Archive for category: Physiotherapy Column

You may have already seen our jaw releases, which can be very helpful to relieve tension in the jaw and give quite immediate relief. There are additional TMJ exercises for motor control and strength that your physiotherapist may give you. These TMJ exercises can help to reduce likelihood of the jaw muscles tightening back up and to provide ongoing relief from your jaw muscle/joint pain.

TMJ Exercises: Resting jaw position

If we have a tendency to habitually hold tension in our jaw (whether it be the result of postures, habits, or stress), we want to break this cycle! It can take a lot of practice and repetition to form a new habit, so we want to be able to practice this regularly. Here is a TMJ exercises to help relax the jaw.

It can be helpful to become more conscious of the tension we hold in our jaw throughout the day. See if you can notice patterns of when you tighten through your jaw. It might be when at work, driving, or just the end of the day. For best effects, these activities/time of day can be the best place to start practicing your relaxed jaw position.

Specifically, this looks like:

· Tongue resting on the roof of your mouth, behind your top teeth

· Bottom jaw should feel “heavy.” Teeth should not be touching, but lips will be closed (or only resting slightly apart)

It can also feel nice for your hands to rest on the side of the face, hanging down to help the jaw feel heavy and relaxed.

TMJ Exercises: Mindful practice with opening/closing of jaw

Feel TMJ with fingertips (just in front of ears) – if you open/close your mouth you should feel the joint moving under your fingers.

Slowly start to open mouth comfortably (stopping before any clicking occurs). Focus on keeping the joints centred through opening, then closing your mouth

Jaw stability exercises and strength exercises

Jaws don’t just open and close. They also move side-to-side and forward-and-backwards.

We want to be able to activate and strengthen the muscles responsible for these movements. Use your fingers to push against the jaw in different positions, and not push your jaw out of the resting jaw position we just learnt.

You will move hands around:

· Bottom of the chin, trying to force teeth together

· Hooking over chin, trying to open jaw further

· Either side of the jaw, trying to push jaw to the side

· Front of the chin, trying to push jaw back

Each position can be resisted for 5-10 seconds to help promote muscle activity around the jaw joint.

If you want to learn more about TMJ Exercises please book in to see one of our Barefoot physiotherapists via the link.

Other blogs to read on our page: How to Release Jaw Tension and Physiotherapy for TMJ

 Here at Barefoot Physio we use a variety of techniques to get the best results for our clients. We often incorporate dry needling as part of our treatment plan because it has a wide variety of benefits. This is always done in consultation with our clients. In this blog, we’ve covered some of the most common questions we get about needling to help you work out if dry needling is right for you.  

What is dry needling? 

Dry needling involves inserting very thin, single use needles into a specific location in the body to elicit a response. It is named “dry” needling as the needle does not contain any fluid. This is unlike a medical injection (eg a cortisone injection) which would be considered “wet needling”. Dry needling should only be performed by a qualified health professional who has done further training.  
 

Is it the same as acupuncture? 

Acupuncture is an entire treatment methodology that comes from Traditional Chinese Medicine. To be an acupuncturist typically requires a 4 year training program. Dry needling (also referred to as Western dry needling) is just one technique from within acupuncture that other allied health professionals (eg physiotherapists, podiatrists or massage therapists) can perform safely after further training. Traditional acupuncture uses meridian lines and the focus of treatment is on the flow of energy (qi) throughout the body.

While Eastern acupuncture can be used as part of a treatment plan for musculoskeletal problems, it is more commonly used for overall wellbeing. Including stress management and can even be helpful in the treatment of morning sickness. On the other hand, dry needling typically focuses on trigger points within muscles and is used for reducing muscle tension.  As a result, dry needling also often uses longer needles. At Barefoot Physiotherapy we mostly use Western techniques though occasionally Eastern techniques are used to support treatment as well. 
 

How does dry needling work? 

Dry needling works using a number of mechanisms: 

• Local (where the needle goes in): needling initiates a small local inflammatory response. There is also release of local endorphins (feel-good chemicals). Increased local blood flow also helps bring nutrient rich blood and clear waste products. Sometimes a muscle twitch occurs resulting in changes to calcium channels in the muscle fibres and subsequent relaxation of the muscle 
   
• Segmental (at the spinal cord) effects: Enkephalin (an endorphin) is released which acts as a pain relief. Pain gating also occurs, which is when information from the needle insertion overrides other information from the area. (think of how you rub your shin if you hit it on a coffee table) 
   
• Extra-segmental (at the brain) effects: A number of chemicals are released including serotonin, adrenaline and endogenous opioids which help to reduce pain felt in the whole body (not just the area where the dry needling occurs). 

• Sympathetic effects: Needling can stimulate the autonomic system and reduce the sympathetic nervous system (“fight or flight”) activity and increase the parasympathetic nervous system (“rest and digest”) activity 
   
• Immune effects: Enodgenous opiods that are released can support regulation of the immunoinflammatory. 

 
What conditions is dry needling helpful for? 

Knowing that it can help reduce muscle tension as well as provide a host of overall benefits, dry needling can be useful for a variety of conditions, including:  

• Back pain 
• Neck pain  
• Rotator cuff injuries 
• Nerve pain and problems 
• Shoulder bursitis and other shoulder pain 
• Hip pain 

It is beneficial for both new and persistent (long term/chronic) problems.

 
What should I expect with dry needling? 

Before getting dry needling, your therapist should ask some general questions about your health to ensure it is safe for you to receive dry needling. They will then explain what is going to happen and gain your consent. Then, the area that is being treated needs to be exposed so that the needles can be inserted directly into the skin (going through clothing is an infection risk). For many body parts, such as your calf, it may already be safely accessible. However, for an area such as your glute or hip, your therapist may need to move your shorts to gain access. Once the area is prepared then treatment can begin.

Types of Dry Needling Techniques

There are a number of dry needling techniques that may be used. Most commonly, needles will be placed into the muscle and left in for approximately 5-10 minutes.Iideally waiting for the muscle to relax before removing them. It is common to feel a dull ache or tugging sensation and your muscle may even twitch. Another option, especially for muscles around the lungs where extra safety precautions are necessary, needles may be inserted and moved around searching for the “twitch” response in the muscle and then removed once that has been achieved. Both of these techniques are effective but one may be more suitable depending on your condition or the body part being treated. For both of these, potential treatment side effects are an achy feeling in the muscle and potentially a small bruise in the area.  

Press Stud Needling

Another treatment option we are using more often at Barefoot Physio is press studs. These are small needles that are attached to a small plaster and are left in for up to 3 days. The needles can be used in the area of symptoms or where treatment is being focused. They work on the neurophysiology model of providing stimulus to an area of tissue to help change the information going to the brain. This in turn, helps to reduce the ‘threat level’ assessment in the brain and consequently reduce overall pain and symptoms. Press studs can be effective for a variety of conditions, including chronic or persistent pain as well as acute injuries.  
 
If you want to know more about dry needling discuss it with one of our physios today. Book in online here.  

What Is TMJ? 

Have you ever wondered if something is wrong with your jaw, or asked yourself “why is my jaw clicking?” Perhaps you have been told by your doctor or dentist that you have something called “TMJ dysfunction.” What does this actually mean? And how can Physiotherapy help your TMJ ?

What is TMJ dysfunction? 

First, to answer this question, we need to answer a different question: “what is the TMJ?” TMJ stands for temporomandibular joint (no wonder we abbreviate it, hey?!). This is the joint connecting our temple bone to our mandible, or jaw bone, and we have two of them – one for either side of our face, and they are located just in front of our ear canals. Like any joint, there are multiple structures that make up the joint, including: ligaments, cartilage disc, and of course the bones. 

Our TMJ is the most used joint in the body! It not only opens and closes, but can also move but side-to-side, and in forward-and-backward directions, meaning it can create many complex movements. This joint is involved in any activity we use our mouth for, including chewing, talking, singing, yawning, and facial expressions. 

When there is a problem with the TMJ, it is referred to as TMJ dysfunction or a temporomandibular disorder (TMD). 

What causes TMJ symptoms? 

TMJ dysfunction is an umbrella term encompassing many different causes of TMJ symptoms. These may be due to: 

Trauma to the joint  

Myofascial causes – changes to the musculature surrounding the joint/s. For example, this may arise due to: 

• Habits such as bruxism (grinding teeth) or clenching the jaw. This can commonly arise with chronic stress and anxiety 
• Poor posture of the head, neck and/or jaw 
• Strain from eating habits – e.g. too large bites, from hard or chewy foods, eating on only one side of the mouth 

Intra-articular causes – changes within the joint as a result of inflammation or mechanical changes to the joint itself 

• Autoimmune and inflammatory conditions affecting the jaw (e.g. osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, lupus) 
• Hypermobility disorders affecting the jaw joint 
• Internal derangement (abnormal relationship of the TMJ disc to any of the other components of the joint) 

What are the symptoms of TMJ dysfunction? 

There can be several different symptoms associated with TMJ dysfunction, and may include any combination of: 

• Jaw pain and/or tightness 
• Jaw clicking, popping or grinding of the jaw during use 
• Limited mouth movements, including reduced ability to open the mouth wide or close the mouth 
• Neck pain and/or stiffness 
• Headaches 
• Ear pain 
• Tinnitus (ringing in ears) 
• Aural fullness (a feeling of blocked ears) 
• Dizziness or vertigo 

So many important structures are housed in the head, the jaw joints being just one of them. We also have eyes, ears, balance organ (vestibular system) and a number of muscles. With so many sensitive and important structures housed so closely together and sharing common nerve supply pathways, problems arising in one of these structures (like the jaw) can also cause symptoms from these other structures. 

How can a physio help with TMJ dysfunction? 

Physiotherapy for TMJ includes a variety of treatment options, you can firstly expect your physiotherapist to assess the range of movement of your jaw and neck. They will also conduct a thorough assessment of the muscles and joints of these areas to help form a personalised treatment plan for you. Treatment may entail: 

• Releasing jaw muscles and teaching you how to do this yourself  with external or internal jaw releases 
• Hands-on treatment around the neck, jaw and head to relax involved muscles and joints 
• Teach you a comfortable resting jaw position and/or neck position 
• Exercises to retrain and strengthen your jaw muscles as appropriate 

• Advice around chewing and eating, such as avoid chewing gum, or switch to softer food choices and smaller bites 
• Breathing exercises to help de-load overactive neck muscles that may be contributing to excessive jaw tension 
• Stress-management strategies 
• May recommend sourcing and trialling a mouthguard or splint to help reduce stress through the TMJ with grinding or clenching 

If you have been experiencing pain in your jaw and are searching for ways to manage and improve your quality of life, book in with a Barefoot physiotherapist. Our Physiotherapy treatment for TMJ aims to understand the different factors contributing to your jaw symptoms to personalise treatment for you. 

Hypermobility can be a complex condition to manage and there are multiple ways that symptoms can be managed. A large part of management for hypermobility is movement. People who are more flexible are often drawn to activities that their flexibility gives them an advantage. One that we see all the time is yoga. It’s not uncommon to hear the phrase “but I can’t do yoga, I’m not flexible enough”. The assumption is only flexible people can do yoga, and they don’t have to try hard. This is untrue. If anything, people with hypermobility doing yoga need to work even harder than others.

What is Hypermobility and how does this affect Yoga:

Hypermobility is due to a dysfunctional collagen tissue. What this means practically, for movement, is that your muscles and ligaments don’t provide enough support and that you are less aware of where your body is in space. In yoga this can lead to hanging on your joints and excessive loading of joint structures. This is not to say that you shouldn’t do yoga, you just need to have the correct strategies.

Tips for practicing Yoga with Hypermoblility:

Co-contraction around joints: Even if you can fully extend your arms and legs, it doesn’t mean you should be hanging in your joints. Especially when putting weight through your limbs it’s important to maintain a micro bend through elbows and knees. This micro bend provides muscular support from all sides of a joint, hugging and supporting. Try leaning on a straight arm (eg in downface dog or plank) and shift between fully straight and relatively passive, and a micro bend of the elbow to “unlock” the joint. You will likely find the micro bend is both more comfortable and more work!

Imagery: As proprioception is often decreased in hypermobile bodies, imagery can be a great addition or alternative to internal awareness. You can include cues such as arms pushing into honey (eg in warrior I and II), hug into the midline (eg in trikonasana or tuladandasana), or a weight falling off your tailbone.

Finish your movements: It’s easy to get caught up in what’s coming next and flop from one pose to another. Really focus on the end of the movement and fully completing the pose (for whatever that looks like for you). For example, in transitioning from downface dog to upface dog it can be easier to flop onto your belly and then push up hanging in the shoulders. Try to break down the poses into smaller chunks, or easier options and experience each movement fully.

Adjustments: Hands on adjustments are fairly common in yoga classes. For a hypermobile body it’s recommended that you talk to your teacher and avoid being pushed further into range. Hands on adjustments that encourage activation and awareness are still useful. If you are not comfortable with hands on corrections in a class, just let your teacher know! Use props: using props such as yoga blocks or straps are a great way to increase the support and awareness of your body. For example, using a strap around the lifted leg in extended hand to toe pose means you can focus on the mini bend of the knees to provide more stability.

Barefoot Physiotherapy Can Help:

If you are hypermobile and practicing (or would like to practice yoga) get in touch with the Barefoot Physiotherapy team for individualised recommendations. Our team will help you be able to practice yoga with hypermobility in a way that helps your body. Contact us at 1300 842 850 or book online via clicking here.

If you would like to read about the use of Props in Yoga CLICK HERE