I was recently performing an evaluation on a 27-year old male s/p car accident. He presented with classic whiplash signs and symptoms- neck pain, tenderness to palpation and hypomobility of the upper cervical spine, cervical joint restrictions, and high fear avoidance to movement. Additionally, he was having near constant headaches with reports of tinnitus and earaches. In this post I want to cover how and why ear symptoms can be related to both upper cervical and TMJ Dysfunction
Cervical nerves 1-3 and cranial nerves V, VII, IX, X, and XI all meet at the trigeminocervical nucleus. These nerves are in very close proximity to one another. When dysfunction occurs in one of the nerves, the other nerves can receive abnormal inputs as well. The TMJ is innervated by the mandibular division of the Trigeminal Nerve (cranial nerve V) and is therefore at risk. The mandibular division further branches into the deep temporal nerve, masseteric, and auriculotemporal nerves. Since the auriculotemporal nerve is responsible for innervating the tempanic membrance and the external auditory meatus, dysfunction of the TMJ can cause ear symptoms. On the same note, the upper cervical nerves exit around the suboccipital triangle, giving the possibility of a cervical patient to have ear symptoms.
In my car accident patient described above, I have been focusing heavily on patient education, proper body mechanics, relaxation techniques, and upper cervical joint mobility. By improving upper cervical mobility, the upper cervical nerves can be taken off tension. Therefore the trigeminocervical nucleus will stop receiving poor inputs and indirectly stop affecting the auriculotemporal nerve.
Within 3 visits, he continues to have headaches, but his ear symptoms have subsided!
James Heafner PT, DPT, OCS:
Owner and lead physical therapist at Heafner Health, cash-based physical therapy in Boulder, CO. Areas of expertise include orthopedic and manual therapy, functional movement, pain science, and movement science.
In May 2013, I earned my Doctorate in Physical Therapy from Saint Louis University. After graduating from the Harris Health Systems Orthopedic Residency in October 2014, I moved to Boulder, CO. Since living in Boulder, I have started my own cash-based PT practice, earned my OCS certification, and teach for the OPTIM Fellowship and COMT program in Houston TX and Scottsdale, AZ.
Chris Fox PT, DPT, OCS: Physical therapist at Foothills Sports Medicine & Physical Therapy in Scottsdale, AZ and regularly lectures at the Phoenix Campus for NAU's DPT program and for Optim Manual Therapy's COMT program. Completed multiple advanced manual therapy courses implementing aspects of biomechanical analysis. He received his DPT from Saint Louis University in 2013. Completed Scottsdale Healthcare's Orthopaedic Residency (now Honor Health) in July 2014. He became a Board Certified Orthopaedic Specialist in 2015. Level I Expert in FMS and SFMA , Kinetacore FDN Level 1 certification, and IASTM Technique course completion. He would like to pursue further education in McKenzie Technique, Dry Needling, Strength & Conditioning, Orthopaedic and Manual Therapy.
Brian Schwabe PT, DPT, SCS, CSCS:
- Board Certified Sports Physical Therapist (SCS) at Elite OrthoSport in Santa Monica, CA which specializes in treating collegiate/professional athletes and clientele from the Beverly Hills, Hollywood, and Santa Monica areas.
- USC Sports Residency Trained Physical Therapist (<1% of all PT's residency trained)
- DPT from Saint Louis University
- Future plans/interest include:
1. USAW, SFMA & Catapult Systems technology for NBA teams
2. Pursuing a position as a sports physical therapist &/or Strength coach for a Division 1 athletic medicine department or professional sport team.
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