Human Performance and Rehabilitation Centers, Inc.

Temporomandibular Disorder (TMD)

It’s been a long day, the pounding of a headache I woke up with and a crazy schedule I’m ready to escape from. A great movie is on the television and a perfect night of relaxation is complete with a warm bag of popcorn. As I settle in and the movie begins, I take the highly anticipated first bite and… OUCH! What was that? It’s from my mouth but not a normal toothache. The pain in my face and jaw travels up to the temple and ear. My headache has not only returned, but intensified! I’m experiencing signs and symptoms of TMD, temporomandibular disorder. Can you relate? The National Institute of Dental and Craniofacial Research estimates over 10 million Americans are affected by TMD. This disorder impacts many within our own community and HPRC is here to help inform, educate and treat to restore a healthy and desired lifestyle.

Background: Anatomy and Function

Temporomandibular disorder involves the temporomandibular joint (TMJ) and/or the surrounding musculature. The TMJ is a hinge joint that connects the jaw to the skull, just in front of the ear on both sides of the head. Movement at the TMJ allows for up and down and side to side motions of the jaw for talking, chewing and yawning. The cervical spine and surrounding musculature influence the position and control of the joint.

What Are the Signs and Symptoms of TMD?

Common signs and symptoms are typically, but not limited to:

  • Pain in the jaw, face, temple region, neck, shoulder and/or ear at rest or during movement
  • Limited jaw motion opening, closing and/or side-to-side
  • A “stuck” or “locking” feeling in the jaw, “clicking” or “popping” when opening and closing the mouth that may or may not be painful
  • Headaches
  • Fatigue in the jaw, head and/or neck region.

These symptoms may be temporary, reoccurring or chronic.

What Causes TMD?

The exact cause of TMD is not clear, but clinicians do believe signs and symptoms arise from problems in the surrounding muscles, the joint itself, stiffness in the cervical spine and poor ergonomics/posture. A rapid onset may occur after an injury, such as a blunt force to the face or whiplash. Other contributing factors include:

  • Grinding/clinching at night
  • Osteoarthritis or rheumatoid arthritis in the TMJ
  • Dislocation of the disc in the TMJ
  • Work, home or emotional stress
  • Recent prolong and/or high-level dental work
  • Recent cervical injury or surgery
  • Diet (i.e., nuts, ice, tough meats)
  • Overuse/habits (i.e., bubble gum, biting nails, chewing the end of a pen/pencil)

Treatment Options

The most effective treatment for TMD typically involves a collaborative team effort between the patient, a physician or dentist and a physical therapist. As the patient, the following steps may be help in easing symptoms:

  • A soft diet
  • Ice applied outside (ice packs, frozen vegetables) and inside (popsicles, pieces of ice) the jaw
  • Avoid extreme jaw motions that hurt and/or create popping
  • Reduce stress and learn relaxation techniques
  • Keep your teeth slightly apart and jaw relaxed during daily activities

A physician or dentist will evaluate you for TMD, as well as for other possible issues in the teeth, jaw, head and neck. X-rays or an MRI may be performed if found necessary to further examine hard and soft tissues. Medication may be prescribed to help with inflammation. Dentist and oral surgeons can prescribe a helpful tool to reduce the effects of grinding at night called a night guard or splint. These custom made appliances prevent the upper and lower teeth from coming together while sleeping, thus reducing the grinding forces that contribute to TMD.

Physical therapists play a key role in the collaborative effort to get you back to a healthy, desired lifestyle. A licensed PT at HPRC will evaluate and treat all factors contributing to your TMD to reduce symptoms today and to prevent recurrences in the future. Treatments include:

  • Manual techniques (i.e., stretching, mobilizations and manipulation of the TMJ and cervical spine)
  • Exercise instruction (stretching and strengthening of the musculature surrounding the TMJ and cervical spine)
  • Patient education (detailed activity modifications, postural instruction and relaxation techniques)
  • Modalities that help reduce pain and improve tissue health.

 

Welcome Back Patrick!

HPRC, Inc. is having a good day.

Patrick Graham returns to work.
Patrick D. Graham, PT, MBA (pictured centered and seated), our President and COO, returned to work this morning after more than a year’s absence due to illness. Patrick is six months post liver transplant and is obviously doing remarkably well. His journey and story is one that miracles are made of. Needless to say, we are thrilled he has returned to us.

The past year has been challenging. Other than Patrick, HPRC lost two senior leaders and executives to retirement. Henry McRae and Joyce Duncan retired in June 2014 and February 2015, respectively, after remarkable careers and contributions to HPRC. Patrick’s return today marks a new beginning for our company, a new chapter.

As I reflect on the past year and what Patrick and the company have been through, I am reminded of several important lessons:

1) Failure is nothing to be feared. I don’t know who performed the first successful liver transplant, but I know one thing about them – they were not afraid to fail. You simply cannot achieve anything great in this life without failing first. As HPRC faces its future in the difficult landscape of healthcare, we must take strong and confident steps forward.

2) Live today. As I understand Patrick’s disease, the day he was born his liver began dying. He was destined to have a liver transplant at some point in his life. We often have our eyes focused so far in front of us that we forget to enjoy today. Our planning for tomorrow trumps the possibilities today offers. Patrick was born with a diseased liver, he was never promised a second one. He was fortunate. Enjoy the people in your life today.

3) Miracles happen. Patrick’s story is the story of a miracle. My theology is far too amateurish to explain his healing. I just know that legions of faithful people were prayerfully thinking of Patrick every day. His work is not complete.

Welcome back, Patrick Graham! Even in your absence, you taught us all.

Brian S. McCluskey, Ph.D.
Chairman/CEO
HPRC, Inc.

Student Blog

Upon entering the HPRC main office, I was bombarded with joy, excitement, and warmth, mostly my own, but I knew that I was in good hands. This is my first long-term rotation, building relationships with patients, seeing their growth, and facing their challenges. I have been nothing but thankful to my patients, my Clinical Instructor, and the organization for the experiences I’ve had thus far and those that are yet to come.

The training and education that I’ve received has proven to be valuable every day. I have been trained to view each person differently, evaluating their symptoms and impairments, and using the findings to reach their personal goals. Even after such a short period of time in clinic, I’ve grown to love this profession even more (which is reassuring after dedicating so many resources to my education).

So what makes a PT’s education and training unique? Physical therapy school is a professional program that focuses on human anatomy and ultimately how the body moves. We consider ourselves the experts in human movement, recognizing abnormalities that are either contributing to an injury or inhibiting a person’s function. This includes three years of continuous learning divided between the classroom and clinic. There, we are subjected to a combination of written and practical exams testing our knowledge and competency in skills. You grow to rely on your PT family, a group of adults gathered with the same passion of bettering people’s lives by utilizing our extensive knowledge of human anatomy, kinesiology, and proper motion.

It should also be known that all physical therapy students graduate with a DPT, or a doctorate of physical therapy degree. The emphasis on higher education has come to light by including differential diagnosis (acknowledging other causes with similar symptoms), pharmacology, among other courses. This is all in preparation of treating patients directly, without the gate of a physician. Every state has some form of direct access of offering services to patients. This assists in cost savings through the elimination of an extra co-payment.   In addition, direct access allows patients the opportunity to have an individualized exercise plan, addressing muscle imbalances, and to provide relief from injury.

While we like to think we are ready to practice right at the start of school, we need guidance and practice to develop our skills, exercise progressions, and patient handling skills. If you ever have the pleasure to work with a student, make sure to maintain open communication. If something is uncomfortable, doesn’t seem to be improving your overall function, or you have a question about your condition or therapy, express your concern. You will improve your therapy as well as future experiences for other patients who are too timid to express their concerns.

Just remember, you are helping to mold the newest member of the healthcare team. Every therapist has memories from their clinical experiences that will affect how they treat and in what specialty they will dedicate their time. Be patient and open. But, most importantly, be an advocate for yourself. This will lead to better overall care for our future patients.