Pain coming from the jaw, also known as the temporomandibular joint (TMJ).
Jaw pain is a small term but can be debilitating and affect other body parts including your sinuses, ears, teeth, or the muscles and bones.
The jaw or temporomandibular joint (TMJ) is a sliding hinge joint responsible for chewing, talking and expressing emotions. Therefore, due to its muscle attachments at the head and neck, you can experience a variety of unpleasant symptoms. The best option for treating TMJ pain is to target the cause of the pain, not just the symptoms. A thorough examination from a physical therapist may show a number of findings: poor control of the jaw muscles, jaw stiffness, myofascial pain, or neck tightness. These findings, if not addressed lead to persistent TMJ pain, headaches and neck pain. We know that there is no one “cure” for jaw pain, however, a blended approach of differential diagnosis, corrective exercise, joint manipulation, and dry needling have been shown to be effective at alleviating symptoms. Above all, treating the “cause” of the pain will help you find long lasting pain relief.
A: The McKenzie Method of MDT is a reliable assessment process intended for all musculoskeletal problems, including pain in the back, neck and extremities (i.e., shoulder, knee, ankle etc.), as well as issues associated with sciatica, sacroiliac joint pain, arthritis, degenerative disc disease, muscle spasms and intermittent numbness in hands or feet. If you are suffering from any such issues, then a MDT assessment may be right for you!
Developed by world-renowned expert physiotherapist Robin McKenzie in the 1950s, this well-researched, exercise-based approach of assessment, diagnosis and treatment uses a comprehensive and clinically reasoned evaluation of patients without the use of expensive diagnostic imaging (e.g. x-rays and MRIs). The treatment principles of the McKenzie Method promote the body's potential to repair itself and do not involve the use of medication, heat, cold, ultrasound, needles, or surgery. McKenzie allows patients to learn the principles and empowers them to be in control of their own symptom management, which can reduce dependency on medical intervention.
If utilized correctly, the achievable goals of the McKenzie Method in a cost- and time-effective manner are to:
Accurately understand the patient's presentation and behaviour of symptoms.
Determine the most appropriate and effective treatment plan.
Eliminate symptoms and restore full function.
Empower the patient to self treat and prevent recurrences.
Help inform patients if other medical advice or testing is needed.
Q: How does it work?
A: MDT is comprised of four primary steps: assessment, classification, treatment and prevention.
Most musculoskeletal pain is "mechanical" in origin, which means it is not due to a serious pathology like cancer or infection but a result of abnormal or unusual forces or mechanics occurring in the tissue. Further, it means that a position, movement or activity caused the pain to start. If a mechanical force caused the problem then it is logical that a mechanical force may be part of the solution. The MDT system is designed to identify the mechanical problem and develop a plan to correct or improve the mechanics and thus decrease or eliminate the pain and functional problems.
In the simplest and most common instance, this may mean that moving in one direction may provoke and worsen the pain, and moving in the opposite direction may eliminate the pain and restore function. This is known as Directional Preference. Other patients may have pain just at the end of movement or with certain functional movements like throwing or stair climbing. The McKenzie assessment explores these different positions and movements, how the patient performs them, and the response to these movements. Interpreting this information, the clinician determines which of the movements and posture becomes the treatment as well as the necessary exercise dosage.
MDT begins with the clinician taking a detailed history about your symptoms and how they behave. You will be asked to perform certain movements and rest in certain positions. The main difference to most other assessments is the use of repeated movements rather than a single movement. How your symptoms and range of movement changes with these repeated movements provides the clinician with information that they can use to categorise your problem.
Each syndrome is addressed according to its unique nature, with specific mechanical procedures, including repeated movements and sustained postures. MDT is a comprehensive classification system, and includes a smaller group of patients that cannot be classified into one of the three Syndromes, but are into the 'Other' Subgroup which includes serious pathologies, non-mechanical causes, true chronic pain etc
Using the information from the assessment, the clinician will prescribe specific exercises and advice regarding postures to adopt and postures to temporarily avoid. If your problem has a more difficult mechanical presentation, a qualified MDT clinician may need to add hands-on techniques until you can self-manage. The aim is to be as effective as possible in the least number of sessions. Treatment that you can perform five or six times a day is more likely to be effective in a shorter period of time than treatment administered by the clinician once or twice per week. The emphasis is on you, the patient, being actively involved. This can minimise the number of visits to the clinic. Ultimately, most patients can successfully treat themselves when provided with the necessary knowledge and tools.
By learning how to self-treat the current problem, you gain knowledge on how to minimise the risk of recurrence. You can also rapidly deal with symptoms if they recur, putting you in control of your treatment safely and effectively. Persisting problems are more likely to be prevented through self-maintenance than by passive care.
Countries all across the world are in various stages of the pandemic with many countries now entering the "day after" COVID-19/Coronavirus phase.
Many people who have suffered from the effects of this disease might now be at risk of long-term impairment and disability.
The extent of this impairment and disability is yet unknown, but it is clear from early research that these patients will be in need of rehabilitation/Physiotherapy in all phases of the disease - acute, post-acute, and long-term.
Physiotherapists are essential to these rehabilitation efforts in all phases to facilitate early discharge, but even more to support and empower patients.
Benefits of Physiotherapy/Rehabilitation in COVID-19 Patients
• Post-Acute COVID-19 Rehabilitation Phase
Physiotherapists can be very useful in the rehabilitation of patients as they transition from the acute phase to the post-acute phase
The consequences of COVID-19 will be specified in each individual and their rehabilitation needs will be specific to these consequences such as:
Long term ventilation
Immobilisation-May lead to neck, back pain, and stiffness in the joint
Deconditioning- leads to muscle weakness and reduced endurance.
Related impairments – respiratory, neurological, musculoskeletal
COVID-19 patients will often present with pre-existing comorbidities and that can also affect their functional recovery, the help of physiotherapist may be needed to overcome it.
The transition from the acute to the post-acute phase needs to be supported through service delivery pathways and the multidisciplinary team will be key to this.
COVID-19 Patient Presentation in the Rehabilitation Unit
Conditions that may arise from lengthy ICU-stays include:
Critical Illness Polyneuropathy (CIP)
Critical Illness Polyneuropathy is a mixed sensorimotor neuropathy that may lead to axonal degeneration and studies have shown that patients hospitalised in ICU with ARDS may present with CIP. Critical illness polyneuropathy (CIP) causes several difficulties such as]:
Difficulty weaning from mechanical ventilation
Generalized and symmetrical weakness (distal greater than proximal, but does also include diaphragmatic weakness)
Distal sensory loss (numbness in fingers)
Atrophy and weakness in muscles
Decreased or absent deep tendon reflexes
Critical Illness Polyneuropathy is associated with]:
Loss of range of motion
Post-traumatic Stress Disorder (PTSD)
Critical Illness Myopathy (CIM)
This condition is present in 48 – 96% of patients in ICU with ARDS. It is a non-necrotising diffuse myopathy with fatty degeneration, fibre atrophy and fibrosis.
CIM is associated with:
Exposure to corticosteroids, paralytics and sepsis.
It has a similar clinical presentation to CIP but with more proximal weakness and sensory preservation. Patients recover more completely from myopathies than polyneuropathies, but with both conditions, there are long term consequences to consider such as:
Loss of Function
Loss of Quality of Life
Post Intensive Care Syndrome (PICS)
Characteristics of PICS include:
Dyspnea/ Impaired pulmonary function
Reduced inspiratory muscle strength
Impaired exercise tolerance
Poor upper extremity and grip strength
Poor knee extension
Low functional capacity
The neuromuscular complications from PICS often result in poor mobility, falls and even quadriparesis.
How can we help you after COVID-19
A randomised controlled trial from China implemented a respiratory rehabilitation program consisting of 2 sessions of 10 minutes per week for 6 weeks post-discharge from acute care. The study results showed a significant improvement in respiratory function, endurance, quality of life and depression. The respiratory rehabilitation programme included respiratory muscle training with a positive expiratory pressure device, cough exercises, diaphragmatic training, chest stretching and pursed-lip breathing.
Muscle and joint range of motion
Exercise capacity – assess with the 6-minute walking test (continuous oxygen saturation monitoring included)
Cardiopulmonary exercise testing
Activities of Daily Living (ADL)
Clinical Management for COVID-19 patients:
Implement clinical management guidelines and protocols of care related to COVID-19 patients based on the best available evidence
Adaptable rehabilitation resources for COVID-19 patients who experience ongoing respiratory and physical deconditioning should be available
These may include:
Exercise programs with graded exercises
Advice on positioning
Recognition of red flags such as signs of medical deterioration
Implement systems for tracking COVID-19 patients and remote-follow-up
Implement referral pathways and develop contact lists for services required by COVID-19 patients
At ACT Physiotherapy and Health Services our professionals are trained and educated in the post covid recovery program, they can help you with any of your needs regarding making your functional life better.
Getting help from a chiropractor can yield many benefits that dramatically improve one’s physical and emotional well-being. Many people think to see a chiropractor only when something has gone wrong, or when they can no longer tolerate their pain symptoms. A chiropractor can help prevent something from going wrong in the first place.
While most people know it is time to see a chiropractor if they are experiencing back pain, there are other clues to keep in mind. Here are 10 things you should see a chiropractor:
Headaches can be caused by a number of factors, including dehydration, malnutrition, oxygen deprivation, tight joint and muscles or a misalignment in the neck or spine. A chiropractor can help to relieve headaches and improve blood flow, which will increase the amount of oxygen that is supplied to the brain.
Your chiropractor also may recommend a change to your diet to help you improve your overall health.
Chronic Back Pain
One of the most obvious signs that a chiropractic visit is needed is if you are experiencing chronic back pain. There are multiple factors that can contribute to back pain, such as posture, previous injuries how long you’re on your feet each day, and the type of work that you do.
A chiropractic doctor can provide you with pain relief without the need for invasive surgery or narcotics.
You Were Involved in a Recent Accident
Being involved in an accident, such as a car, work or motorcycle collision, can cause serious injuries that only an experienced chiropractor can help heal. Many chiropractors specialize in car accident injuries, and are able to diagnose and properly treat a multitude of different injuries.
Joint or Muscle Pain
A chiropractor is trained to make sure your body is functioning as optimally as possible by using spinal manipulations to relieve pain in your joints and muscles. These spinal adjustments will increase blood flow and nerve conductivity to the joints and muscles that are experiencing pain.
Sharp, Shooting Pain in Your Legs
If you are experiencing a sharp, shooting pain in your legs, or tingling and weakness, this could be a sign that you are suffering from a pinched nerve or slipped disc.
A trained chiropractor can diagnose the cause of the pain in your leg and perform a spinal adjustment to alleviate the unwanted pressure that is being placed on the nerve and causing you pain.
Your Job Requires You to Sit for Long Periods of Time
If your job requires you to sit for long periods of time, especially hunched over a keyboard or phone, it is not uncommon to wind up with very poor posture. Poor posture puts unwanted pressure on the upper back, neck, and shoulders. The pressure can cause the discs and bones to shift enough to cause problems such as a slipped or herniated disc.
A chiropractor can make sure your spine is aligned correctly, so you do not run into any future problems.
Limited Range of Motion
If you notice that your arms and legs are not as flexible as they used to be, or if your neck won’t turn as far in one direction or the other or you can not bend forward this is a good indication that you need to see your chiropractor.
Chiropractic adjustments realign the bones and joints, relieving pain and increasing the body’s range of motion. Having normal range of motion helps the body to function optimally.
The Soles of Your Shoes Wear Out Differently
If you begin to notice that the soles of your shoes wear out differently, this is a sign that your body is out of alignment and needs to be adjusted. Uneven wear on your shoes is a very reliable indicator that you are experiencing a subluxation in the spine and need a chiropractic spinal manipulation to realign your spine to ensure the problem does not continue and turn into a chronic issue.
You’re an Active Person
If you have an active lifestyle and spend time working out or playing sports or working on very active jobs your body is subjected to additional strain and pressure. This added stress can cause the spine to become misaligned. After spending time engaging in these activities, the body can become prone to pinched nerves, slipped discs, or other alignment problems.
Seeing a chiropractic doctor on a regular basis helps to keep your body functioning at its prime so you can continue to live the active lifestyle that you love.
You Want to Live a More Health-Conscious Life
If you want to live a more health-conscious life, or just want to be more aware of how to best take care of your body, your chiropractor is an excellent source of information. Your chiropractor can provide you with exercise routines, nutritional guidance, and specific techniques to help relieve stress. All of this, along with spinal adjustments, will help to improve your physical and emotional well-being.
What is mechanical lower back pain? Mechanical lower back pain is a common problem and almost accounts for more than 90% of the lower back pain. Mechanical means that the pain source may be in your spinal joints, discs, vertebrae, or soft tissues. Mechanical back pain may also be called low back pain, lumbago, lumbosacral strain or sprain and sciatica.
What causes mechanical back pain? It is not possible to find the main cause of the pain right away, but sometimes it starts with being in one particular position or repetitive movement and continues to progress. Weak spinal or core muscles can also be responsible for it.
What are the symptoms of mechanical back pain? Most people with mechanical back pain experience pain primarily in their lower back. The pain may spread to your buttocks and thighs on the side or on both sides. Many people may also experience spasms with mechanical back pain. The symptoms of the mechanical lower back pain may include pain on bending, morning pain, stiffness in lower back and hip, weakness in lower extremity and tingling and numbness symptoms.
How is back pain diagnosed? Best way to diagnose mechanical lower back pain will be by seeing McKenzie trained or certified therapist, who will take a detailed history of pain and function as well as overall health and complete full neurological and repetitive movement examination. Therapists will be able to find out which movement will help and which one will hurt or be harmful. If needed, further investigations will be recommended by the physiotherapist.
How is back pain treated? Non-surgical treatment with limited rest, over the counter medications and supervised Physiotherapy program for ongoing mechanical pain, may be recommended. Physiotherapy may be an essential part of acute back pain rehabilitation. It is important that you work with a physical therapist trained in this exercise approach to promote rapid healing. Active physical therapy can help shorten recovery time and make you return to work and leisure activities as quickly as possible. Active physical therapy is an exercise program that may require home exercises as frequently as every two hours while you are awake. The exercises generally take about five minutes to do and do not require special equipment, nor do you need to go to a gym to do them.
What is the outlook for people with back pain? The prognosis for complete recovery is excellent. Most people with acute mechanical back pain respond very rapidly to treatment. About 90% of people with acute low back pain are symptom-free in one to two weeks. Many of the remaining estimated 10% recover within three months.
Recurrences of back pain are common. Continuing your home exercise program may help reduce your risk of another episode.
When can I return to work? It’s usually recommended that you return to work right away. If you cannot do your regular job, it is in your best interest to return to some kind of modified duty (light or restricted duty). Your healthcare provider can give you a prescription for a limited period of modified work duty.
It is very common to be afraid to promptly return to work and other activities because of fear of re-injury. However, if you are receiving proper treatment, your risk of re-injury should be limited. It is in your best interest to return to a normal lifestyle promptly. Early mobility has been found to directly result in a more rapid recovery. Maintaining a positive mental attitude is also imperative to a quick recovery.
The hips are very commonly reported areas of discomfort. This pain becomes exceptionally common as people age, due to the “wear and tear” of cartilage in the hips, and lower back. However, people can also experience hip pain from overuse, injury, or underlying conditions, such as arthritis. Some cases may become severe enough that surgery is unavoidable; however, physiotherapy has been proven to treat hip pain without the need for pain-relieving drugs or surgery.
What are the causes of hip pain?
Osteoarthritis (disease-causing the breakdown of joints)
Bursitis (joint inflammation)
Hip labral tear
Osteomyelitis (a bone infection)
How is hip pain determined?
When you schedule an appointment with a physiotherapist, the first thing you can expect is a thorough Assessment. Your physiotherapist will examine you to figure out where the painful area is, as well as where the pain is coming from. For example, sometimes pain is in the hips but it can be coming from the lower back, buttocks, or groins.
Pain can be from an acute injury or trauma such as ligament sprains or from the muscle strains, it can be also from the chronic joint, ligament of muscles dysfunction.
Hip pain is typically reported as a constant dull ache that doesn’t seem to go away that can be caused by the internal joint pain.
Getting Started With Physiotherapy
As part of your evaluation process, your physiotherapist will do the following things;
Checking a range of motion – Your physiotherapist will check how your joint moves and how much they move
Checking strength – Testing the strength of hip muscles gives ideas about muscle imbalance.
Palpation – To Figure out where the pain is originating.
Gait analysis – Your physiotherapist will assess how you walk to determine if anything is out of the ordinary with your gait.
Your balance may also be checked.
Depending on your initial evaluation information, physiotherapists will be happy to help you with guiding proper exercises. Your prescribed exercises will help you strengthen the muscle structures around the knee or hip (or both) that’s bothering you and also help you to improve your mobility. Physiotherapists may use some modalities like ultrasound, laser therapy, Shockwave therapy or decompression to help you with the initial pain and inflammation. Your physiotherapist will work with you to monitor your progress and make sure you are on track to reaching your end goal. He or she will also encourage and support every achievement you make along the way!
Knee pain can keep you away from moving and exercising. It can be challenging as it progresses further and affects your ability to walk and pain becomes constant and debilitating.
Most of us seek medical care right away for a serious injury causing knee pain, we tend to take far longer to address lingering pain or irritation that slowly develops. If your knees are aching, making sounds, swelling or feeling stiff for a while, it’s time to see your rehab professional.
Cause Knee Pain
Knee joint is composed of bone, ligaments, tendons, cartilage and muscles, and it is a very complex joint, a range of issues can affect your knees and cause different degrees of pain.
Here are some of the most common ones that can affect kids and adults.
Arthritis is a one of the major reasons for knee pain. Two types of arthritis affect the knee joint most frequently:
Osteoarthritis, which is the most common type of arthritis, happens when the cartilage that cushions the ends of your bones wears away. Without intact cartilage, bones rub against each other, causing pain and stiffness.
Rheumatoid Arthritis, also known as “RA,” is a chronic inflammatory condition that develops when your immune system attacks a membrane that lines and lubricates joints. RA causes your joints to become swollen, unstable, painful and stiff.
Osgood-Schlatter disease develops most often during adolescence when growth spurts rapidly change muscles, tendons and other knee structures. Kids will feel pain below the kneecap because tendons that connect the knee to the shinbone become inflamed.
Physical activity puts more strain on the knee, so those who participate in sports with running and jumping are more at risk.
Excess weight puts more stress on your knee joints and is a risk factor for arthritis.
Gait issues, often caused by hip or foot problems, can affect your knees.
Overuse Injuries That Affect Knees
While exercising offers multiple health benefits, sometimes it leads to overuse injuries in your knees, which include the following conditions.
Bursitis usually happens when you experience a blow to your knee or fall, causing the bursa — the fluid-filled sac between your muscles — to swell and become irritated.
Tendon inflammation is known as “tendinitis” and is most often caused by sports that require a lot of jumping, like basketball. Your knee will feel tender and painful to the touch when running, walking or jumping if you have tendinitis.
Strengthening muscles properly surround the knee and working on flexibility can prevent some knee injuries and conditions.
Iliotibial Band (ITB)Syndrome
Iliotibial band syndrome causes the band that runs along the outside of your legs from your hips to your knees, to rub against the bone and become inflamed or tight. Certain sports where your knees often bend, such as cycling, running, hiking or walking long distances, are more likely to cause IT band problems.
Meniscus tears typically, give painful symptoms, such as a knee that slips, locks or feels extremely stiff.
Care for knee problems:
A detailed and thorough assessment by a physiotherapist or your health care professionals will help to identify the problem early and prevent it from getting worse and help you to improve faster. Therapeutic intervention like pain relieving modality, Ultrasound, LASER therapy will be useful to reduce your pain and inflammation, and graded exercises with help of a therapist will be useful to help you restore your strength and mobility.
Most of us have experienced ankle pain at some point in our life by rolling the ankle by simply walking or hiking or while even playing sports. Many times, pain comes without any injuries or reasons and you wonder how that is possible.
Simple Ankle sprains:
As physiotherapists, we come across many simple ankle sprains or strains which simply heal well without any further problems, and that could be healed by the initial phase of Rest, Ice, Compression and Elevation, and later on by exercise to strengthen muscles around the ankle in conjunction with modalities like LASER Therapy and ultrasound. Electrical stimulation can also be helpful to reduce swelling.
Non-Healing Ankle Sprain/Strains:
Ankle sprain which doesn’t heal properly can lead to the issue of sensory receptors (small organs located in the skin, tendon, muscles, and fascia) that transfer information to the brain. If the tendon or muscles continue to send wrong or non-meaningful information to the brain the chances of losing balance and re-injuries are very high. Fortunately, those kinds of cases can be treated by sensory re-education and decreasing receptor sensitivity with specialised techniques like P-DTR or Mckenzie Approach can be very useful if it is implemented by the certified therapist.
Ankle Derangement Mimicking Ligament Sprains:
There are some cases where actually pain or injury looks like ligament injury but it is just an ankle derangement that can lead to pain. Therapists who are specifically trained in repetitive movements examination can easily diagnose this kind of problems and help to give instant relief from pain and dysfunction. Many times, one or two sessions of proper education, mobilization and exercises are enough to help clients to achieve full recovery.
Ankle Pain Caused by Lower back Issues:
Third most common cause of the ankle pain or mimicking ankle pain is coming from spinal origins. Many times, compression on spinal nerves due to stenosis or disc injuries can lead to radiating pain in the ankle from the compression on Lumbar nerve root number 4,5 or Sacral 1 nerve root. It can be on one side or both sides of the ankle. Again, a complete spinal exam is always essential for any ankle pain, so we don’t miss any of the other diagnoses.