Treatment of Muscle Spasm, Muscle Pain and Myofascial Pain in TMJ Disorders: Myomonitor and ULF TENS

Dr. Shapira Blog, TMJ 0 Comments

This is an answer I gave on Reddit.com to the question of treating muscle spasm in TMD disorders associated with a close-lock TMJ. A link to discussion will be at bottom of post

“What would you recommend doing about the muscle spasms?” is an excellent question. The first step is to make a specific diagnosis. You question is perfectly meaningless without understanding the type of muscle spasm we are talking about.

Acute Muscle Spasm is usually related to specific trauma and treatment is symptom specific. This does need to be differentially diagnosed from myoclonic muscle problems (both positive and negative) which could be related to underlying disorder.

Acute muscle spasm and muscle splinting can be closely related when an acute injury leads to muscle splinting or contacture of muscles to protect an area of injury. This can be a muscle tear, broken bone, damaged joint or tendon or tendon attachment problem. A blood clot can also result in acute muscle spasm but is rear in TMD.

Acute muscle spasm will usually self correct and is probably what happened to you in the episode you descibed as a close-lock though it is possible you had acute spasm and a partial dislocation of the disk.

Muscle splinting is an important body function that protects against additional injury and allows some function.

If the injury is a muscle tear or if the spasm is strong enough to cause a tear in the muscle you have a completely different problem. You will still have splinting and severe muscle inflamation and ice will usually be first line of approach. It is also possible to tear a tendon or have enthesis of tendon attachment. These all appear very similar to acute muscle spasm but are very different.

Muscle Splinting can lead to Myofascial Pain and Dysfunction (MPD) with trigger points, taut bands and referred pain. This is the most common type of pain anywhere in the body and is often misdiagnosed to the fact that the pain and where it is coming from are usually not correctly identified when doctors are not familiar with these problems. In the TMD field this often leads to Root Canal Treatment, Extractions and diagnosis of non-existent sinus or ear infections

MPD diagnosis is crucial. When confronted with this type of “muscle spasm” Travell Spray and Stretch techniques can often give instantaneous relief. Hot and Cold and Stretching can all be useful. Teaching patients to use Spray and

Stretch with vapocoolants at home is ideal and should be taught to patient. MPD is caused by repetive strain injuries and correction of these problems is important. This may be related to postural condition, anxiety and stress and muscle misuse. Not correcting underlying structural issues is unwise for many patients, it is ethically required to explain postural considerations including bite to patients.

Treatment with ULF-TENS is an excellent modality. The Myomonitor has been used to relax muscles in Neuromuscular Dentistry for over 50 years. It works as a muscle stim peripherally causing muscles to contract and relax every 1.5 seconds. This time is based on time it takes nerve and muscle membranes to return to normal after firing. This effectively eliminates fatigue and and causes repetitive contraction and relaxation of muscles increasing blood flow with nutrients from blood and taking away waste products.

NMD usues this on muscles innervated by the Trigeminal Nerve and the Facial Nerve (cranial nerves 5 and 7 respectively). In TMD patients this relaxes all muscles that are trigeminally innervated. This includes the masseters, the medial pterygoids, the temporalis, the superior and inferion lateral pterygoids, the sphenomandibularis, the Tensor Veli Palatini that opens and closes eustacian tubes and the Tensor Veli Tympani that cotrols tension and eardrum and the anterior belly of the digastric. It also works on muscles innervated by facial nerves when used in standard position over coronoid notch.

The myomonitor can also be used on muscles anywhere in the body directly or indirectly such as on accessory nerve (cranial nerve XI) to work on upper neck, back and shoulder muscles. The BioTens is another ULF-TENS that is used by some NMD dentists. There are many reasons why the Myomonitor is special in dealing with bites and high tech adjustments but the BioTens is excellent at relaxing muscles and I often use it on Cranial nerve XI.

Nutrition is important in dealing with muscle issues and muscles require both calcium and magnesium to contract and to relax. Some medications can cause severe muscle pain and issues.

Trigger point injections, dry needling, prolotherapy, prolozone therapy are all used to treat muscle spasm and taut bands. Spray and Stretch should be utilized with injections .

Posture stability is key. This video https://www.youtube.com/watch?v=kdWhfeOcFAQ is a patient with TMD/ Headache/Migraine that is secondary to postural instability of hips. Treatment will fail if initial problem is ignored. This patient had a similar experience years previously.

We swallow 2000 times a day when our teeth touch momentarily when there is underlying postural instability we are more likely to have repetitive strain injuries. Clenching, grinding and misuse of muscles exacerbates these problems. Preventing issues is more effective than treating them after the fact. It is far easier to change the oil than change the engine in your car. It s better to prevent severe damage to TM Joints that wait till there is a disaster.

Locked Jaw – Is this permanent damage to my jaw? from TMJ

Sinus Headache, Sinusitis, Sinus Pain and TMJ Disorders

Dr. Shapira Blog, Chicago, Highland Park, Lake Bluff, Lake Forest, Libertyville, TMJ, Uncategorized 0 Comments

Chronic Sinus Headache and other Sinus Pains are closely related to TMJ Disorders. The connections between these problems is multifacted.

The Trigeminal Nerve also called the Dentist’s Nerve is the underlying common source of all of these problems.

Dentists are the experts on the Trigeminal Nerrve Disorders and in particular neuromuscular dentists who optimize eliminating noxious input to the trigeminal system. The term “TMJ: The Great Imposter” was coinded because patients with TMJ disorders frequently report symptoms not specifically related to the joints.

Dentists who practice TMD and Neuromuscular Dentistry are well versed in Myofascial Pain and Dysfunction or MPD as it relates to upper body, head neck and facial pain referred from active myofascial trigger points.

The Sphenopalatine Ganglion (SPG), the largest parasympathetic ganglion in the head is on the maxillary division of the trigeminal nerve. I have taught hundreds of neuromuscular dentists both from the USA and from across the world how to utilize SPG Blocks as part of Neuromuscular Treatment.

The Sphenopalatine Ganglion also contains Sympathetic fibers of superior cervical change responsible for “Fight or Flight” reflex and when not controlled create a wide variety of stress, pain and emotional issues.

The Myomonitor utilized by Neuromuscular Dentistry effectively neuromodulates the sympathetic and parasympathetic autonnomic input from the Trigeminal Nervous System.

The majority of sinus pain and sinus headache are NOT primary issues or infections within the sinuses. Antibiotics may actually create new sinus issues related to fungal infections.

Sinus pain and Headaches can be relieved with SPG Blocks very quickly.

Long term sinus improvements are related to function and structure.  The following is a video of a patient who has experienced a cure of her lifetime sinus issues with DNA Appliance.  Neuromuscular Dentistry treated her TMJ disorders and the DNA is used for long term stabilization and to increase the size of her airway.

There are over 150 additional videos on treatment of TMJ Disorders, Headaches, Migraines, MPD, Fibromyalgia, Sinus pain, Sleep Apnea and snoring mat this link:  https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg/videos

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Pain Is Destroying My Life! Pain Solutions Restore Your Quality Of Life.

Dr. Shapira Blog, Chicago, Chronic Daily Headache, Clicking & Popping, Cluster Headache, GURNEE OROFACIAL PAIN, Headaches and Migraines, SPG Block Anxiety, SPG Block Cluster Headache, SPG Block Migraine, SPG blocks, Sphenopalatine Ganglion Blocks, TMJ affects your posture, TMJ ARTHRITIS, TMJ Causes Stress, TMJ Dentist, TMJ Migraines, TMJ Neck & Back Pain, TMJ Numbness in Arms & Fingers, Uncategorized 0 Comments

Living day to day with severe or chronic pain can be agonizing to your spirit, your family and your life.

There is hope for patients with chronic head, neck, face and back pain.

Millions are disabled with chronic pain. It i estimated that 100 million Americans have chronic pain and as many as 11 million are disabled by chronic headaches and migraines.

Just outside Chicago in Highland Park is a small office dedicated to giving patients their lives back by freeing them from their painful prisons. Dr Shapira utilizes SPG (SphenoPalatine Ganglion) Blocks that were featured in the book “Miracles on Park Avenue” and was the story of Dr Milton Reder a New York ENT who saw thousands of patients from around the world seeking pain relief.

Dr Shapira has over 100 patient testimonials on his YouTube channel.

https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg/videos

Many of the testimonials are from physicians or dentists who have taken Dr Shapira’s courses on techniques for utilizing these “Miracle” blocks.

Each and every patient is unique and different methods of giving the blocks are important to some patients. Self-Administration is the ideal method according to Dr Shapira because it frees the patient from trips to doctors offices and emergency rooms and gives them immediate access as needed.

The Sphenopalatine Ganglion is the largest Parasympthetic Ganglia of the head and lies in the Pterygopalatine fossa behind the palate and is attached to the maxillary division of the trigeminal nerve.

SPG Blocks are especially effective for chronic headaches, migraines, cluster headaches and other Trigeminal autonomiccephalgias because of its control of the autonomic nervous system of the head and throughout the body. Sympathetic fibers from the cervical ganglion chain also pass through the ganglion and travel along the course of the Trigeminal Nerve.

The Trigeminal nerve is the primary driver of all headaches and migraines but it is most commonly known as “The Dentist’s Nerve” If you suffer headaches, blame the trigeminal nerve and the autonomic nerves that travel down its fibers. https://www.sleepandhealth.com/disorders-and-treatments/

We are all familiar with trips to the dentist where we receive anesthetics for dental work and know the feeling of numbness when we leave. What many of us are not aware of is the the Trigeminal Nerve is actually part of the brain as are the other 11 cranial nerves.

The Trigeminal Nerve or fifth cranial nerve goes to the teeth, the jaw bones, the jaw joints or TMJ (TM Joints), the jaw muscles, the periodontal ligaments, the gingiva and mucosal surfaces of the mouth (the gums), the anterior 2/3 of the tongue. ENT’s are also extremely familiar because it goes to the mucosa of the nose and sinus linings and is responsible for sinus pain and sinus headaches as well. Many patients have hearing problems related to the Trigeminal nerve because it innervates the tensor muscle of the ear drum (Tympanic membrane) or Tensor Veli Tympani. It also controls the opening and closing of the eustacian tube thru the Tensor Veli Palatini muscle. This is the muscle that prevents food and liquids from entering the nose.

There are three branches of the trigeminal Nerve. The mandibular Branch and the maxillary branch are where Dentists are the acknowledged experts. The opthalmic branch is often thought of belonging to the opthamologists and facial surgeons but in truth dentists are primarily responsible for input to this part of the trigeminal nerve as well. Retro-orbital pain and the lower eyelid are controlled by the maxillary branch while the upper eyelid and forehead is the opthalmic branch.

Control of nociception into Trigeminal Nerve is the ideal method of reducing or eliminating headaches and migraines. The Sphenopalatine Ganglion is a tool to control the autonomic aspects of the Trigeminal Nerve.

The largest input to the brain is thru the proprioceptive aspects of the Trigeminal nerve that pass thru the mesencephalic nucleus of the brain. This is where Neuromuscular Dentistry becomes invaluable to correcting and eliminating long term chronic head and neck pain. While SPG Blocks address the autonomic nervous system neuromuscular dentistry addresses the Somato-Sensory nervous system that controls muscle function and posture. Myofascial Pain is the most common cause of pain anyhere in the body.

The Trigeminal nerve accounts for over 50% of all input to the brain after amplification in the Reticular Activating System. The Reticular Activating System is part of the Limbic (emotional Center of Brain) System and connects to the Hypothalamus-Pituitary-Adrenal complex. This is also where we experience anxiety, depression and symptoms form stress overload. SPG Blocks can eliminate many of those feelings.

Stress overload causes us to move into Sympathetic Overload and is frequently responsible for Sympathetically Maintained Pain seen in CRPS or Chronic Regional Pain Syndrome, previously called causalgia and RSD or Reflex Sympathetic Dystrophy. SPG Blocks help our bodies and mind reset from Sympathetic Overload and the “Fight or Flight reflex” and turns on the parasympathetic “Feed and Breed reflex” where we experience feelings such as well being and love. It invokes the feelings we have playing with puppies or babies, just the opposite of “being stressed out”.
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