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This article will conclude the topic that has been covered for the previous two months: chronic pain diagnosis and treatment.
The previous articles have discussed biomechanical compensation patterns and how they can lead to chronic pain. These biomechanical compensation patterns can be ascending or descending. In other words they can start with a poor bite and affect the entire body from the top; or, for example, a foot or pelvis problem can initiate biomechanical compensation patterns that can eventually cause pain in your jaw joints or lead to headaches.
Bodywork is an essential element of any recovery from chronic pain. Bodywork may the following modoalities: physical therapy, osteopathic manual therapy (OMT), chiropractic, massage therapy, Rolfing, acupuncture, Trager therapy, Feldencrisis therapy, Jin Shin Do, and Acupressure. These therapies are all capable of assisting the body in assuming proper balance and symmetry. It is important to find a practitioner and therapy that you feel comfortable with. For example there are 206 different types of chiropractic care. A bad experience with one type of chiropractic does not imply that all chiropractic treatment will yield the same results. The same is true of physical therapy. In the current political climate the health care industry finds itself in, physical therapy benefits as defined in a contracted health benefits package is usually the bare minimum. Often, the physical therapists, who place a value on the quality of client contact are often outside the large physical therapy groups, working by themselves. I want to be very clear that this does not mean that physical therapists in a large group are not good. Rather I want to emphasize that large physical therapy groups bid for insurance contracts and as a result of economic reasons must limit the amount of time the physical therapists spent with the clients. Look for physical therapists with advanced training; ie cranial sacral therapy, myofascial release techniques, and osteopathic manual therapy techniques. It has been my experience that Physical Therapists with training in osteopathic manual therapy techniques are very effective.
The journey back to health from chronic pain is not a quick trip. The average client has suffered for many years and has sought the advise of numerous specialists. Temporomandibular joint problems and chronic pain may start as early as childhood; but are compensated for, in the young, through postural and muscular changes. These compensatory patterns are effective until adulthood, when the client begins to seek treatment. During the intervening years, the original problem becomes overlaid with other problems which also require treatment if complete recovery is desired. It is the overlaying of problems, which make TMJ therapy and chronic pain treatment complex and often require the efforts of bodywork therapies. Treatment is like peeling an onion; you have to remove one layer at a time.
Successful treatment requires the recognition of compensating patterns and their effect on the whole person. To leave any secondary problems may very well mean a reoccurrence of symptoms in a matter of time.
Consequently a team approach is the most effective manner in which to treat these chronic pain patterns. I refuse to treat chronic head and neck clients who refuse to seek some form of manual therapy in conjunction with establishing the proper biomechanical position of the mandible. It has been my experience that those clients who actively participate in a team approach get better results in much less time.
The following pictures are from “Clinical Management of Head, Neck, and TMJ Pain and Dysfunction” edited by Harold Gelb D.M.D. These pictures represent a 16 year old boy with scoliosis and other defects of posture. His bite was corrected by adding to the surface of the lower 12 year molars, or second molars. The patient was also receiving manual therapy. It was with great difficulty that the patient was convinced to return for further visits. The result are the second picture:
Resolution of jaw pain and headaches not only involves a dentist but also bodywork. Seeking both treatments simultaneously yields effects far greater than if each modality were sought one after another. There is a synergistic effect that becomes apparent when a team approach is taken to assist the clients on a path towards regaining their health.
Dr. Kevin Flood, DDS
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