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September 4, 2009

Necks, Headaches and TMJD

We're wrapping up our unit about the cervical spine (neck) and moving into our study of the of the temporomadibular joint (TMJ). These regions of the upper body go together like peanut butter and jelly when we consider the neck and the jaw's relationship to headaches.

This an area of my studies that I'm a bit more comfortable with thanks to my massage therapy background. So let's start with neck problems. From a PT perspective we're taught that neck troubles fall into 5 basic categories: mobility, centralization, exercise, pain, and headaches. These categories are not based upon signs and symptoms like many of the other conditions we treat, but are based upon what responds best to treatment. The black box in between those is our knowledge of clinical prediction rules -- the neck is complicated, we still don't know everything.

How are these 5 categories useful to massage therapists? They're helpful in deciding what kinds of problems we can safely address and which problems should be referred to a more qualified health care practitioner. Mobility: a client comes in with a crick in their neck and they cannot look into traffic -- massage can help with this. Centralization: a client presents with pain that radiates down their arms -- the more they move their neck, the further down the arm the pain radiates -- refer them to their doctor. Exercise: a client who suffer with chronic neck pain also has forward head posture -- massage and advise with tips about postural correction, stretching, strengthening. Pain: intractable, unremitting, pain from an accident -- refer to emergency room. Headaches: massage can help with this.

In order to address headaches, it's helpful to know what kind of headaches your client has. Tension headaches: this is a no-brainer -- massage can help along with stress reduction techniques. Cervical headaches: from neck tension -- this is the same as above -- massage and stress management, with the added component of postural correction techniques. Cluster headaches: not much massage can do about these with the exception of addressing anticipatory stress.Migraine headaches: massage can ease many of the surrounding symptoms of these headaches such as muscle tension in the neck, shoulders, and upper back. Also, craniosacral therapy may help with anticipatory stress, otherwise, massage can do little to help with vascular type headaches. Trigeminal neuralgia: this is a nerve entrapment problem. Patients are in so much pain and anticipatory stress that they get tension headaches -- massage can help with these aspects of trigeminal neuralgia. Sinus headaches: I've mentioned this on previous blog posts -- I have developed a protocol that combines pressure point therapy, craniosacral therapy and lymph drainage. Most people feel their sinus opening up while having their sphenoid bone decompressed.

TMJ dysfunction is a problem with the jaw that creates muscle tension, popping. clicking, and sometimes freezing of the movement of the mandible. Massage therapists can help with the muscle tension surrounding this joint. Some massage therapists specialize in TMJ therapy and have a close relationship with dentists for the management of TMJD. If you don't mind mouth work, TMJD therapy may be a good niche for a massage therapist looking to separate themselves from their competition. I remember having one client who presented with jaw pain, only to discover a nauseating, gristly sensation while palpating over the joint. I referred them to their dentist and they subsequently had jaw surgery to reconstruct the joint capsule.

Also, from my experience, jaw work is inseparable from neck work. Many times, I would spend 85% of a massage session addressing shoulder, neck and occipital tension before addressing the muscles of the jaw. So interrelated are these muscular systems, that to neglect them would be missing a majority of the problem.

tags: massage massagetherapy wellness massage therapy bodywork health

Posted by linda at September 4, 2009 8:39 AM