learning with laughter cathy russell. dip pt (uk), mcpa, atm humor helps us relax… when we relax
TRANSCRIPT
![Page 1: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/1.jpg)
Learning with Laughter
Cathy Russell. Dip PT (UK), MCPA, ATM
www.cathymrussell.com
http://www.cathymrussell.com/blog/
Humor helps us relax…
When we relax we learn
![Page 3: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/3.jpg)
SYMPTOMS of TMD
HeadachesChronic Neck / Shoulder
Pain Earaches
Facial /throat painSinusitis
ToothachesUndermining balance
against gravity
SYMPTOMS of TMD
HeadachesChronic Neck / Shoulder
Pain Earaches
Facial /throat painSinusitis
ToothachesUndermining balance
against gravity
![Page 4: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/4.jpg)
1st HALF
WHAT IS PHYSIOTHERAPY?
ANATOMY
CERVICAL JOINTS & FASCIA
BIOMECHANICS
ETIOLOGY
DIAGNOSTIC CLASSIFICATION
![Page 5: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/5.jpg)
1.MANAGEMENT OF PATIENT WITH COMPLEX TMD2. ROLE OF PHYSIOTHERAPIST3. ROLE OF DENTAL PROFESSIONAL4.TMD CHECKLIST FOR DENTAL PROFESSION 2nd HALF
![Page 6: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/6.jpg)
TM and CV JOINTS
![Page 7: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/7.jpg)
TM JOINT
![Page 8: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/8.jpg)
TMD & VESTIBULAR SYSTEM
• The vestibular organs sense head motion: canals sense rotation; otoliths sense linear acceleration (including gravity).
• The central vestibular system distributes this signal to oculomotor, head movement, and postural systems for gaze, head, and limb stabilization..
• The visual system complements the vestibular system.• Visuo-vestibular conflict causes acute discomfort.• Peripheral and brainstem vestibular dysfunction causes
pathological sense of self-motion and visuo-vestibular conflict.
![Page 9: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/9.jpg)
TMD & The Vestibular Organ
Horizontal canal
Anterior vertical canal
Posterior vertical canal
Vestibular Nerve
Facial Nerve
Vestibulocochlear(VIII) Nerve
Cochlea
Cochlear NerveCochlear Nerve
UtricleSaccule
![Page 10: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/10.jpg)
There are 3 major vestibular reflexes
• Vestibulo-ocular reflex – keep the eyes still in space when the head moves
• Vestibulo-colic reflex – keeps the head still in space – or on a level plane when you walk
• Vestibular-spinal reflex – adjusts posture for rapid changes in position.
![Page 11: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/11.jpg)
EMBRYOLOGY AND CRANIAL NERVE LINKS
Pharyngeal Arches- 5 & 20 weeks
Trigeminal Facial Glossopharyngeal Vagus
Art by Renee Peterson & John Chitty, based on Larsen, Human Embryology, p. 362
![Page 12: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/12.jpg)
THE CHEWING MUSCLES
![Page 13: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/13.jpg)
TEMPORALIS
![Page 14: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/14.jpg)
MASSETER MUSCLE
![Page 15: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/15.jpg)
PTERYGOIDS & EAR SYMPTOMS
Tensor velipalatini
Levator veli palantini
![Page 16: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/16.jpg)
MOUTH OPENERS
From Gray’s anatomy
![Page 17: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/17.jpg)
© 2012 Pearson Education, Inc.
Figure 11-7 Muscles of the Tongue
Styloid processPalatoglossus
Styloglossus
Genioglossus
Hyoglossus
Hyoid boneMandible
(cut)
![Page 18: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/18.jpg)
EVERYTHING’S CONNECTEDphotos from Tom Meyers Anatomy trains
![Page 19: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/19.jpg)
Cranium, Jaw, thorax connections
![Page 20: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/20.jpg)
From grey’s anatomy
![Page 21: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/21.jpg)
The Trigeminocervical nucleus.
![Page 22: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/22.jpg)
TRIGEMINAL NERVE
Sensory -face, scalp, teeth, mouth and nasal cavity
Motor nerve to muscles of mastication
3 Nerve Branches
Opthalmic
Maxillary
Mandibular
![Page 23: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/23.jpg)
SUMMARY OF BIOMECHANICS
![Page 24: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/24.jpg)
ETIOLOGY
• Factors which may be involved in the onset of TMD/J:
Specific onset event or
No specific onset event
![Page 25: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/25.jpg)
TMJ
SPECIFIC EVENT ONSET
![Page 26: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/26.jpg)
MODEL OF TRAUMATIZATION FOR BRUXISM?
TRAUMA IN MVA / HEALTH PROFESSIONAL VISITS
• Meaning of event… in state of relative helplessness
• Life history of specific traumatic events especially from childhood “fans the flames”
Together may result in “Bruxism”which now becomes an unconscious activity incorporated into
muscle tension when triggered by memories
![Page 27: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/27.jpg)
TMD
POSTURAL ABNORMALITIES/FORWARD HEAD POSTURE
SINUSITUS/PROLONGED MOUTH
BREATHING
PARKINSON’S
FIBROMYLAGIA
IBS
RIGHTING &
MOTOR REFLEX
CRANIUM SHAPESMALOCCLUSION
NARROW VAULTED PALATE
TENSION / STRESS BRUXISM
NO SPECIFIC ONSET EVENT
SLEEP DISORDERED BREATHING/APNEA
![Page 28: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/28.jpg)
My Cranial base with C1 and rotation of C2
![Page 29: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/29.jpg)
RIGHTING REFLEX
The proper alignment ofBipupillary, Otic plane, Occlusal plane
![Page 30: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/30.jpg)
NORMAL C-SPINE ALIGNMENTX-RAY: LATERAL VIEW
• Schematic lateral view of a normal cervical spine. Note (A=anterior spinal line; B=posterior spinal line; C=spinolaminar line;
![Page 31: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/31.jpg)
Forward Head PostureC1 encroaching on airway
Loss of Cervical spine stability
Weakened and lengthened hyoids- ABNORMAL SWALLOW
Spondylolisthesis
![Page 32: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/32.jpg)
LOOK FOR NARROW PALATES
Blue triangle represents narrow airway
![Page 33: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/33.jpg)
P = palatal height
Mx= maxillary intermolar distance
Mn=mandibular intermolar distance
OJ = over jet
NC = neck circumference
BMI = body mass index
Stanford Morphometric Model P + (Mx - Mn) = 3 x OJ+ 3x (BMI - 25) x (NC/BMI)
A Predictive Morphometric Model for the Obstructive Sleep Apnea Syndrome, Annals of Internal Medicine, Vol. 127, No. 8(Part1), Oct 15, 1997. Pages 581-587)
![Page 34: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/34.jpg)
Cerebellum
From greys anatomy
![Page 35: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/35.jpg)
RESEARCH DIAGNOSTIC CRITERIA
• Group1-Myofascial pain in face, neck and shoulders
Most common category
• Group 2-Internal derangement of the joint Disc Displacements ~ 3 types Injury to Condyle
• Group 3-Degenerative joint diseaseEg. Osteoarthritis, Pyogenic Arthritis, Rheumatoid Arthritis
![Page 36: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/36.jpg)
Group TwoDisc Displacement With Reduction
![Page 37: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/37.jpg)
Group 2-Disc Displacement without reduction, with limited
opening
<35mm (Less than 35mm)
![Page 38: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/38.jpg)
GROUP 3
![Page 39: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/39.jpg)
CERVICOGENIC HEADACHES
• Anatomical basis for these is the convergence of the afferent input of the upper cervical spine nerve roots(C1-3) and the afferent tracts of the trigeminal nerve in the trigeminocervical nucleus
Journal of manual & manipulative Therapy.
Vol 15 No 3 (2007),155-164
![Page 40: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/40.jpg)
![Page 41: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/41.jpg)
MANAGEMENT OF TMD
The Role of Health
Professionals &
Physiotherapist
The Role of the Dental Professional
![Page 42: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/42.jpg)
THERE IS ALWAYS A WAY TO MANAGE A CHRONIC PROBLEM!
![Page 43: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/43.jpg)
DIAGNOSTIC CRITERIA QUESTIONNAIRE FOR ALL HEALTH
PROFESSIONALS
If have TMD proceed to
INTAKE FORM
![Page 44: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/44.jpg)
PHYSIOTHERAPY INTAKE FORM-QUESTIONS ARE KEY!
• HISTORY: MEDICAL –BIRTH, BREASTFEEDING HABITS, PARKINSONS, FIBROMYALGIA, IBS, LYME DISEASE, CONCUSSIONS
• DENTAL: ORTHODONTIC WORK, LONG DENTAL PROCEDURES, FACIAL TRAUMAS & SURGERY
• POSSIBLE CONTRIBUTING ETIOLOGY (MVA, Airway issues, Birth and childhood traumas)
• HISTORY OF PRESENT ILLNESS in own words
• SOCIAL HISTORY –HABITS AND WORK/HOUSEHOLD RESPOSIBILITIES• EMOTIONAL STRESS
• MEDICATIONS
• EPWORTH SLEEPINESS SCALE for OSA /CSA
• DIAGNOSTIC IMAGING-Plain film radiography; MRI- disc position only relevant when ROM restricted or non reducing disc is suspected
![Page 45: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/45.jpg)
REFERRALS • PATIENTS WHO HAVE MANY SYMPTOMS ON THE
DIAGNOSTIC CRITERIA SCREEN
• DIFFERENTIAL DIAGNOSIS
• MVA PATIENTS
• TYPICAL TMD PROFILE PATIENT – FH POSTURE, ROUNDED SHOULDERS, MOUTH AND ACCESSORY MUSCLE BREATHING, ABNORMAL RESTING PLACE FOR TONGUE AND MANDIBLE, & ABNORMAL SWALLOWING PATTERN
• ACUTE TMD PATIENTS-SOONER THE BETTER.
• Please send to physiotherapy before making night guard- teeth
will change and patient needs educated
![Page 46: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/46.jpg)
TREATMENT STRATEGIES
• EDUCATION ON HABIT MODIFICATIONS, CORRECT RESTING POSITION OF TONGUE
• ROCOBADO-THERAPEUTIC EXERCISES & DIAPHRAGMATIC BREATHING
• CRANIAL TECHNIQUES, HEAT, TENS, ULTRASOUND,
• STRETCHING: ACTIVE, ASSISTED & PASSIVE –USE OF TONGUE DEPRESSORS OR GAUZE PAD
• SOFT TISSUE MOBILIZATIONS: MYOFASCIAL MASSAGE TO 6 FASCIAL CENTRES OF FUSION & DEEP FRICTIONAL MASSAGE
• JOINT MOBILIZATIONS TO JAW AND NECK
![Page 47: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/47.jpg)
ROCOBADO’S 6x6 PROGRAM
Involves Six components which are repeated six times each and performed six times/day
• Targets the craniocervical and craniomandibular systems
• Educate/instruct patient on proper breathing, tongue position & posture
![Page 48: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/48.jpg)
AQUALIZER“THE BIOFEEDBACK TRAINING TOOL” ROCABADO TRAINING TOOL
![Page 49: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/49.jpg)
DIAGNOSTIC CRITERIA FOR TMD
• Pain in jaw, temples, in or in front of ear?
• Headache
• Joint noises
• Closed or open lock
![Page 50: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/50.jpg)
PAIN
1.EVER IN JAW, TEMPLE, Etc? IF YES CONTINUE. IF NO SKIP TO 9
2.HOW LONG in these areas?
3.DESCRIBE the DURATION-One response selected
4. IN LAST 30 DAYS: if No to 4 & 5 skip to 9• Describe BEHAVIOUR OF PAIN-one response
5. WHERE on awakening
6. What aggravates
7. HOW MANY DAYS PER MONTH?
8. On average, how long for single episode?
![Page 51: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/51.jpg)
HEADACHE
9. In last 30 days: ANY HEADACHES? If No skip to 20
10. AREA? Did it include the Temples? If No skip to 20
11.DURATION
12. TEMPLE HEADACHE -1 response
13. SINGLE EPISODE DURATION?
14. INTENSITY-1 response
15-17. BEHAVIOUR
18. What AGGRAVATES?
19. LOCATIONS
![Page 52: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/52.jpg)
JAW JOINT NOISES
In last 30 days:
20. NOISES
21. CLOSED LOCK? If No skip to 28
22-27. BEHAVIOUR OF LOCK
28-30 OPEN LOCK? If no skip to 31
29-30. BEHAVIOUR
![Page 53: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/53.jpg)
THE ROLE OF DENTAL PROFESSIONAL
DIAGNOSTIC CRITERIA CHECKLIST & KEY QUESTIONS
![Page 54: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/54.jpg)
Screening for TMJ(After: Epstein 1993)
• Variable onset and duration of jaw area pain• Night pain and bruxism• Pain with function, eating, wide opening• Joint noise variable, clicking, crepitus• Limited opening, deviation on opening• Associated symptoms: headaches, dizziness, tinnitus, fatigue,
chronic pain syndrome• Referred pain: neck, ears, face, upper ant chest, headaches• Sometimes general dysfunction state
PATIENT SYMPTOMS
![Page 55: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/55.jpg)
TMJ EXAMINATION
• OBSERVATION
FACIAL VISUAL SCAN
PALATE SHAPE
TEETH
EMOTIONAL STATE
![Page 56: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/56.jpg)
OBSERVE
FACIAL AND PALATE SCAN
![Page 57: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/57.jpg)
Visual scan: Look for these
![Page 58: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/58.jpg)
OMD - Orofacial Myofunctional Disorder
![Page 59: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/59.jpg)
LOOK FOR THESE DENTAL SIGNS
![Page 60: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/60.jpg)
• Skeletal anterior overbite
• Over jets < 6mm
• Retruded cuspal
• position/intercuspal position
• Slides < 4mm
• Unilateral lingual crossbite
• 5 or more missing posterior teeth
Reference: Occlusion, Orthodontic treatment and TMJ disorders: a review. McNamara JA Jr, Seligman DA Okeson JP. J Orofac Pain 1995 Winter;9 (1) ;73-90
![Page 61: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/61.jpg)
3.PALPATE
Trigger points are an area of muscle characterized by local area of firm hypersensitive bands of muscle tissue
~~~ REFERRED PAIN ~~~
eg: in TMJ - tension type headache painful teeth
![Page 62: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/62.jpg)
From Janet Travell
![Page 63: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/63.jpg)
From Janet Travell
![Page 64: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/64.jpg)
From Janet Travell
![Page 65: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/65.jpg)
From Janet Travell
![Page 66: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/66.jpg)
ACTIVE RANGE OF MOTION
![Page 67: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/67.jpg)
Normal TM Joint ROM
• Active opening-35-50mm (3 fingers)
• Functional opening -25-35mm (2 knuckles)
• Protrusion- 5mm
• Lateral deviation- 8-10mm
![Page 68: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/68.jpg)
CLICK –MORE THAN 3 IN SUCCESSION
![Page 69: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/69.jpg)
HYPER MOBILITY SYNDROME “painful and possible end range
clicking/clunking TMJ”
On opening, the lateral deflection will be towards the Hypo mobile side
On opening, the lateral deflection will always be away from the Hypermobile / subluxing side
Inconsistent opening late click and early closing click
Right Left
Over 55mm opening
![Page 70: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/70.jpg)
“S” Shaped Deviation
COULD BE bilateraldisc displacement or
poor muscle patterning
LeftRight
![Page 71: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/71.jpg)
Dynamic Loading of TM joint
– Load contralateral TMJ - bite on cotton roll
– Compression of bilateral TMJ – Grasp the
mandible bilaterally and tip the mandible down and back to compress the joints
– Distraction of bilateral TMJ – Grasp the mandible bilaterally, distract both joints at the same time
![Page 72: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/72.jpg)
EDUCATION KEY TO REDUCE HEALTHCARE COSTS AND SUFFERING
SELF CARE • Awareness of tension in
muscles, tongue position, habits
• BREATHING properly!
What are stressors • Techniques-breathing swaying,
forgiveness • TONGUE mobilization,
traction, yoga and myofascial release ball techniques
• Rocabado 6x6
PREVENTION start early!
• BREASTFEEDING • (TIGHT FRENUMS
INTERFERE with BF)• NEWBORNS SHOULD BE
EVALUATED FOR TIGHT FRENULUMS
• MALOCCLUSION
![Page 73: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/73.jpg)
QUESTIONS
![Page 74: Learning with Laughter Cathy Russell. Dip PT (UK), MCPA, ATM Humor helps us relax… When we relax](https://reader030.vdocument.in/reader030/viewer/2022033022/56649dc85503460f94abdc35/html5/thumbnails/74.jpg)
Learning with Laughter
Cathy Russell. Dip PT (UK), MCPA, ATM
www.cathymrussell.com
http://www.cathymrussell.com/blog/
Humor helps us relax…
When we relax we learn