Case Studies

37 year old male with one month history of left sided jaw pain and headache.

History

The patient had developed left sided jaw pain 4 weeks prior for no obvious reason. Yawning biting and chewing were painful. In addition, he was experiencing pain around his left ear and a headache on the left temple region. His Dentist ruled out a dental cause. X-rays were normal and the patient was referred to an Oral Medicine Specialist but could not get an appointment for over a month (and had not been at the time of writing this case study). The patient has a history of night time teeth grinding. He also has a history of whiplash and gets regular neck stiffness related to his exercise regime and rock climbing. The patient was referred to us for very specific Physiotherapy by his Physiotherapist friend.

Examination

The patient had good posture but with stiffness and tenderness in all associated jaw and neck structures. Jaw opening range was normal but with some left sided pulling (deflection). Other jaw movements were painful on the left side. The left jaw joint was tender along all aspects, as were the associated muscles of the jaw and related neck muscles. There was a mild left joint clicking.

Response to very specific Physiotherapy Treatment

The patient responded extremely well to 2 physiotherapy treatments which focused on improving mechanics at both the neck and jaw and educating him about avoiding aggravating activities and posture when exercising. The patient was discharged and reported being over 90% pain and headache free.

52 year old female with right sided locked jaw and pain eating following a long dental procedure

History

Patient was experiencing sensitivity of a tooth, consulted her dentist and was told she needed an old filling replace requiring her to keep her mouth open for 45 mins. Following the dental procedure, the patient experienced pain around the area of her right jaw and felt as if her ‘bite was out’. She returned to her dentist who filed down the filling and diagned the pain as being from muscular spasm either from the nerve block during the procedure or as result of the filling being too high. The patient then reported the bite as feeling better but the pain persisted.

The patient continued to experience pain and some jaw dysfunction and presented for very specific physiotherapy treatment 3 weeks after the first dental procedure.

Examination

Mouth opening was reduced at 31mm (average opening = 45mm) and painful on the right side with the jaw pulling to the right when opening. There was tenderness along the jaw joint and associated muscles. Clinical diagnosis was that the disc of the right jaw joint (TMJ) was dislodged blocking normal opening movement (closed lock), with subsequent pain and spasm of the muscles.

Response to very specific Physiotherapy Treatment

The patient responded very well to the first treatment to unlock her right joint, achieving 40mm of opening. Treatments progressed over a 3-week period (6 treatments in total) achieving a pain free function and opening of 49mm.

NOTE: if you suspect your jaw may be partially locked (can’t open more than 2 fingers width) – please don’t delay in seeking qualified help. There is roughly a 2-week window within which to unlock the jaw.

Call us on 9824-8868 TODAY and mention your jaw is locked.

38 year old female with chronic right sided upper cheek pain, earache & headaches

History

Patient had a 5-month history of right side pain in her upper cheek region, which came on during a period of heightened stress at work. Investigations ruled out dental cause. CT scan showed up a nasal polyp which was thought to be the cause of the patient’s symptoms but did not respond to 2 courses of antibiotics or a course of nasal steroids. Neurological causes were also ruled out and the patient was prescribed a drug for nerve pain which she stopped after 5 days as she said she could not function properly.

Examination

The patient was self-referred for treatment as she was not getting anywhere despite seeing various medical specialists. She described a constant ache in the region of her right cheek bone with an associated hot and sometimes swollen sensation in this region. She also experienced headaches on the right side of her forehead. She reported a right sided 'ear ache' and hot sensation. Her symptoms were worse at the end of the day. The patient had a night time teeth clenching habit. She described her bite (how her teeth meet) as feeling abnormal. In addition, she also experienced episodic neck 'stress’ requiring treatment but never associated that with her other symptoms.

Response to very specific Physiotherapy Treatment

The patient responded very well to 5 treatments to all associated musculoskeletal structures, some of which reproduced her exact upper cheek pain. Provocative postures and activities were also modified to help the patient prevent recurrent episodes. The patient is now pain free.

26 year old female with chronic daily headaches

History

The patient was referred to me for very specific Physiotherapy by her Dentist. She had an 11-year history of chronic daily headaches which had become more severe and more constant since November 2014. She described her headaches as constantly present and experienced them as being on her forehead and behind both eyes with an intensity ranging from 4-6/10. Other symptoms reported include tenderness in the area in front of her ears and under her jaw, left sided ear ringing and a sensation of 'brain fog'. She also experienced stiffness and discomfort at the back of her head and neck. The patient suffers anxiety, clenches her teeth during the day and night and had been told by her dentist that she has a tooth grinding habit. The patient has tried many approaches for her headaches and related symptoms which have included medication and diet elimination approaches. She has also tried a different Physiotherapy approach but none addressing her jaw specifically.

Examination

The patient had poor posture with stiffness and tenderness in all associated jaw and neck structures which reproduced aspects of her headache and other symptoms. Her postural habits, jaw clenching and grinding were other contributing factors to her issues

Response to very specific Physiotherapy Treatment

The patient has responded extremely well to physiotherapy treatment which has focused on improving mechanics at both the neck and jaw and educating her about correct work and sleeping postures. She reported a marked reduction in the intensity (1-2/10) and frequency of her headaches (now only very occasional) which are shorter in duration when they do occur. The patient has also reduced her medication. She is followed up roughly every 2 months currently and is almost headache free at the time of writing this case study.

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