1. The TMJ and upper cervical spine connection
jerry hesch
Wednesday, November 14, 2007 at 12:05 PM
Stacy, et al,
Thank you for your post. I think there may still be hope, if the upper cervical spine is contributory.
I don't know much about your history or cuent symptoms other than they are related to the TMJ.
One additional proimal contributor to TMJ symptoms can be inputs from the upper cervical spine. Within the spinal cord is what is called the cervico-trigeminal nucleus. You can do a literature search on that if interested. Basically, there are connections with the upper cervical nerves (#1, sometimes #2, and perhaps less common #3), and the nucleus (the part in the brainstem and spinal cord where the nerve originates) of the nerve that supplies the jaw, TMJ, etc.
It is my belief that one of the cervical nerves that may oftentimes be over-looked, is the 3rd one. A deep inquiry into anatomy reveals that it has a very vast supply to the neck and to deeper structures of the head and neck and it even joins the nerve supply to the TMJ (5th cranial nerve) superficially/peripherally (away from the spinal region). However, at first glance in some anatomy texts or charts that show nerve supply to the skin, appear to grossly under-represent its vast connections.
I believe that this 3rd spinal nerve is very much under-diagnosed and therefore undertreated.
My own TMJD resolved after more than 30 years when I got appropriate care for my cervical spine and I no longer have atypical facial pain.
When I asked for a cervical discogram, it was significantly helpful re diagnosis and the flurosopy that is part of a discogram was very helpful (more so than x-rays, Ct scan, MRI) in visualising the pathology. Unfortunately discograms are rarely used because they only give new information 17% of the time, and medicine is geared toward the majority not the minority, etc, etc.. Every diagnostic test, be it x-ray, CT, MRI, discogram, etc has something to offer (+) but has limitations (-). Diagnostic block can be very helpful in determining if the cervical nerve roots are involved. I am NOT suggesting that any of these diagnostic tests are appropriate for you or anyone else, but if not considered previously, an inquiry with a competent health care provider may be helpful in addressing the topic.
I hope that I did justice to introducing this topic and of course it does NOT apply to all with TMJD, yet does appear to be overlooked.
I could go on but will stop here.
Best Regards,
Jerry Hesch, MHS
THE RIGHTING REFLEX TYPE 1 PELVIC FLARING AND THE UPPER CERVICAL ADAPTATION
Jerry Hesch, MHS, PT
The righting reflex is a powerful reflex that responds to asymmetries in the body. The purpose is to symmetrically allign the eyes and the brain in all 3 planes of the body and to allow symmetrical circulation to the brain. A very common transverse plane rotational pattern in the pelvis is named type 1 right inflare/left outflare. This is distinctly different from the rare type 2 inflare/outflare described by the Osteopathic Muscle Energy paradigm. This pattern is common in our society perhaps due to the fact that; we live and function in a right-handed environment, thus both right-hand and left-hand dominant individuals; often present with this pattern. The type 1 flare pattern has a discernable movement dysfunction in the A-P/P-A directions using spring tests as utilized in the Hesch Method of treating SI joint dysfunction. The type 2 flare pattern is not evaluated in the same manner as it has a greater motion dysfunction in the medial-lateral/lateral-medial directions. The type 1 pattern remains after treatment for a right anterior ilum and left posterior ilium SI dysfunction. The evaluation and treatment of type 1 inflare/outflare will be demonstrated. Prior to doing so, the craniocervical counterrotation will be demonstrated. After resolving the pelvic flare pattern the craniocervical rotation will be reevaluated. Typically, the craniocervical response is to reflexively, immediately released while the "client" is still lying supine. This demonstrates the reflexogenic effect and the fact that this reflex is not an anti-gravity muscular response. This demonstration will highlight the value of screening the pelvis for type 1 flare patterns in the presence of a cranicervical counter-rotational pattern, and it reinforces the paradigm of treating the bottom first-top last. The craniocervical response is not just rotational, however; rotation is the greatest response. The other accessory motion responses will be elaborated upon, briefly addressing evaluation of each, and treatment as relevant; when not a reflexogenic response. Right anterior ilium/left poterior ilium with type 1 flare pattern Dysfunction are part of the Most Common Pattern of SI Joint Dysfunction (Hesch) and all 7 components will be described, with evaluation and treatment explained. Other transverse plane patterns in the lower body will be mentioned as relevant to a craniocervical counter-rotation.