​What is temporomandibular joint dysfunction?​
The jaw is also known as the temporomandibular joint (TMJ). The joint is formed by the mandible (the main bone that we consider to be the jaw) and the temporal bones on either side (these form part of your skull). TMJ dysfunction is a term used to describe pain felt in and around the jaw.
​The masseter (one of the main muscles that controls the movement of the TMJ) is the strongest muscle in the body, relative to its size. There’s no wonder why tension held here can have a huge impact on other areas of the body too. Although some people will feel pain directly in or around the jaw, you may not necessarily be aware of the tension that you are holding there. However, tension or dysfunction of the TMJ can contribute towards neck pain and headaches. 

What can cause TMJ dysfunction?
During times of stress and anxiety, it’s common to clench or grind our teeth. This can often happen subconsciously, particularly at night when we’re sleeping, which is known as nocturnal bruxism. This could mean that you wake with headaches, neck pain or pain directly in the jaw. Sometimes, we can be more aware of this going on during the day. We may notice that our breathing has become shallow, we are holding tension in our shoulders and we are clenching our teeth, which will cause tension through our jaw.
Tension or dysfunction of the TMJ can also occur following direct trauma or dental work. Having to hold our jaw open for a period of time can create strain of a key ligament that helps to support the joint. TMJ dysfunction can also be caused by having an under or overbite ,and also if there is derangement of the articular disc which cushions between the two bony surfaces that form the joint.

How will I know if I have dysfunction of my jaw?
Structures in the body are intrinsically connected. The muscles and ligaments that attach to the jaw, also attach to bones in your face, head and neck. Therefore, pain or dysfunction originating in the TMJ could be felt in the jaw itself but could also be felt in the face, neck or base of the head. As well as pain, you may notice clicking or clunking in the jaw as you open and close it. If one side of your jaw is tight, compensatory patterns can occur and the two sides of the jaw can become slightly out of sync which contributes towards the clicking and clunking that you hear and feel. You may also feel a restriction of movement and not be able to open your jaw fully.

How can Osteopathy help?
​We can examine the movement that is occurring at the TMJ by asking you to do some simple opening and closing movements whilst we palpate the joint which is located just in front of your ear lobe. We can also palpate for tension in the muscles and ligaments that control the movement of your jaw. If there is dysfunction of the joint or tightness in the soft tissue structures, we can gently but directly treat these.
We can also work on other structures in the neck and head where the muscles of the jaw attach. The techniques that we use are often external, however we’re able to do intraoral techniques with your consent. Our patients often really enjoy treatment of the TMJ as it is common to feel the benefits immediately afterwards. They often feel that they can open their jaw further and feel less tense through the jaw, face and neck. 

What can I do at home to help?

Relaxation methods
Given that pain in the jaw is often caused by clenching or grinding the teeth due to stress or anxiety, managing this stress and anxiety can help to prevent us from holding tension in the body subconsciously. Diaphragmatic breathing is key, as effective breathing will physiologically help to calm the nervous system. Check out City Osteopath’s blog post by Becky on how to breathe effectively. Otherwise, relaxation can look different for everyone, whether it be meditation, yoga, listening to music, reading a book or heading out for a walk, the most important thing is for you to take the time to unwind.

Set a reminder to be conscious of tension that you may be holding
Write a note to yourself and have it near your screen or set a reminder on your phone to remind you to think about your posture, and tension that you could be holding. We often end up leaning over our computers, shallow breathing and holding tension in our shoulders, neck and jaw. It is important to make ourselves aware of this, so every 30 minutes, take a moment to sit back, relax your shoulders, take some deep breaths into your lower rib cage and allow your jaw to soften.

Apply heat
The application of heat will encourage blood flow to the area to promote healing, reduce muscle tension and therefore help to reduce pain. Be careful that the heat pack isn’t too hot and keep it on for just 10 minutes at a time. You can repeat this every 2-3 hours throughout the day.

Self-massage
To locate the masseter muscle, contact the space just below your cheekbones and about two fingers width in from your ear lobes. A good way to test if you are in the right spot is to gently clench your jaw and you will feel your masseter contract into your hands. (Try not to clench to test this too often; once you’re in the right spot you don’t need to keep clenching to check). You can use two or three fingers to apply gentle pressure to the muscle and use circular motions for one to two minutes on each side to increase blood flow and reduce muscle tension.
 
There are many other exercises that we can explain to you in further detail. It is best for a practitioner to examine and advise you directly to provide personal advice specifically for you.

We are now offering online consultations so please feel free to contact us for further advice.  
 
 
http://www.advances.umed.wroc.pl/pdf/2012/21/5/681.pdf?_ga=2.173678890.882744632.1585797841-837875174.1585797841
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​Rhianna Smith 
DO M.Ost. Reg. Osteopath, MONZ 
www.cityosteopaths.co.nz
​Phone 04 4991439

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Whenever I mention breathing to my clients, the reply is usually along the lines of “Breathing? Don’t we all know how to do that already?”
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Of course, we all breathe, but how we breathe is the interesting part. Do you breathe with your ribcage moving outwards, to the sides and back? Or do you breathe by moving your ribcage upwards, using your neck and shoulder muscles to raise it?  

​During inspiration, when we breath in, our ribcage must expand to make space for the lungs to inflate. This happens due to the muscular action of the diaphragm and the intercostal muscles (the muscles between our ribs). The intercostals pull the ribs up and outwards while the diaphragm flattens and pushes the lower ribs out to the sides. Both actions create space in the ribcage for lung expansion.  
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The diaphragm is dome shaped and its vertical fibres attach to the lower ribs. When it’s contracted it flattens and these fibres push the lower ribs outwards as they shorten (1). This movement is known as lateral excursion. You can imagine it like an umbrella opening.  

We also need mid-back expansion when we breath. This is the movement of the back, just under the shoulder blades, at the level of the bra-line. Known as posterior excursion, mid-back expansion ensures that the diaphragm can also work to stabilise us in the upright position (2). When we lack good movement of the diaphragm, it reduces our ability to maintain our balance (3). This leads to stiffness in other muscles in the torso, as they take up the slack, causing pain and tension in this area.  
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If we raise our shoulders when we breathe this shows that we are in a shallow breathing pattern.  It means our ribcage is rising upwards to create space for the lungs to expand. To do this, we are pulling the ribcage upwards using accessory breathing muscles; the muscles that attach from the shoulder to the ribcage (pectoralis minor) and the muscles that attach from the neck to the ribcage (the sternocleidomastoid and the scalenes). This can lead to neck and shoulder pain and tension, and headaches.  

So, what does this mean? Essentially, it means we need to pay attention to the way we breathe. 

When we learn to breathe using lateral and posterior excursion, we improve the strength of the diaphragm and increase the ability of our ribcage to move. Improved ribcage mobility takes the pressure off the neck and shoulders, decreasing pain, tension and headaches. It allows the diaphragm to move through its full range of motion, becoming stronger and more efficient.    

When we breathe using our diaphragm, we activate the vagus nerve which leads to an increased parasympathetic nervous system response, slowing our heart rate and breathing, and calming us down.
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Good diaphragm breathing increases our blood oxygen levels, promoting tissue healing and repair (4)  and improving energy and cognition. Anxiety and dizziness reduce as our ability to expel carbon dioxide from the body improves. We get less aches and pains in our neck and shoulders. Our posture improves along with the stability of the spine, reducing back ache. Mobility of the ribcage and mid-back improves, increasing movement in the areas that should move, and stability in the areas that should be stable.

Shallow breathing patterns are very common during everyday stress and especially so during this time of uncertainty. Diaphragmatic breathing is fundamental to our health and wellbeing, and now more than ever we need to breathe well. 

1. Wallden, M. (2017). The diaphragm; More than an inspired design. Journal of Bodywork and Movement Therapies, 21(2), 342-349. https://doi.org/10.1016/j.jbmt.2017.03.013
2. Osar, E. (2014). Corrective exercise solutions to common hip and shoulder dysfunction. Lotus Publishing.
3. Kocjan, J., Gzik-Zroska, B., Nowakowska, K., Burkacki, M., Suchoń, S., Michnik, R., Czyżewski, D., & Adamek, M. (2018). Impact of diaphragm function parameters on balance maintenance. PloS one, 13(12), e0208697-e0208697. https://doi.org/10.1371/journal.pone.0208697
4. Duvall, S. E. (2017). Postpartum Corrective Exercise Specialist [online training programme] [Audiovisual]. Core Exercise Solutions LLC. www.coreexercisesolutions.com​

Headaches and migraines are two of the most common ailments in the world, with up to 80% of the population having at least one headache per year. They can widely vary in their type and intensity, meaning that some may rarely suffer at all, however there are individuals who suffer so much that it begins to take a toll on their everyday life, even causing them to take time off work or cancel their social plans.
There are various types of headaches that all have different causes. These include migraines, tension, cluster, cervicogenic, sinus headaches and many more. As osteopaths, the two most common types that we treat are tension and cervicogenic, however osteopathic treatment can help to relieve many variations of headache.
At City Osteopaths, we are specially trained to assess and determine the cause of your headaches. We conduct a thorough case history, in order to ascertain how often they occur, when they occur, where they occur and whether there are any specific triggers to your headaches. We can rule out certain headaches that may need further medical investigation from your GP and we will conduct a postural assessment to decipher the cause of your headaches. ​
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What causes tension or cervicogenic headaches?

• Tension or tight muscles in the neck, back, jaw and eyes are common causes of tension headaches.
• Nerves that are irritated or inflamed in the neck can lead to pain symptoms in the form of a headache.
• Dysfunction or stiffness in the upper three cervical (neck) vertebrae are another common cause.​

Osteopaths use specific and gentle techniques to loosen the muscles and joints in the neck and back which can help to relieve the symptoms of headaches. We can also provide you with exercises that you can do at home to help to stretch specific muscles and improve posture. A combination of manual therapy and home exercises has been found to be highly effective in treating cervicogenic and tension headaches. Every individual will manage their symptoms in different ways, often through a system of trial and error. 

 
​Rhianna Smith 
DO M.Ost. Reg. Osteopath, MONZ 
www.cityosteopaths.co.nz
​Phone 04 4991439

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​Melanie Young
B.A., BSc.(Clin Sc.) B.Osteo Sc. MONZ
Reg Osteopath
​Director City Osteopaths
Wellington
​New Zealand

​Phone 04 4991439

http://www.cityosteopaths.co.nz