then heads down into the arms and the legs in order to supply the lower and the upper extremities with nerve supply, and the ability to contract and control musculature and activity.

Invertebral Disc

Figure 2

The spinal nerves come in very close proximity to the intervertebral discs. This diagram (see Figure 2) shows what it would look like if we were to look directly down from the top of the spine to see the disc itself. What we would see is bone. This little projection of bone on the top of the drawing is the spinous process. That is the bone that we feel when we push on to the back of our spine.  Just in front of that, or below from the perspective of the drawing, is the spinal cord, it is the red circle which runs from north to south in your body.  The spinal nerves exit to the spinal intervertebral disc, it is represented here by the horizontal red line, and that’s where the trouble can start if we have a disc herniation.

"disc bulge"

Figure 3

The black fibrous-looking material surrounding the blue circle is the disc itself. The blue circle is representing a mucoprotein jelly, called the nucleus pulpous, and is designed to further the ability of that disc to absorb shock.  What often occurs is that disc itself, the fibrocartilaginous material, can weaken and start to bulge backward toward or even into the nerve root area. That’s called your disc bulge (see Figure 3).

The disc bulge is present in about 30% of the population. Studies have been done which have taken 100 people who have no back pain at all and had them scanned by MRI machines. The results showed that 30% of the people studied who reported no pain or symptoms actually had large disc bulges or disc herniations in their spine.

If you do have sciatica or a disc herniation, the difference between them and you right now is simply inflammation and that inflammation is what is driving your pain. The bulge in the disc can exist for quite a long time causing some low grade back pain that comes and goes, gets better, gets worse. Each time it will come back a little sooner and a little worse. This is classic for the development of a disc problem in your spine.

"Disc Herniation"

Figure 4

What can eventually happen, if that goes on long enough, if that inflammation we spoke of continues beyond a certain point, is that you will start to get some radial tearing in the disc material or the fibro cartilage itself. The nuclear matter starts to bulge outward and that is when we start to consider it a disc herniation (see Figure 4).

In some instances what will happen is the outer material of the disc itself will actually tear through and rupture and that jelly can leak outward or even pieces of the disc itself can break off and then start to transit up and down the spine cord area floating around and causing all kinds of trouble. That is called a disc rupture.  So we have three terms: the initial bulging, the herniation, and finally the rupture of the material.

How do you know if you are suffering from something that’s related to nerves, muscles, or discs? If you have a disc problem, you are probably going to have a sharp, linear or line-like pain that radiates down the back of the leg into the calf or down the arm into the hand area, or even into the shoulder blade area.  Again, it’s probably pain that’s come and gone for a long time. The longer the pain is there, the worst it gets, and it continues to become an issue a little sooner each time.

The bottom line when you get into this situation is that the disc is inflamed. You may feel like it’s a muscle problem, which is normal because the muscles actually contract and splint to protect the body. The muscles may actually pull you into antalgic postures where you will be pulled to one side or the other.

One of the things you need to understand is that just because you are stiff, immobile, and have a muscle spasm; it does not necessarily mean that this is a muscle problem. The muscle spasm may be the result of the disc herniation itself, and this is your body’s attempt to protect you from it.

Without treatment, these conditions often progress and worsen. You may experience progressive pain, progressive neurological deficit, or you may lose motor control. Ultimately, you may end up requiring spinal surgery of the neck or lower back.

At Wake Forest Chiropractic, we have three goals when you visit our office to seek treatment of these conditions.

  1. Pain relief
    1. We will work to make you comfortable and functional so that you can continue with the normal activities of your life.
  2. Restore the function of the spine
    1. Restoring the function of the spine will allow you to move so that the structures are not creating pressure on the nerves.
  3. Strengthen the spine and the musculature
    1. Strengthening the spine and the musculature will help to make sure that you don’t end up with a chronic situation and have to experience the condition and treatment over and over.

Once the inflammation and swelling has been reduced, you can function with a disc bulge or a disc herniation in the spine because the disc is no longer impacting the spinal nerve. And the good news about getting older is that the discs will tend to dehydrate and toughen up as you age. Therefore, even if you’ve had a disc herniation, come close to surgery, or have had to undergo care for this condition, it does not necessarily mean that you a “bad back” or that you will eventually have to have surgery.  What it means is that you need to get the discs to a point where the inflammation is under control and they can toughen up naturally as the years go on, and then you should be able to manage your activities without fear of further injury.

If you would like further information on disc conditions and sciatica, please go to our website, http://wakeforestchiropractic.com. To make an appointment to be examined at our office, please get in contact with us by calling 919-562-0302. We would be happy to help you. Thank you.

Wake Forest Chiropractic
851 Wake Forest Business Park, Suite E
Wake Forest, NC 27587
919-562-0302

February 23, 2010
© copyright 2010 Wake Forest Chiropractic. All rights reserved.

Joint pain

Joint pain can occur anywhere in your body and usually includes stiffness or restricted motion and inflammation.  As long as there is no fracture, infection or disease process involved: restoring movement and reducing inflammation is the most direct route toward resolution.  Think of two hinges.  One is shiny and right off the shelf and the other is well used, rusty and creaky.    So if you had the rusty, creaky hinge on your garden gate, you would spray it with WD-40 and work the hinge until it moved smoothly.  It may not look like it came off the shelf, but it would function as if it did and last a long time.

We are basically biological machines with hinges (joints), that can either function smoothly like shiny hinges or stiff and creaky like the rusty one.  Chiropractic adjustments or manipulation of stiff, creaky joints in the body restores the movement and joint health, just as you restored the movement and “health” to the garden gate hinge … thereby getting rid of the inflammation and pain.  Whether the pain has been there a day of a year, the application of this oldest form of medicine is just as effective and available to you right now.

Shoulder Pain and Injuries

Shoulder Pain and Injuries

Learn more: watch the video or read the transcript below.

The Structure of the Shoulder

The shoulder is a complicated joint. It moves in many directions, and it can be very stubborn when it starts to become painful. The first thing a person wonders when they experience shoulder pain is “What’s going on with my shoulder?” Since the term rotator cuff is so common, many patients come in to my office and ask if they might have a rotator cuff tear.

First let’s talk about the structure of the shoulder which is one of the most movable joints in the body, but not the most stable. The way the shoulder is structured, you will see that it is basically a ball-and-socket joint. The ball-and-socket joint sits beneath a bony ceiling that is made up by the clavicle and the acromion, which is a bony projection at the outer edge of the shoulder blade. When you reach and touch your shoulder, you will feel that bony ceiling. Between the bony ceiling and the top of the ball-and-socket joint is a very complex and dynamic environment. Contained in this area is a group of tendons, blood vessels, and other structures, which include fatty tissue and bursa.

The bones of the shoulder are held in place by tendons, muscles and ligaments.  The five tendons of the rotator cuff, which hold the bones of the shoulder in place, begin as muscles that come up and insert into the ball part of the ball-and-socket joint. Those muscles and tendons provide us with all of the fine motor movements of the shoulder.

Tightness of the Shoulder

Many of my patients with shoulder pain come to see me because they are experiencing a limited range of motion, pain that occurs with everyday activities, and pain while sleeping. This can be caused by a person creating an impingement, or pinching, in their shoulder just by tensing the shoulder during activities. The repeated tensing of the shoulder can begin to shorten and tighten the musculature that houses the shoulder, and it can create a condition called Impingement Syndrome. This is when the tendons can be trapped under the acromion, and the ball-and-socket joint is pulled and starts to rub and grind away at the tendons.

Tendon Problems of the Shoulder: Descriptions and Symptoms

  • Tendonitis
    • This is simply inflammation of the tendon. This not only occurs in baseball pitchers who constantly use their shoulder, but can be a result of injury or simply from aging.
  • Tendinopathy
    • This when we start getting tearing of the tendons themselves. The tears come in four grades:
      • Grade one is an inflammation or some very, very fine tearing of some of the fibers in the tendon.
      • Grade two has a little bit more damage to the tendon, and it’s starting to get some depth to the tear itself. The person is probably already starting to have some problems sustaining weight with that shoulder motion.
      • Grade three is when the tendon has a fairly deep tear to it, and the person is probably going to have some real difficulty taking the shoulder through ranges of motion.
      • Grade four is where the tendon is torn completely in two.

Diagnosis and Treatment

The first step in dealing with shoulder pain, as with any large joint, is getting a correct diagnosis. A determination needs to be made as to whether it is a muscular issue; a tendonitis, an inflammation of one or more of the five tendons of the shoulder; a tendinopathy with tearing or a combination of issues.

That’s where the diagnostic process comes in. In our office we perform testing to make a determination about which category a patient’s pain or injury is in.

When a patient is in the early stages of these conditions, our treatments includes rest, ice, massage therapy, physiotherapy in the office, and perhaps manipulation of the neck or the shoulder. We will usually carry out about a two-week course of care as long as we see improvement and we are convinced that we are helping. If there is no improvement, we will provide you with a timely referral. We have referred patients for physical therapy, massage-therapy, and if needed, for an MRI and then on to the orthopedic surgeon for a consultation.

If you would like further information on shoulder pain or problems, please go to our website, http://wakeforestchiropractic.com.  To make an appointment to be examined at our office, please get in contact with us by calling 919-562-0302. We would be happy to help you. Thank you.

Wake Forest Chiropractic
851 Wake Forest Business Park, Suite E
Wake Forest, NC 27587
919-562-0302

November 19, 2009
© copyright 2009-2010 Wake Forest Chiropractic. All rights reserved.
Color images are courtesy of the US Library of Medicine and the US National Institutes of Health

Back and Neck Pain, Causes and Solutions

What is Causing that Back or Neck Pain

Learn more: Watch the video or read the article below

There really are two types of pain that we will experience when we feel back or neck pain. The first is mechanical pain, and the second is non-mechanical pain. You can see a breakdown of the causes of each in the following lists:

Potential Causes of Non-Mechanical Back or Neck Pain:

  • Infection

  • Tumor

  • Cancer

  • Other Diseases

Potential Causes of Mechanical Back or Neck Pain:

  • Joints

Dr. Phelan describes jointsA joint is the point of contact between elements of an animal skeleton whether movable or rigidly fixed together with the surrounding and supporting parts (as membranes, tendons, or ligaments).

  • Ligaments

Dr. Phelan describes ligamentsLigaments are a tough band of tissue that serves to connect the articular extremities of bones or to support or retain an organ in place

  • Nerves

Dr. Phelan describes nerves

Nerves are any of the filamentous bands of nervous tissue that connect parts of the nervous system with the other organs.

  • Discs

Dr. Phelan describes discs in thespine

A disc is any of the tough elastic discs that are interposed adjoining vertebrae and that consist of an outer fibrous ring enclosing an inner pulpy nucleus.

  • Muscle

Dr. Phelan describes muscles
A muscle is a body tissue consisting of long cells that contract when stimulated and produce motion.

  • Tendon

Dr. Phelan describes tendonsA tendon is a tough cord or band of dense white fibrous connective tissue that unites a muscle with some other part (as a bone) and transmits the force which the muscle exerts.

  • Bursa

Dr. Phelan describes what a bursa is

The bursa is a small, thin, watery sac between a tendon and a bone.

When going to see a provider of any kind, whether it’s a medical doctor or a chiropractor, the first thing that we have to do is determine what type of pain you are experiencing. Once we’ve safely eliminated the non-mechanical pain category as a source of your pain, we can start to focus on the origin of the pain itself. We will check the potential sources for your pain, which may be caused by one or more of these sources. All of these sources are capable of producing pain, either by themselves or in concert with any of the others.

Your top priority should be to receive an accurate diagnosis. Dr. Phelan is an outstanding diagnostician, and he will provide you with the most conservative plan possible to help you to heal as quickly as possible. When treatment plans require services outside of spinal manipulation, physiotherapy, exercise, ergonomic lifestyle changes, or massage, then Dr. Phelan will provide you with a referral to another highly qualified physician.

If you’re interested in speaking with us about back or neck pain, please go to our website, http://www.wakeforestchiropractic.com.  If you would like to make an appointment, please get in contact with us by calling 919-562-0302. We would be happy to help you. Thank you.

Wake Forest Chiropractic
851 Wake Forest Business Park, Suite E
Wake Forest, NC 27587
919-562-0302

November 14, 2009
© copyright 2009-2010 Wake Forest Chiropractic. All rights reserved.
Images are courtesy of the US Library of Medicine and the US National Institutes of Health

Barefoot Running, plantar fascitis, achilles tendonitis, foot, knee, ankle problems

A Basic Overview of Barefoot Running and its Benefits

Learn more: watch the video or read the transcript below.

Transcript of Video:

Barefoot Running

This video showcases a barefoot running clinic conducted by Dr. Phelan at Wake Forest Chiropractic. Strengthening and reconditioning the feet are part of our protocol for treating plantar fasciitis, Achilles tendonitis as well as foot, knee and ankle problems. To restore the integrity of the feet, we run on trails in as close to bare feet, as possible. The “shoe” that I have found to be as close to bare feet as possible is the Vibram fivefingers™. They are running shoes that are designed specifically for running while wearing as little material, so that your feet are protected, and yet retain the natural flexibility they would have if you were not wearing any shoes at all.

Vibram fivefingers Barefoot Running Shoes

Vibram Brand fivefingers™ Barefoot Running Shoes

People have been running barefoot or in thin soled shoes such as moccasins until the introduction of modern running shoes in the 1970’s.  The running shoes generally have extra padding at the heels and therefore change the way we walk and run.  When shod, the heel bears the most strike force, and that is then sent up the leg to the knees and hips. In barefoot running, the balls of the feet strike the ground first. Therefore, the foot and lower leg absorb the impact and turn this energy into a forward, springing motion.

Key Points for Barefoot Running

You can stub your toes in “barefoot running shoes”. It’s not that bad, so don’t be too nervous about that.  It is helpful to build up a few calluses on your feet and also to transition slowly to increase the strength of your foot and calf muscles. Take your time, and walk if you have to and when you get tired.

Lean your weight forward. You’re going to run differently than you have been in your running shoes. What will happen is your strike will be forefoot back, instead of heel striking down and forward. It’s very different. Your engine is in your lower leg and thigh. There’s not a whole lot of drive muscle in your shin, but it does exist in your calf and thigh. Conversely, on the hills, what you’ll be doing is landing forefoot first and your drive is going to be coming from the back of your leg in the gluteus muscle instead of using all of the quadriceps (thigh muscles) to push you up and forward.

Dr. Phelan's barefoot running clinic

Dr. Phelan's Barefoot Running Clinic

When you begin, bend your knees and keep them bent throughout the run.  This should help transfer your weight to the front of your feet and decrease the possibility of landing heel first.  Also, take shorter strides than you did in your running shoes – you may even find that this happens naturally.

Please keep in mind that there is an unwritten rule on trails: if you want to pass someone, always  up on their left and just let them know you’re coming by.

NOTE: In the video, you may see that many of the runners are not landing forefoot first. That is because this is a clinic for beginners. Landing heel first is a hard habit to break.

Read more about how barefoot running can help symptoms of plantar fasciitis.

If you would like further information about barefoot running, or if you’re interested in speaking with us, please go to our website, http://www.wakeforestchiropractic.com.  If you would like to make an appointment, please get in contact with us by calling 919-562-0302. We would be happy to hear from you. Thank you.

Wake Forest Chiropractic
851 Wake Forest Business Park, Suite E
Wake Forest, NC 27587
919-562-0302

October 20, 2009
© copyright 2009-2010 Wake Forest Chiropractic. All rights reserved.

Knee Pain and Injury

Getting the Right Diagnosis for your Knee Pain

Learn more: watch the video or read the transcript below.

Transcript of Video:
Knee Pain and Injury

Hi, I am Dr. Shawn Phelan and I’m here to talk with you about knee injuries or knee complaints. In our office we often have people coming in thinking they have arthritis or an injury involving their knee.

The first thing we need to do is determine a correct diagnosis.  So, the purpose of this video is to give you a little information and some idea of the structures involved in knee conditions and how they might be addressed.

Front view of knee

When you look at the knee itself from an anatomical standpoint it is fairly simple. The femur attaches to the tibia and the patella or knee cap sits in front. Stabilizing the patella on the outside and the inside are the medial and lateral collateral ligaments – the ligament tissue is in purple. In between the femur and the tibia is a structure called the meniscus, this is a fibro-cartilaginous type of material that acts as a cushion between the femur and the tibia.

When we look at the leg or knee from the side, what we see is the patella, or the knee cap, sitting in front of the femur and the tibia. It is connected to the musculature in the front of the leg and it is connected to the tibia via the patellar tendon.

ACL injury

Image courtesy of the US Library of Medicine and the US National Institutes of Health

Inside the knee what we have are the cruciate ligaments (ACL). They are called cruciate because they are in the shape of a cross. Then, in-between the femur and the tibia, again we have our meniscus. So this is the universe as far as how the knee is built and how it can be injured.

In injuries, what we will typically see is damage to the ACL or to the medial and lateral collateral ligaments.  It is possible to simply strain the medial collateral ligament and not injure the meniscus but, often when you injure the medial collateral ligament, or the ligament on the inside of the knee, you will also injure the meniscus since they are attached.

If you injure the lateral collateral ligament, or the ligament on the outside of the knee, you can often do so without affecting the meniscus because they are not attached.

You will often hear the term meniscal tear, or you will hear the term cruciate ligament tear – anterior cruciate ligament tear in particular. These are the deeper injuries within the knee. Most often when a person is having knee pain and comes to our office, it is usually because they have inflammation of the musculature attaching to the knee cap or they’ve got inflammation to the patellar tendon, which are both superficial structures. That is fairly easily dealt with if we work with the inflammation in these structures.

Deep inside the knee, the cruciate ligaments can be injured during trauma. This is typically going to require an MRI and a referral to physiotherapy or possibly to a surgeon for repair of that structure.

meniscal tear

Image courtesy of the US Library of Medicine and the US National Institutes of Health

The meniscal injuries can come in a number of different forms. They can simply come in the form of small cracks and tears due the trauma or degeneration or they can be torn straight through. You can also get what are called bucket-handle tears, where a little piece of the meniscus actually peels backwards and kind of flip-flops around. That is where the knee will lock and click and cause problems intermittently.

I have talked about many different conditions some of which require surgical interventions or physical therapy. Other conditions may just require a look at the feet, or their daily lifestyle habits.

The most important thing a person with knee problems needs is a good diagnosis. If you come to see us we will help provide you with a proper diagnosis, and if needed, proper treatment or a timely referral.

If you would like further information on knee pain or problems, please go to our website, http://wakeforestchiropractic.com.  To make an appointment to be examined at our office, please get in contact with us by calling 919-562-0302. We would be happy to help you. Thank you.

Wake Forest Chiropractic
851 Wake Forest Business Park, Suite E
Wake Forest, NC 27587
919-562-0302

October 13, 2009
© copyright 2009-2010 Wake Forest Chiropractic. All rights reserved.

Overcoming Situational Stress and Fear

When experiencing stress and fear remember that you are dealing with the “Bully.” You first met the Bully on the playground. He or she singled you out, picked on you, made you miserable and made you dread school. It got worse until one day you had enough and stood up to the bully.  Then he or she backed down.  Fear is no different. (more…)

What Makes Fish Oil and Omega-3 so Special?

Are Fish Oil Supplements Right for you?

Learn more: watch the video or read the transcript below.

Transcript of Video:
What Makes Fish Oil and Omega-3 so Special?

There are a lot of questions about nutritional supplements such as; which ones to take, when are they appropriate and what is the correct dosage.  Today, we will concentrate on fish oil because of its current popularity and its many potential benefits.

Why should we take it? Why should we not take it? How does it help us?

If we look at the length of time that we’ve been consuming food on this planet as a species, it is only the last ten thousand years that we’ve been eating agriculturally produced grains. Imagine that the entire pencil represents the length of time that modern humans have existed, and that the eraser represents the length of time that modern humans have been eating grains, which is just ten thousand years.

Prior to this period of time we were hunter/gatherers who consumed rooImagine that the entire pencil represents the length of time that  modern humans have existed, and that the eraser represents the length of  time that modern humans have been eating grains, which is just ten  thousand years. ts, tubers, berries and meat, when we could bring it down. When we developed grain, it helped us to become stationary. We could stay in one place; we didn’t have to travel with the seasons and with the food which helped us become civilized. The problem with that is our gastrointestinal tracts have not caught up to the need to process these grains.

consuming grains increases the level of omega-6 fatty acids in our bodiesWhat happens when we eat a lot of grains and pastas and baked goods? These foods are all essentially made from grains, and the grains produce something in our bodies called omega-6 fatty acids. We should have some omega-6 fatty acids in our systems, but not an excessive amount. What we should have is a ratio of omega-3 fatty acids and omega-6 fatty acids which is equivalent to about a 1:1 ratio. That’s what we are looking for and that’s what our bodies need – the omega-3 fatty acids. We are used to hearing that we should eat our fish, such as salmon, to protect our hearts with the omega-3 essential fatty acids, and that is true.

The ratio that we are looking for is 1:1 and that was the ratio that we had when we were hunter/gatherers before we started producing grains. In the USA, our diets are very heavily laden with grains. The reason that is a problem is it produces the omega-6 fatty acids in much higher ratios than our bodies need.

If we look at the American diet, what we see, instead of a 1:1 ratio of omega-6 to omega-3 fattThe ration of omega-6 to omega-3 fatty acids should be 1:1y acids, are ratios as high as 60:1. The problem with that is the excessive omega-6 fatty acid will produce arachidonic acid (an essential fatty acid found in most animal fats). This fatty acid crosses our cell membranes and creates prostaglandins (an unsaturated fatty acid found in all mammals), which in turn creates inflammation.

too much omega-6 fatty acids can cause inflammation in our bodiesLet’s look into what happens with inflammation, and the reason we need fish oil. The inflammation that we are talking about isn’t just muscle inflammation, a stiff neck, or tight muscles. This inflammation is occurring on a cellular level in our bodies and is driving certain diseases such as heart disease. There are other conditions that we may not commonly associate with this ratio imbalance such as: obesity, diabetes, hypertension, cancer, neurological disorders, and many others.

This country, although it is one of the wealthiest on the planet, is leading the world in these diseases. So how do we stop this from happening?  We need to realize that we should consume less grain – safely one to two servings per day. If you are eating a bowl of cereal for breakfast, a big lunch with sandwich bread, and a bowl of bowtie pasta and garlic bread for dinner, then you are consuming an a lot of omega-6 fatty acids. As discussed above, too much omega-6 will create arachidonic acid which leads to inflammation, and imbalanced ratios. The consequence can be the production of the same diseases you have seen in your ancestors such as high blood pressure from arteriosclerosis and heart disease.

What can we do about it?  One proactive step we can take is to supplement our diets with fish oil. This will allow us to continue to consume grains and protect ourselves with the fish oils’ rich omega-3 fatty acids. The EPA and DHA, two fatty acids found in fish oil, are going to protect the cell wall. Protecting the cell wall will then reduce the amount of arachidonic acid that is able to enter the cell. Less prostaglandin will be made and therefore, the amount of inflammation is reduced.

Should you take fish oil? Check with your doctor.Not everyone should take fish oil.  Excessive dosage of fish oil may create allergic reactions and adverse side effects on the body. Further, fish oil can be problematic in many conditions and hence, it is necessary to take fish oil supplements cautiously. You should consult a doctor or physician for the correct dosage.

To summarize, if you are going to consume grains, which most of us are, do it within limits and also take fish oil in the correct amount. Remember to check with your physician before you begin adding any kind of supplement to your diet.

If you’re interested in speaking with us about fish oil or other supplements, please go to our website, http://wakeforestchiropractic.com.  If you would like to make an appointment, please get in contact with us by calling 919-562-0302. We would be happy to help you. Thank you.

Wake Forest Chiropractic
851 Wake Forest Business Park, Suite E
Wake Forest, NC 27587
919-562-0302

March 25, 2009
© copyright 2009-2010 Wake Forest Chiropractic. All rights reserved.

Temporomandibular Joint Disorders – TMJ

The Importance of Obtaining the Correct Diagnosis for Jaw Pain

Learn more: watch the video or read the transcript below

Transcript of Video:

Let’s look at TMJ or TMJ dysfunction (TMJD or TMD). Temporomandibular joint disorder is a condition that can cause popping, clicking, or pain in the jaw. Other symptoms associated with TMJD are headache, ear pain, ringing in the ears, neck pain, shoulder pain, dizziness and nausea.

There is a significant level of confusion regarding this condition, and the person suffering from jaw pain often wonders whether they have a muscle problem, joint problem, or problems with their teeth.  Many TMJ patients will visit multiple healthcare providers in their search for an accurate diagnosis and the proper treatment. Unfortunately, this is very common, and the process may take years. In turn, the symptoms may become more severe, money and time are unnecessarily wasted, and the patient may become confused and frustrated.

It is crucial to find a healthcare provider who has strong diagnostic skills and an open mind to that can see issues beyond their own specialty.  Once you have a correct diagnosis, your healthcare provider can recommend that you see the proper specialist such as a dentist, an orthodontist, a chiropractor or an oral surgeon.

Image of the tempormandibular joint anatomy

TMJ Anatomy

This image shows the anatomy of the temporomandibular joint. The lower jaw is called the mandible.  Above the joint is the part of the skull referred to as the temporal bone. The joint where the temporal bone connects to the mandible make up the T and the M of the TMJ. The J is simply the joint. Everyone really has two TMJs, one on each side in front of your ears.

What we’re really talking about here is temporomandibular joint (TMJ) dysfunction. What can become dysfunctional in the temporomandibular joint? There are several conditions that can cause TMJD and its symptoms.  Let’s look at them one by one.

As shown, the jaw itself articulates with the temporal bone, and this demonstrates the location of the temporal bone. In between the mandible and the temporal bone is a small fibrocartilaginous disc called the articular disc, which is bonded to the jaw by some ligaments. Popping and clicking can occur if we have a situation where the disc itself becomes disrupted and dislodged from the condyle, or rounded part, of the jaw itself.

Now, you have a situation where the disc can become free floating. Attached to the posterior elements, or the back, of the disc is a material called retrodiscal tissue that produces the synovial fluid which lubricates the joint. This tissue will work to hold the disc in place, but what can happen over time that is the disc can migrate forward and become adhered to the anterior portion, or front, of the temporal bone.

Close-up of TM joint including disc, ligaments, condyle, and muscles

Close-up of a Healthy Tempormandibular Joint (TMJ)

When this occurs, we have a situation where the mandible rotates and translates forward as you open and close it. As it translates forward, it has to climb up and over the disc instead of the disc riding with it. When this happens you will notice that when you initially open your jaw there is no pop but as you open wider, the pop occurs as the jaw slides up and over that disc. Now you understand the first diagnosis, which is disc disruption in the jaw.

A second diagnosis involves the capsule. In the image above, the capsule is illustrated by the thin, light blue area that begins at the back of the TMJ, goes under the condyle, and in front of the muscle.  The capsule is the ligamentous envelope that wraps around the joint itself, and the capsule itself can become inflamed. The person can have perfectly normal open and closing of the jaw and they may or may not experience popping or clicking. The problem is not the disc, even if the disc is dislodged, but the capsule itself is inflamed.  This tissue is the same ligamentous material that holds our ankle together. When you sprain your ankle, it swells, becomes inflamed and uncomfortable. The same thing can happen in that capsule in the jaw. So, if the person has jaw pain, they may automatically assume they have TMJ or TMJD when they really do not. What they have is ligamentous inflammation of the capsule itself.

The third possibility may involve the retrodiscal tissue which we mentioned previously. The retrodiscal tissue is the structure in the posterior elements of the jaw that connects to the disc. The retrodiscal tissue itself can become inflamed.  That will typically happen with people that frequently clench or grind their teeth (called bruxism) while they are sleeping. This contracts the jaw, driving the mandible back up into the temporal bone and squeezing the retrodiscal tissue in between. When the retrodiscal tissue is inflamed, the result is jaw pain.

If the inflammation of the retrodiscal tissue lasts long enough, you will actually start to get adhesions that form in the jaw inside the joint itself. You may have vascularization, or the development of blood vessels, of the adhesions.  The trauma that results from these adhesions and scar tissue can also become a source of pain.

The fourth issue we will discuss is problems with occlusion or with the teeth as the teeth are fitting together. When a person opens and closes their jaw, they may notice that some of the teeth are not lining up properly. What they will notice is that when they close their jaw some of the teeth will land early on one side, and the jaw will then have to settle into a normal closure.

Another problem with occlusion can be an under bite. We have heard of people who close their lower jaw and their lower teeth are actually too far forward, and they have to move their jaw backward in order to close fully. That can cause problems with the TM joint as well.

The last problem that we can see with the temporomandibular joint is really somewhat external. This involves the musculature that runs the joint and the muscles that open and close our jaw, move it from side to side, and forward and back. These are very big powerful muscles which are inserting on the jaw itself. These muscles can become short and tight, and like anywhere else in our body with short, tight contracted muscles, they are going to cause pain sooner or later whether it’s in our necks or in our backs or in our jaw.

To summarize, there are five possibilities when we have temporomandibular joint dysfunction:

  1. Issues with the disc
  2. Inflammation of the capsule
  3. Inflammation of the retrodiscal tissue
  4. Alignment of your bite, or occlusion
  5. Tightening of the musculature of the jaw

When we see you in our office, we will typically begin an examination that allows us to arrive at an accurate diagnosis. We can treat some of these conditions in our office in Wake Forest, NC. There are some that we do not treat, and for those we will refer you to an experienced specialist for the proper treatment.

If there is a problem involving retrodiscal tissue inflammation, capsulitis or musculature that’s hypertonic, short and tight, that is probably something that we can help with here in the office. Approximately 70 percent of the people that I see with a diagnosis of TMJ dysfunction fall into this category, and we have the ability to treat them.

The other condition that would not respond as well to conservative care would be a disc problem where the disc is dislodged. Often, if you can treat the inflammation in the retrodiscal tissue and the capsule, and balance the musculature, the person can go on and live normally with a disc that’s displaced.  There should be no pain, but there may be a little popping once in awhile. These people are not necessarily surgical candidates. This is a non-surgical or a “leave alone” condition unless the jaw is locking and not allowed to open or close.

Once you have an accurate diagnosis and you know exactly which one of these structures is the problem, then you are in a situation where it can be treated. A good diagnosis and directed care, either in our office or at the appropriate orthodontist, dentist or surgeon is the pathway out of chronic temporomandibular joint dysfunction.

If you would like further information on TMJD, jaw pain or jaw problems, please go to our website, http://wakeforestchiropractic.com.  To make an appointment to be examined at our office, please get in contact with us by calling 919-562-0302. We would be happy to help you. Thank you.

Wake Forest Chiropractic
851 Wake Forest Business Park, Suite E
Wake Forest, NC 27587
919-562-0302

March 09, 2009
© copyright 2009-2010 Wake Forest Chiropractic. All rights reserved.

Migraine Headache or Cervicogenic Pain?

How do you know if it’s really a migraine?

Learn more: watch the video or read the transcript below

Transcript of Video:
Migraine Headache or Cervicogenic Pain?

Hello, I’m Dr. Shawn Phelan. I’m here to speak to you about head pain, primarily migraines, and another condition called cervicogenic headaches. In the general population, there is often some confusion about head pain. We often assume, or are being told, that we are suffering from a migraine, because we have a severe headache that is causing us nausea, sensitivity to light, ringing in our ears, a funny taste in our mouth, or funny things happening in our visual field. That is not always the case.

Migraine headaches are considered to be something that is either of vascular origin, something that’s caused by a chemistry issue in the brain, usually in the serotonin pathway, neurologic issue, or sometimes a combination of some of all of these issues. Migraine headaches caused by a serotonin imbalance, vascular, or neurologic issues are really rather rare. A true migraine sufferer should only have about seven migraines per year. If you are having more than seven migraines per year, there’s a pretty good chance that there’s an overlay of some sort.

Greater and Lesser Occipital Nerves

Figure 1

Different conditions can cause overlays. The one am speaking about today is called the cervicogenic headache. So the question is, if we are suffering from migraines, is it truly a migraine that we’re suffering from, or is it possibly a cervicogenic headache?

So, let’s take a brief look at the anatomy. Figure 1 (left) shows the skull and two nerves that are coming out of the upper cervical spine. The first is the greater occipital nerve, and the second is the lesser occipital nerve. They exit the spine at the level of the upper cervical spine, and then they transit up into the head. Irritation of those nerves will cause head pain.

Cervicogenic pain radiating to the head

Figure 2

Figure 2 (right) shows us the skull with nerves traveling up into the face. That is another area that we often see pain generated from. Consider the fact that cervicogenic headache can cause all of the same symptoms that a migraine will cause. It will cause visual field disturbances, a funny taste in mouth, ringing in the ears, nausea, and sensitivity to light, called photophobia, but it is not really a migraine headache. It is a problem with the upper cervical spine.

So, if the upper cervical spine and the joints are irritated, inflamed or causing irritation to the nerves then it can cause all of the symptoms that a migraine sufferer will be familiar with. Yet, it is not a not a serotonin imbalance, vascular or neurological issue. It is simply a mechanical compression or mechanical irritation of the nerves in the upper cervical spine that is causing the headache.

The Facet Joints

Figure 3

Figure 3 (left) shows you the upper cervical spine and the facet joints that can become symptomatic and cause cervicogenic headaches. If you are a migraine sufferer, you should be examined by a professional to determine if there is a situation that is driving the cervical spine problem for you. Cervicogenic headaches can be fairly easily treated, and can help you get control of your symptoms, so that you are not at the whim of the migraines.

If you would like further information on cervicogenic headaches or migraines, please go to our website, http://wakeforestchiropractic.com. If you would like to make an appointment to be examined at our office so that we can determine whether or not you are not you are suffering from cervicogenic head pain versus migraines, then please get in contact with us by calling 919-562-0302. We would be happy to help you. Thank you.

Wake Forest Chiropractic
851 Wake Forest Business Park, Suite E
Wake Forest, NC 27587
919-562-0302

March 04, 2009
© copyright 2009-2010 Wake Forest Chiropractic. All rights reserved.

So, let’s take a brief look at the anatomy. Figure 1 shows the skull and two nerves that are coming out of the upper cervical spine. The first is the greater occipital nerve, and the second is the lesser occipital nerve. They exit the spine at the level of the upper cervical spine, and then they transit up into the head. Irritation of those nerves will cause head pain.