My clinic recently had an inservice by a dentist about restricted airways and the possible contribution to TMJ dysfunction. As physical therapists, we are seeing an increase in the amount of referrals for Temporomandibular Dysfunction (TMD), due to its relation to cervical issues. Long have we known about the link between forward head posture and decreased diameter for our airways. This is typically treated with postural education. Another component of TMD includes parafunctional habits, such as chewing gum, bruxting, and grinding teeth. Dentists treat this with relaxation training and mouth guards when sleeping. But why do people grind their teeth?
In the lecture, the dentist reported that a lot of the recent research suggests there is a link between disturbed sleep and TMD. With the abnormal sleep patterns, there is increased muscle activity, including the TMJ muscles. This activity may include grinding of the teeth, which is why the night guards are often prescribed. But are we treating the symptom or the cause? There are theories that the sleep patterns become dysfunctional due to a lack of oxygen. Restricted nasal passages are often overlooked. Try breathing through one nostril and see if there is a difference compared to the other side. This or a restricted air passageway in the neck could be significant contributions that we cannot treat. This leads us back to the discussion about night guards. With the presence of a night guard, the tongue is positioned in a way that increases the airway restriction. In treating the symptom, we may actually be worsening the disorder.
With the impact sleep (or lack thereof) has on all diseases and things like chronic pain, we have to regularly review and improve upon our treatment of any disorder that can affect sleep. If you come across any patients with TMD, be sure to ask about any breathing issues or waking up out of breath. These patient in particular may benefit from referral to a ENT physician or at least a dentist that is skilled in treating TMD.
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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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