The temporomandibular joint (TMJ) is located in the face where the temporal bone (cheek bone) and the mandible (jaw bone) meet, often simply referred to as the jaw.

We have a TMJ on each side of the face and these can sometimes become sources of pain. When this occurs it is often referred to as ‘TMD’ or temporomandibular joint dysfunction. This is a catch all term which includes both intra-articular (joint and disc) and extra-articular (usually muscle, but also ligament and tendon) sources of pain.

TMD can be treated with many different physiotherapy techniques including manual therapy, electrotherapy, exercise and medical acupuncture (sometimes referred to as dry needling).

After 17 years as a practising Chartered Physiotherapist, completing an MSc as well as a Diploma in Medical Acupuncture, and having attended many further education courses on Physiotherapy related topics, I found myself earlier this year asking myself ‘what next?’.

Continuing professional development is very important to me both personally and professionally. However it was proving difficult to find courses and educational opportunities in physiotherapy either not already completed or relevant to my area of practice as a musculoskeletal specialist.

I have always had a keen interest in health in a broader sense, not just physical but also in relation to diet and nutrition, exercise as well as other lifestyle factors such as sleep, the role of sunlight, recreation, communication etc. All factors which can also have a profound impact on pain management and physical function which have helped me develop as a physiotherapist over the years.

In today’s world of constant technological growth and progress, it is important that we as chartered physiotherapists ensure our clinic is up to date with the software and systems we use, to allow our practice to grow and evolve in the modern era. Here at Mount Merrion Chartered Physiotherapy, we use an online practice management system called TM3 which leads to great benefits throughout our patient care and in the overall running of our practice.

The social and economic burden of lower back pain (LBP) is very apparent in our society. It was estimated that the prevalence of absenteeism due to LBP was a massive 32% for hospital employees in Ireland (Cunningham et al, 2006).

According to a 2006 review, the total costs associated with LBP in the United States exceed $100 billion per year, two-thirds of which are a result of lost wages and reduced productivity (Katz et al, 2006).

Following on from my last post where I emphasised the importance of moving frequently, here I’ll be discussing how we can take a few further steps towards improving physical health.

Strengthening

First up is the importance of pushing, pulling or lifting something reasonably heavy which would include our own bodies. This means taking some time out away from our normal day to day activities to do some focussed strengthening exercise.

So what are some of the benefits?

• You’re more likely to burn stored fat which is useful for weight management. That is assuming of course you’re not loading up on lots of sugar and other carbohydrates such as bread, pasta, potatoes etc. The body will burn carbohydrates as an energy source first, and if taken in excess will be stored as fat, not good if you are trying to lose weight.
  
  
• Regular movement helps reduce aches and pains, motion is lotion.
  
  
• Movement enhances brain function, concentration and memory.
  
  
• As well as the function of the heart, lungs and vascular system.
  
  
• Slow, regular movement helps with stress management and promotes longevity.

It was 10 years ago when I remember hobbling down the stairs to collect my next client. I was holding my back upright and rigid, almost afraid to move in fear that I might further strain what I suspected at the time was painfully ‘unstable’ sacroiliac or pelvic joint. I had also been assessed by an experienced clinician who had told me I was ‘misaligned’.

Roll on ten years and I now understand, based on current research and expert opinion that the pelvic joints really don’t move very much, hardly at all in fact. When reflecting on my injury and considering my age, gender and how I injured myself (pulling a suitcase awkwardly form under a bed), it became clear that my strained lower back and pelvis wasn't likely to have been left unstable. But at the time I did not have this knowledge and so felt very threatened by this part of my body. It felt weak and I lacked the confidence to move freely as well as run and exercise in the gym. The pain I felt added to this sense of threat.

I was watching Toby, our 5 year old, bending down to pick up his box of wooden blocks a few days ago. The box was reasonably heavy and a little awkward but this did not seem to deter him. He bent his hips and knees, also allowing his back to flex, then took hold of the box and while holding it close straightened up. He tottered with the box into the living room then reversed the process to put the box down onto the floor.

Why did this simple functional task get me thinking?

In recent years there has been a strong move away from this idea that we should be ‘bracing’ our backs before we bend and lift everyday objects. The notion of contracting your ‘core’ muscles, becoming rigid, not allowing your back to move before doing anything of a physical nature has been strongly challenged and is now considered by low back pain researchers to be very unhelpful. This way of moving, once considered the ideal, is now understood to promote pain, limit function and encourage people not to trust their backs.

Exercise is crucial to good mental and physical health, variety is also important, the body thrives on variety. My body was getting too used to going through the weekly motions. I am familiar with the CrossFit concept and was keen to shake up my exercise routine. So I decided to give it a go.

As a chartered physiotherapist I have treated many injured CrossFitters, I knew the potential risks. I was therefore keen to take it easy and hopefully not pick up an injury myself. Form and technique first, increase load later. When I turned 40, I asked for life advice, a sports doctor friend of mine simply said ‘look after your joints’.

Running is an excellent form of aerobic activity to improve your health status, reduce disease risk, modify body composition(best when combined with a good diet) and improve all around physical fitness. It is also a weight-bearing activity that helps in maintaining bone mass and preventing osteoporosis.

Current guidelines by the American College of Sports Medicine recommend 30 minutes of moderate intensity aerobic activity at least 5 days a week for adults. Brisk walking is an excellent activity to reach this desired level of activity as it is easy to perform, uses the large muscles of the body, both upper and lower, and it does not require any expensive equipment. Running will burn more calories than brisk walking due to the increased intensity of the activity. This is great for energy expenditure but does bring with it an increased risk of injury.