This Is MS Multiple Sclerosis Community: Knowledge & Support

Thanks Dania.

The presentation and procedure is a sham and totally unscientific. The scientific method challenges and builds new hypotheses based on existing knowledge. There are standard well accepted tests in neurology and orthopedics for checking muscles and joints. What the dentist is doing has no basis in current clinical sciences. What he says about the relationship of the TMJ to posture is nonsense. It has no merrit from a anthropological, comparative anatomical, neurological or orthopedic sciences. Muscles and joints leave telltale marks and bumps on bones that reveal their action and function. In humans, the TMJ leaves only slight bumps from mechanical stress on the parietal and temporal bones. It has no impact and leaves no marks on the sagittal suture. In contrast, in apes, the powerful jaw muscle cause a massive ridge of bone called the sagittal crest to cover the sagittal suture. In either case the TMJ leaves no impression on the occipupt. The ridges on the occiput come from the stress of the trapeizius and cervical muscles. It's slight in humans compared to apes due to the balance of the skull on the spine. The powerful neck muscles in apes leave a huge ridge called the nuchal crest. The TMJ is a non-weight bearing hinge joint related to the face. It is only indirectly related to the spine, balance and proprioception. The dentist uses muscle testing procedures that were introduced by a discipline in chiropractic called applied kinesiology. AK got a bad name because of all of the subjective muscle testing doctors were doing. It became a circus. The original AK muscle testing protocols were adapted from "Muscle Testing and Function," by Kendall and McCreary. Many AK doctors and dentists contine to use sloppy subjective shammanistic style muscle tests. In this case the dentist is doing a lousy version of an infraspinatus test. It really should be done lying supine to stabilize the body and isolate the muscle. He is also quite theatrical in that he can't overcome a relatively small female's bicep muscles even when he is standing on his toes and pressing down with all his might and weight, which is absolute hogwash unless he is a complete whimp. If this is his method for testing TMJ function it is very indirect. The best and most direct way to test the TMJ is the same as any other joint in the body. You palpate for the muscles and connective tissues for tenderness using standard trigger point, origin and insertion points, test the muscles for strength (masseter, buccinator, pterygoids, temporalis, platysma, hyoids, digastric etc.) and check the motion and stability of the joints (jaw wagging, clicking and crepitis).

TMJ splints work because of their impact on the upper cervical spine. Placing a splint in the mouth is similar to putting a jack under the front end of a car. Putting the jack under the front left side causes the car to tilt back and to the right. Putting a chock in the left side of the mouth tilts the skull back and to the right. I treated many TMJ patients including those who had been to dentists. I used craniosacral, soft tissue work and physiotherapy. Except for cases of frank bruxism, I rarely found anyone who need a splint. Unlike the TMJ, the upper cervical spine is directly related to the base of the skull and lower spine, which are orthopedically and neurologcially directly related to upright posture, balance and proprioception.

I understand what you are saying.This video made me aware of how much I am clenching my jaw. Creating more pain. I noticed as I relaxed my jaw I was able to breath easier (take bigger breaths) and I was in less pain.

Jaw clenching? Hm. My only MS flares occurred at a time when I was clenching my jaw extremely tightly whilst I slept. I had a crown on a top back molar that was ill-fitted and I guess I was trying to crush it into place. Well, I crushed it and it finally fell out. It felt so much better without it in so I just left the tooth naked (dentist-phobiac). I stopped clenching and I've not had an exacerbation since. I'm scheduled to have a new crown placed soon. Now I'm nervous about that! My new dentist is pretty good at making my crowns "short" because I told him I'm a clencher so maybe it won't be a problem. Still nervous. Would it be better to have the tooth pulled?

Stress affects the facial muscles. It also affects breathing. Relaxing the face and the rest of the body and focusing on relaxed deep breathing is better for health no matter what condition you have. Balanced breathing is the basis of all yoga and Chi Kung health exercises and meditation.

Don't pull a good tooth. Get someone who knows what they are doing to work on your jaw.

Jaw clenching is more typically a sign of hyperexitability of the muscles which can be due to physical, mental or emotional stress. Pain and disability due to MS causes plenty of stress. There are many things you can do to improve the mental and emotional side. The physical side can be worked on with using a sound scientific approach that reduces the mechanical stresses and relieves the muscle hyperexcitibility, joint pain and inflammation.

Thanks for the advice. I shall keep the tooth.

I haven't clenched my jaw at all before that crown was placed or after it fell out. The clenching couldn't be the body's attempt to properly align the jaw?

A high crown throws of the proprioceptive receptors of the TMJ used for chewing. It's also like a pebble in your shoe. A pebble in your shoe can cause and antalgic lean and a tilt away from the source of irritation.

Thanks again. Love your prompt responses!

Your welcome.

I like the part in the TMJ presentation where the dentist is discussing entrapments of the extensor muscles of the neck due to forward tilt of the head caused by inflammation in the TMJ, which is nonsense. He means tension in the extensor muscles. But I don't know why he says that the head tilts foward. I have never seen that happen. I have seen TMJ problems associated with many different conditions of the cervical and lower spine due to spondylosis and scoliosis that can't be changed with a splint. He next discusses entrapment of the brachial plexus and points to the trapezius muscles. The trapezius and sternocleidomastoid (SCM) muscles get there nerve supply from the spinal accessory nerve, which is cranial nerve 11 of the brainstem, not the brachial plexus. The brachial plexus arises from the lower cervical spine. He then mentions entrapment of the radial nerve but I don't know what it had to do with his previous faulty discussion of entrapments of muscles and nerves. Entrapment neuropathies in the arm occur in the thoracic outlet, brachioradialis muscle of the outer forearm (similar to tennis elbow) and the carpal tunnel. They typically effect flexor or pronator muscles. The radial nerve which effects extensor muscles is more typically affected by compression injuries like hitting your funny bone or Saturday night type palsies. Entrapment neuropathies in the arm have nothing to do with TMJ. You certainly don't start testing for entrapment neuropathies by examing the patient's TMJ. That's poor science and the hypothesis is far fetched. This doctor is not using standard sound clinical sciences and protocols.

The proprioceptive nervous system provides information about body movement, position and balance. It involves input from the eyes, ears and mechanical receptors in all the muscles of the head and body, especially the spine, legs and feet. While the proprioceptive nervous system of the face and jaw are essential for facial expressions, speaking and chewing etc., they aren't that important to upright posture and balance and trigeminal and facial nerves project to different parts of the thalamus and cortex. Except for thalamic association type nuclei, they don't directly communicate with or regulate the proprioceptive system of the spine and lower extremities used for upright posture and balance. If they did it would be difficult to chew gum an walk at the same time. Romberg's test is used to check the proprioceptive nervous system. The eyes are closed to eliminate them as a problem which leaves the ears and mechanical receptors.

To test the doctor's theory regarding the impact of TMJ position on proprioception such as balance and postural muscles you could have the patient perform a Romberg's test while straining the mouth in various positions such as wide open, to the left and right sides and biting down. It won't impact balance. You can also take tongue depressors and have the patient bite down on one side or the other using 1-3 sticks and it won't affect balance. Next, you can ask the patient to stand on one foot with the eyes closed. It will be a challenge that is easy to see in the muscles. Spinning someone around with their eyes closed will likewise impair proprioception. You could further include EMG tests of the calf, leg and paraspinal muscles, as well as thermograms to check for increased motor activity during different strain positions of the TMJ compared to standing on one leg or following spinning.

Testing strength in upper extremities is not a specific or clinically recognized test for problems with proprioception.

Hi Dr. Flanagan,

Would a bone spur that "indents the ventral spinal cord centrally" at the C3 level be worrisome for having an Atlas/Axis adjustment, i.e., is the spur far enough away from C1/C2 that an adjustment wouldn't make the situation worse?

The radiologist started the MRI report section "Significant findings by level" at C2-C3. Do you know why he didn't start at or mention C1? If my Atlas had been out of alignment, would/should the radiologist have noted the problem? Do such Atlas/Atlas misalignments show on MRI, or does imaging require an open-mouth odontoid X-ray?

Thx!

Hello Poet,
Upper cervical adjustments, especially the AO type will not cause an adverse reaction due to the spurs in the lower cervical spine. If any thing it will improve joint alignment and function and thus reduce the negative impact of the spurs.

The standard current brain and cervical MRI scans aren't specific for examination of the upper cervical spine, especially alignment. As you know, Dr. Rosa uses special coils that are placed around the neck like a cervical collar. He also uses different plane lines for scanning his selected regions of interest that focus on the structural elements of the upper cervical spine. He further uses an axial view as well. An axial view of the upper cervical spine is similar to what chiropractors call a base posterior or vertex view. It is basically a top down or bottom up type view. The upright upper cervical axial view is much better for visualizing malrotation of the upper cervical spine, including counter rotation of C1 on C2. Open mouth odontoids are old school (my school). The problem with x-rays taken through the mouth is that opening the mouth is like putting a splint in the jaw. It causes the skull to roll back on the atlas, which changes its neutral alignment. It isn't great for viewing atlas either. It is better for axis. Instead, AO and NUCCA use nasium views to check upper and lower cervical angles and atlas laterality.

Thank you very much, Dr. Flanagan.

Your welcome Poet.

Thank you. This is terrific, hopeful news... no adverse reactions and possible improvement in joint alignment. I think I should have the adjustment asap, especially before I travel for my spinal consultation for removal of the bone spurs which will allow the surgeon to get images, such as MRI or X-ray, with my Atlas and Axis properly aligned with my head on straight; and the sooner my CSF starts flowing more properly, the better. I plan to discuss my AO chiro treatment with him and ask about upright MRI if he wants new images. How would you describe the possible impacts of a 1/2" difference in leg length in my case, i.e., is the 1/2" a mild, moderate, or severe difference, or some other descriptor(s)?

So the atlas can be malrotated left or right (with chin pointed left or right), and/or the head can be rolled backward or forward (with chin pointed up or down), and/or the head can be be tilted left or right (with one ear higher than the other)? Does this explanation make sense? I'm trying to visualize a thought experiment in 3D of the head, Atlas and Axis and the possible misalignments. To some extent, I understand how AO chiro works, but I wish I understood it better and how just one pressure wave can correct all those misalignments simultaneously. Took me awhile to work through your reply which helped me see things more clearly. The more I learn, the more I realize I need to learn... never stops. Thank you for your clear explanations.