Question
QUESTION: Hello,

I have clenched my teeth for years, and I've worn a nightguard since 1993 to help. Around 2005, I was diagnosed with TMD (a disorder of the TMJ). It has given me varying degrees of discomfort, though it's usually been tolerable. Then last September, I was attacked on the New York City subway when I tried to get help for a man who was being beaten. The assailant punched me several times in the face, hard enough to break my nose and leave me with 2 black eyes. (Also suffered a brain bleed and a broken collarbone, which has healed). For at least a month, the right side of my jaw was stiff. Hospital X-rays of my jaw showed nothing was broken, I was simply told my TMJ had been bruised. I have been going to chiropractors 2-3 times a week to get neck adjustments, and the chiropractors have assured me (A) that these will not hurt my neck, and (B) that they should help with the TMD discomfort. Sometimes, immediately after an adjustment, I do indeed feel less discomfort. Now it's February. At present, I am having quite a bit of pain, mostly on the right side of my face, from the cheek down to the back of my neck. I am spending a huge amount on chiropractors, and along with not being certain this is the best treatment, I have also begun to hear ominous things about neck adjustments leading to strokes. So, at last, my questions are: Can these adjustments of my neck help with the TMJ pain; is it dangerous; and,if it's not going to help, do you have any recommendation for other therapies? Please help, some days (like today) I'm in a lot of pain.

ANSWER: Hi Tom,

I'm sorry to hear about your situation.  That was courageous of you to help that guy while risking your own health.   I'll do the best I can to help you.  First, understand that not all doctors of chiropractic (DC) are the same.  We have different methods and techniques, and even when employing the same manual method, some are better than others at getting the job done.  Neck joint manipulation is very safe.  Yes, there are rare cases of stroke, but it's so rare that you are more 200 times more likely to get struk by lightning than to have a stroke.  You have the exact same odds of having a stroke by visiting your primary care doctor as you do by seeing a chiropractor [I just wrote a letter to a journal on this very topic].  Just receiving neck joint manipulation is not going to fix your jaw.  You must have manual cranial and TMJ work performed.  You must try a multi-modal approach where the doctor can try different things on the same visit, e.g. low level laser, massage, jaw mobilization, jaw exercise training, AND neck joint manipulation.  Soft tissue therapy can be performed by skilled and unskilled providers.  If you can find providers of Active Release Technique (ART)and Graston Technique (www.grastontechnique.com) they you'll more likely be in good hands.  You might also need to tweek your night appliance as well as consider a day appliance (at least for the short term). A dental TMJ specialist is the person to see, not your average dentist.   You may want to look up Scott Duke, DC in midtown Manhattan.  

I hope this was helpful.  Let me know if you need more info.

'Best,

Dr. G

---------- FOLLOW-UP ----------

QUESTION: Hello, Dr. Gillman. I really appreciate your quick response, and I will look up Scott Duke (does he specialize in TMJ?). You mentioned a multi-modal approach. I am currently receiving instructions from Dr. Jennifer Bassiur, the director of Columbia U's Center for Oral, Facial and Head Pain. She has me doing a mild stretching exercise (she was a bit taken aback at how little I could comfprtably open my mouth), taking Aleve twice a day, using a warm compress on the side of my face that hurts, and then massaging it with a homeopathic ointment, Traumeel. Next week, I'm going back for a follow-up, and she has indicated she's going to send me for Physical Therapy. Does it sound like I'm on the right track with her at least? Does any of this qualify as the Manual Cranial and TMJ work you recommended?

Also, I've been getting deep tissue massage of my shoulders and neck (and to a lesser, much more gentle extent, my jaw). Is this counter to the soft-tissue therapy you recommend? I'm not sure what soft tissue therapy is, actually. My next massage is scheduled for Saturday morning.

By the way, what makes all this even more complicated is, I'm a singer! And I'm trying to improve. Singing is a great joy to me, so it's really important that I overcome this to whatever extent possible. I don't want to use muscle relaxants; they turn me into a zombie. The most I'll use is this homeopathic (herbal?) thing called Formula 303 which has valerian root.

Thank you for any response you can give me. This is truly a pain, but I'm hopeful I'll come out on the other side of it.

Tom Angelo
Brooklyn, NY

Answer
Hi Tom,

First, any massaging or digging into muscles, tendons, ligaments is considered "soft tissue therapy."   Whether the practioner is skilled in the various methods makes a difference.  My most recent TMJ patient was a college-aged female that could only open her mouth 17 mm.  40 is deemed the lower limit of normal.   She opened her mouth to 38 mm after one session using a Graston Technique instrument underneath/behind the lower jaw.   The technique mattered.  Others will only change with specific soft tissue release methods targeted to specific structures.   Mild stretching exercises are not likely to be effective.   Neither will warm compresses.  

Dr. G