Monday, April 28, 2008


This week's post is from our practice newsletter. Osteoartritis is something that affects all of us and I think it's important to stay informed.

Osteoarthritis and You
Did you know that 90% of all adults age 50 and older have some degree of osteoarthritis (OA)? That’s practically everybody! OA is arthritis that results from gravitational forces pulling on the body. Without intervention, OA can result in significant joint degeneration and will eventually result in joint fusion. Since we cannot avoid gravity, how are we supposed to prevent this from happening?

Then answer is movement. Studies show that when a joint is kept immobile, the process of OA accelerates dramatically. When movement is restored, the degeneration slows again. On a large scale, the best thing we can do is KEEP MOVING: take a walk, swim, stretch, roll your shoulders, make circles with your wrists and ankles. On the small scale, you need an expert. Chiropractors are trained to find joints that are not moving enough and help them move better. Every time you get adjusted it is one more step in the fight against OA.

If you want to learn more about OA or other types of arthritis, stop by the office to pick up a free brochure on your topic of interest. These are provided by the Arthritis Foundation to help our patients learn about the dangers of arthritis and how to prevent it from happening to them.

The Arthritis Foundation is also a great resource for information on local aquatic exercise programs. A lot of arthritis sufferers feel the worst when they are cold, making exercise such as swimming difficult. Because swimming is a low-gravity activity, it is the perfect exercise for people with arthritis. To solve the obvious problem, the Arthritis Foundation has begun aquatic exercise programs where the pools are HEATED. Not hot tub temperatures, just pleasantly warm. There are three heated pools in San Francisco, alone, and many others across the Bay Area. You can contact us at the office or the Arthritis Foundation to find a heated pool near you.

Tuesday, April 8, 2008

Case of the Week – TMJ Headache

Patient: 35 year old male police officer

Patient presents complaining of nagging headaches located on both sides of his head. The pain is throbbing but not pulsating; pain can spread to the forehead as the condition worsens. He has headaches 2-3 times per week, but there is no time of day or activity that seems to aggravate the symptoms. He has tried Advil, which helps, and increasing his water intake. The frequency of the headaches is increasing and he is concerned the pain will begin to affect his judgment at work. The patient has had temporomandibular joint (TMJ) issues in the past and has been prescribed a night guard by his dentist. He clenches and grinds his teeth in his sleep, causing him to wear through one night guard per year.

Physical examination reveals abnormal TMJ gait, with the jaw swinging out to the left upon opening and following the same course upon return. The action is accompanied by popping in the right TMJ. The TMJ muscle group (masseter, temporalis, medial and lateral pterygoids) is tight and tender with trigger points bilaterally. Trigger points in the lateral pterygoids reproduce the patient’s headache. There is restricted motion of the left TMJ and the right C1-2 vertebral facet joint. Other testing, including vascular, neurologic and orthopedic testing of the neck and head are within normal limits.

Discussion: In this case, the patient had increased muscle tension in the jaw complex, causing a referral headache similar in mechanism to a tension headache. As the muscles tighten, the TMJ is compressed which decreases its ability to move properly and causes pain and inflammation. Our goal here is to first release the tension in the muscles and joints of the complex, including the upper cervical vertebrae. This will help the patient get out of pain. The second and more important goal is to find the cause of muscle tension and eliminate it. Without finding the root cause, the problem will continue to crop-up, over and over again.

Many people don’t realize that it is possible to massage the muscles of the jaw from inside the mouth. This is really the best way to access them, especially the pterygoid group, and can be a very simple but effective procedure. The doctor uses a gloved finger to gently apply pressure to the areas of tension until the tension is released, just as in traditional myofascial release. Once the muscles of the jaw are relaxed, the TMJ itself can be adjusted. In this patient’s case, the left joint was not moving well, causing the right joint to be hypermobile. We adjusted the patient’s left TMJ using gentle chiropractic manipulation and also adjusted the upper cervical joints to complement the new motion in the jaw.

It is important to note that the TMJ and the upper cervical joints have a very close relationship. Often, adjusting only the neck will relieve the tension in the TMJ. Other times, the TMJ is really the source of neck pain and the TMJ should be addressed first. In this case, the TMJ was the primary issue, so the treatment to the neck was only in relation to the TMJ’s needs.

It is also very common for people to suddenly develop TMJ problems after protracted dental work, orthodontics or a motor vehicle accident.

For a cool perspective from a dentist who later became a chirorpactor, visit this link:

Outcome: With a course of myofascial release and chiropractic manipulation, the patient’s headaches decreased and finally disappeared within 3 weeks. In this case, we found that the patient’s night guard from his dentist was not fitted properly. This, combined with increased stress at work, was causing irritation to the muscles and resulting in headaches. With a new night guard and stress-reduction techniques, the patient was had a full recovery.

Exercise of the week: If you suspect you have TMJ pain, try this: Wrap the eraser end of a pencil in a sturdy paper towel, creating a bulb of about 2cm in thickness. Using the writing end of the pencil as a handle, place the bulb at the very back of the mouth, to the side where your teeth end and the soft tissue of the jaw begins. Bite down slowly on the bulb. This creates a gapping motion in the TMJ itself and can give pain relief to a compressed joint. Make sure to try both sides. If this exercise provided pain relief for your jaw, you may want to seek a chiropractic consultation to evaluate your TMJ complex.
Remember never to engage in an exercise without first consulting your chiropractic physician to see if it is safe for you and your unique conditions.

Suggestion of the week: Evaluate your own TMJ gait
Stand facing a mirror and very slowly open and close your mouth repeatedly. Open it all the way and close it all the way. Watch your chin. Your chin should follow a straight line up and down. If it curves off to one side in a C shape or S shaped pattern, your TMJs are not functioning properly. Also, if you have significant clicking or popping in your jaw with opening and closing the mouth, it can indicate a problem with the TMJ. Try it today and see how your jaw is doing!
Remember never to engage in an exercise without first consulting your chiropractic physician to see if it is safe for you and your unique conditions.

Tuesday, April 1, 2008

Events, Events and More Events!

Spring is here and that means community outreach! Now that the warmer weather is upon us, we are working hard to educate people about chiropractic with every free moment we have.

This past weekend, we were at the AIDS Lifecycle expo. ( For those who don’t know, the AIDS Lifecycle is a week-long bike ride from San Francisco to LA that takes place every summer. The riders pledge to raise at least $2500 each and the money goes to AIDS education and awareness. This is such an awesome event to be a part of, and I love helping the riders. Many of the riders are not experienced cyclists and it is fun to watch them grow in their training rides. Many of them end up on my chiropractic table at some point and we work through those injuries as well. It is so rewarding to be helping people participate in such a great event. Maybe one of these years I’ll be on the ride with them:)

Also, because April is Stress Awareness Month (, we are going to be in local bank branches doing quick and fun public education on stress and its effects on health. Next week we’re going to be at the local B of A and the week after that we’ll be at WaMu (woohoo!). I’m excited about it because it’s always fun to get out into the public and answer people’s health questions. I find that a lot of people really do care about their health, they’ve just never have the opportunity to get all their questions answered by a professional. Most doctors spend less than 5 minutes per patient, which doesn’t leave time for much in the way of questions. I’m hoping these events in the banks will be helpful for everyone. Especially this time of year, when taxes are due, and with the way the economy is tanking, I think we can all use a little extra stress relief!

In closing I just want to say that I’m really looking forward to spring and I hope some of you will stop by and see us one of these days. We’re always out on the town and would love to say hi.

Suggestion of the week: Visit and donate to help the riders. It doesn’t have to be much. Even a dollar is more than they had before you donated. Or, if you prefer, find out how you can help by volunteering or find a way to support the riders like we do, with healthcare. Find a way to donate bike clothes, get reduced prices on tune-ups, or some other creative way to show you care. Have fun with it! You’ll feel better when you’re done:)

Exercise fo the week: Breathe.
No, seriously. Breathing is an exercise. Most of us spend our days hunched over a computer or in a car and our lungs are constantly under-inflated. Sit up straight and breath in slowly while counting to 4 in your head. Hold the breath for a count of 4 and then exhale slowly for a count of 4. Take a break and repeat. This is called 4x4x4 breathing. Advanced athletes can breathe at higher counts, like 7x7x7, and some of you may want to start at 3x3x3, but try it and see. Bringing your consciousness to your breathe helps quiet the mind AND increases the amount of oxygen available to your tissues…always a good thing!

Never engage in an exercise before consulting your chiropractic physician to determine if it is same for you and your unique conditions