Cervical Dysfunction & Pain

INFLAMMATION from Southern neighbor to chewing system

Neck affects jaw-ear-head:

  1. Muscle bracing into hyoid into jaw
  2. Refers pain into ear-periorbital-temple area
  3. Inflammation contributes headaches
  4. Cervical Pain jacks up pain system
  5. Anxiety couples to pain system

Science of joint muscle complex, like cervical dysfunction, is orthopedics.  

Treatment of Cervical Dysfunction, Chewing System Dysfunction, or Multisource Inflammation Headaches by solo practitioners is woefully inadequate due:

  1. complexity of chronic pain
  2. comorbid conditions
  3. autonomic dysfunction
  4. psychological issues
  5. complexity of Zap joints neck & TMJ joints
  6. Poor healing ability  

Pains from neighboring structures affect TMD:

  1. Pains from north or south neighbor affect jaw pain
  2. Northern neighbor is head, southern neighbor is neck
  3. Inc. contraction of neck increase contraction in jaw
  4. Increase contraction jaw increases contraction in neck
  5. Reciprocal contraction in neighboring muscle systems

Cervical dysfunction:

  1. Prevalence: 30% population have neck pain
  2. Inflammation: Muscles, joints, & ligaments
  3. Terms: Cervical dysfunction, neck pain, cervicalgia
  4. 82% TMD have neck pain (comorbid pathology)
  5. Poor cardio & high anxiety reduces healing
  6. Pain severity associated w/ psychosocial factors
  7. MVA & neck pain are well established
  8. MVA & TMD pain is well documented

Damage in neck system ( DJD )

  1. Bracing
    1. Neck muscles brace to protect joints
    2. Sub hyoid muscles brace
    3. Suprahyoid muscles brace
    4.  Chewing muscles brace
  2. Posturing
    1. Head tilt
    2. Forward head
    3. Forward shoulder
    4. Computer
    5. Phone on shoulder
  3. Tension
    1. PTSD
    2. Anxiety
    3. High stress
    4. Negative thinking
  4. Parafunction in neck
    1. Clenching jaw causes neck muscle contract
    2. Neck shrugging causes jaw muscle contraction
    3. Shrugging
    4. Phone on shoulder
    5. Heavy book bags & carry ons
  5. TRAUMA
    1. MVA
    2. Falls
    3. Blows
  6. Repetitive behaviors
    1. Increase head/neck activity
    2. Movement disorder

Neck discomfort:

  1. Shrugging-Bracing-Posturing
  2. Shrugging = wearing shoulders as ear rings
  3. Bracing = steady contraction
  4. Steady contraction builds up lactic acid
  5. Lactic acid causes inflammation in muscle fibers
  6. Long exposure inflammation causes muscle damage
  7. Muscle damage causes trigger points

Neck contraction causes Jaw contraction

  1. Kinetic Chain Analogy:
    1. Pebble in pond cause ripple effect  
    2. Rock drop in water
    3. Ripple largest center
    4. Ripples smaller go outward
  2. Observations ripple effect
    1. Closer chewing system = more contraction jaw
    2. Farther away  = less jaw contraction
    3. Hyoid cause more jaw contraction
    4. Neck cause less jaw contraction
  3. Neck to Hyoid to Jaw 
    1. Torn Ligament neck joint increase muscle bracing
    2. Neck muscles brace = contraction hyoid muscles
    3. Hyoid contraction = contraction jaw muscles

Reciprocal contraction:  

Chewing system-------------------

Hyoid-----------------------------

Jaw’s muscle brace----------------

Subhyoid”s brace------------------

Suprahyoid brace---------

Neck muscle brace--------

Trauma

  1. Relationship exist neck damage & whiplash injuries
  2. Jaw damage occurs in 10% whiplash injuries or MVA's
  3. Traumas tear ligaments in jaw and neck
  4. Types trauma:
    1. MVA-Whiplash injury neck joints
    2. Flexion-Extension injury
    3. Backward Falls-body hits 1st is whiplash injury
    4. Blows-Lateral fist to jaw, snaps neck back-sideways
    5. 1 in 3 whiplash injuries set up chronic pain neck
  5. Whiplash: Sudden acceleration-deceleration tears ligaments in neck
Whiplash Injury

Tearing fibers of disc of cervical vertebrae

Posturing
Bracing
Repetitive motion

Tension
Phone shoulder
Falls

Posturing
Blow
MVA

At some point, the extent of accumulative damage to disc-cervical joint-vertebrae causes instability/dysfunction/pain creating a source of inflammation & reciprocal contraction in neighboring systems.

Damage cervical system:

  1. Study 1987, 22 out 25 post whiplash cases had disc displacement
  2. Study 1976, cervical muscle bracing stimulated jaw clenching
  3. Study 1993, jaw clenching activated SCM activity 93% cases
  4. Study 2004, 44 to 99 % cervical problems are caused trauma
  5. Study 2012, 1 in 3 people have frequent or chronic neck pain

A microtrauma like whiplash injury can macrotear fibers ligaments to cervical vertebrae; whereas, an ongoing tension or posturing in muscles causes microtear to fibers of cervical vertebrae.

Cervical muscle damage is revealed:

            Enlargement muscles
            Trigger points in muscles

Trigger points in neck refer to other structures:

  1. SCM refers to ear & frontal bone above eyes
  2. Little devils refer to pre & post ear
Clavicular head of SCM refers to pre & post auricular
Suboccipital muscles refer to pre-auricular area: Janet Travell- TR PT Manual

Posturing head

  1. 30-pound bowling ball
  2. Held off vertical axis
  3. Causes prolonged contraction neck muscles

Tale twin sisters:

          MVA occurs with twin sisters in back seat car w/ seat belt
          First sister is cardiovascular conditioned
          Second sister is decondition
          1st sister enjoys neck pain for week,
          2nd sister enjoys neck pain lifetime

Comorbid Conditions

  1. IBS
  2. Tension Headache
  3. Fibromyalgia
  4. Sleep disorder
  5. Anxiety
  6. Hypermobility

INFLAMMATION from Southern neighbor to chewing system

Neck affects jaw-ear-head:

  1. Muscle bracing into hyoid into jaw
  2. Refers pain into ear-periorbital-temple area
  3. Inflammation contributes headaches
  4. Cervical Pain jacks up pain system
  5. Anxiety couples to pain system

Science of joint muscle complex, like cervical dysfunction, is orthopedics.  

Treatment of Cervical Dysfunction, Chewing System Dysfunction, or Multisource Inflammation Headaches by solo practitioners is woefully inadequate due:

  1. complexity of chronic pain
  2. comorbid conditions
  3. autonomic dysfunction
  4. psychological issues
  5. complexity of Zap joints neck & TMJ joints
  6. Poor healing ability  

Pains from neighboring structures affect TMD:

  1. Pains from north or south neighbor affect jaw pain
  2. Northern neighbor is head, southern neighbor is neck
  3. Inc. contraction of neck increase contraction in jaw
  4. Increase contraction jaw increases contraction in neck
  5. Reciprocal contraction in neighboring muscle systems

Cervical dysfunction:

  1. Prevalence: 30% population have neck pain
  2. Inflammation: Muscles, joints, & ligaments
  3. Terms: Cervical dysfunction, neck pain, cervicalgia
  4. 82% TMD have neck pain (comorbid pathology)
  5. Poor cardio & high anxiety reduces healing
  6. Pain severity associated w/ psychosocial factors
  7. MVA & neck pain are well established
  8. MVA & TMD pain is well documented

Damage in neck system ( DJD )

  1. Bracing
    1. Neck muscles brace to protect joints
    2. Sub hyoid muscles brace
    3. Suprahyoid muscles brace
    4.  Chewing muscles brace
  2. Posturing
    1. Head tilt
    2. Forward head
    3. Forward shoulder
    4. Computer
    5. Phone on shoulder
  3. Tension
    1. PTSD
    2. Anxiety
    3. High stress
    4. Negative thinking
  4. Parafunction in neck
    1. Clenching jaw causes neck muscle contract
    2. Neck shrugging causes jaw muscle contraction
    3. Shrugging
    4. Phone on shoulder
    5. Heavy book bags & carry ons
  5. TRAUMA
    1. MVA
    2. Falls
    3. Blows
  6. Repetitive behaviors
    1. Increase head/neck activity
    2. Movement disorder

Neck discomfort:

  1. Shrugging-Bracing-Posturing
  2. Shrugging = wearing shoulders as ear rings
  3. Bracing = steady contraction
  4. Steady contraction builds up lactic acid
  5. Lactic acid causes inflammation in muscle fibers
  6. Long exposure inflammation causes muscle damage
  7. Muscle damage causes trigger points

Neck contraction causes Jaw contraction

  1. Kinetic Chain Analogy:
    1. Pebble in pond cause ripple effect  
    2. Rock drop in water
    3. Ripple largest center
    4. Ripples smaller go outward
  2. Observations ripple effect
    1. Closer chewing system = more contraction jaw
    2. Farther away  = less jaw contraction
    3. Hyoid cause more jaw contraction
    4. Neck cause less jaw contraction
  3. Neck to Hyoid to Jaw 
    1. Torn Ligament neck joint increase muscle bracing
    2. Neck muscles brace = contraction hyoid muscles
    3. Hyoid contraction = contraction jaw muscles

Reciprocal contraction:  

Chewing system-------------------

Hyoid-----------------------------

Jaw’s muscle brace----------------

Subhyoid”s brace------------------

Suprahyoid brace---------

Neck muscle brace--------

Trauma

  1. Relationship exist neck damage & whiplash injuries
  2. Jaw damage occurs in 10% whiplash injuries or MVA's
  3. Traumas tear ligaments in jaw and neck
  4. Types trauma:
    1. MVA-Whiplash injury neck joints
    2. Flexion-Extension injury
    3. Backward Falls-body hits 1st is whiplash injury
    4. Blows-Lateral fist to jaw, snaps neck back-sideways
    5. 1 in 3 whiplash injuries set up chronic pain neck
  5. Whiplash: Sudden acceleration-deceleration tears ligaments in neck
Whiplash Injury

Tearing fibers of disc of cervical vertebrae

Posturing
Bracing
Repetitive motion

Tension
Phone shoulder
Falls

Posturing
Blow
MVA

At some point, the extent of accumulative damage to disc-cervical joint-vertebrae causes instability/dysfunction/pain creating a source of inflammation & reciprocal contraction in neighboring systems.

Damage cervical system:

  1. Study 1987, 22 out 25 post whiplash cases had disc displacement
  2. Study 1976, cervical muscle bracing stimulated jaw clenching
  3. Study 1993, jaw clenching activated SCM activity 93% cases
  4. Study 2004, 44 to 99 % cervical problems are caused trauma
  5. Study 2012, 1 in 3 people have frequent or chronic neck pain

A microtrauma like whiplash injury can macrotear fibers ligaments to cervical vertebrae; whereas, an ongoing tension or posturing in muscles causes microtear to fibers of cervical vertebrae.

Cervical muscle damage is revealed:

            Enlargement muscles
            Trigger points in muscles

Trigger points in neck refer to other structures:

  1. SCM refers to ear & frontal bone above eyes
  2. Little devils refer to pre & post ear
Clavicular head of SCM refers to pre & post auricular
Suboccipital muscles refer to pre-auricular area: Janet Travell- TR PT Manual

Posturing head

  1. 30-pound bowling ball
  2. Held off vertical axis
  3. Causes prolonged contraction neck muscles

Tale twin sisters:

          MVA occurs with twin sisters in back seat car w/ seat belt
          First sister is cardiovascular conditioned
          Second sister is decondition
          1st sister enjoys neck pain for week,
          2nd sister enjoys neck pain lifetime

Comorbid Conditions

  1. IBS
  2. Tension Headache
  3. Fibromyalgia
  4. Sleep disorder
  5. Anxiety
  6. Hypermobility

Cervical Dysfunction & Pain Navigation

Pearls of Pain

Side effects Appliances
a) soft biteguard: increase grinding, bulky, decrease airway space b) soft-hard guards (Hybrids): increase clench, can’t repair-retread-tighten c) hard nightguard: tighter insertion, loose retentiveness, can be adapted d) ARS (worn 24/7): major changes bites, requires cost Ortho or CR/BR e) Orthotic: requires use other orthopedic tools
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