How to measure the strength of your (or your patient’s) shoulder external rotator muscle. Physical Therapy Diagnosis is predicated on simple, reliable and standardized measurements.

How to precisely measure shoulder external rotator strength and range-of-motion using a universal goniometer. See all of the Physical Therapy Diagnosis and Treatment videos and downloads at www.Physical-Therapy-Videos.com .

A demonstration of a rotator cuff strengthening exercise as performed in a physical therapy clinic. See all of the Physical Therapy Diagnosis and Treatment videos and downloads at www.Physical-Therapy-Videos.com .

If you suffer from pain in your jaw, face, neck and/or shoulders, the answer might lie in your jaw alignment. Even recurring migraines, numbness in the hands and fingers, or tinnitus—ringing in the ears—can be related to a misalignment of the jawbone.

What is TMD?

TMD stands for Temporomandibular Joint Disorder. It’s also often abbreviated as TMJ. It refers to a problem in the alignment of the mandible, or lower jawbone. The temporomandibular joint is the joint where the mandible joins the temple. If this juncture is not optimally positioned, it can adversely affect your bite, causing a variety of symptoms which sometimes seem unrelated to the jaw.

TMD can be very difficult to diagnose, largely due to the wide variety of symptoms it can cause. Among these are:

As you can see, many of these symptoms would seem to be caused by something other than a misalignment of the jaw. If you suffer from any of these symptoms, and have not been able to find an underlying cause, a visit to a neuromuscular dentist might be in order. It’s estimated that as many as ten million Americans suffer from TMD. Many remain undiagnosed.

Since many of these symptoms can also indicate issues other than TMD, it’s important to get a reliable diagnosis. A neuromuscular dentist can determine if your symptoms are a result of TMD, or if another issue might be causing them.

How can neuromuscular dentistry help?

Only a small number of dentists are trained in neuromuscular dentistry, a field which includes the diagnosis and treatment of TMD. While general dentistry focuses on the health and well-being of the teeth, neuromuscular dentistry focuses on the relationship between nerves, muscles and bones in the mouth and jaw. A neuromuscular dentist can determine the optimal positioning of the jawbone in relationship to the temple, and correct your alignment and bite such that this optimal positioning is achieved and maintained.

A neuromuscular dentist will begin by determining the best position for your jaw. Since the position of the jaw also affects your bite, some changes might need to be made in the way your teeth fit against each other. Malocclusion, or a bad bite, is often a symptom of TMD. You might require crowns to raise your bite, or even Invisalign® clear braces.

Another goal of neuromuscular dentistry is to train the muscles of the jaw to hold the bone in the correct position. After numerous tests to determine the optimum position of your jaw, various techniques are used to retrain the jaw muscles. These can include use of appliances, physical therapy, and Transcutaneous Electrical Nerve Stimulation (TENS), which uses small electrodes to relax the muscles into the proper position and provide pain relief.

Treatment for TMD is highly individualized. Only a neuromuscular dentist will be able to determine what approach will work best for you and your particular symptoms.

What causes TMD?

The causes of TMD are varied and uncertain. Many things can cause the jaw to shift and move out of alignment, including trauma, long-term natural wear and tear, tooth grinding, or even genetic factors.

Whatever the cause, the result is the same—long-term discomfort or chronic pain. If you think you might suffer from TMD, a consultation with a neuromuscular dentist might be the first step toward relieving your pain for good.

Use ice to decrease pain

There are several structures that can cause a painful shoulder. Injury to these structures can lead to the common diagnosis of shoulder tendinitis or a rotator cuff injury. This is not always the case and the source of the pain may not be the shoulder muscles and tendons at all. This article discusses the possible pain generators of the shoulder.

The most recognized way for pain to develop in the shoulder is through trauma. This could consist of something obvious like falling onto your outstretched arm causing your shoulder to jam or trying to push or pull on a stuck object. A less obvious traumatic event could be forcefully using the muscles of the shoulder over time and then pain occurs. This could happen during activities such as chopping firewood, hammering, or exercising in a repetitive fashion. The first traumatic event is identified as a macrotrauma meaning it’s a large and obvious event. The second situation is termed a microtrauma meaning it’s less obvious and occurred with repetitive insults to the muscle tissue. One does not necessarily occur more than the other, but both can cause significant injury and pain.

The macrotraumatic event can lead to injury of the muscle by causing a major tear in the muscle fibers. A muscle tear describes just that, a tear in the muscle. The muscle fibers actually rip apart and become separated from each other or where the muscle tendon inserts on a bone in the shoulder. The rotator cuff muscles can tear to different degrees. The size of the tear can vary and will be termed partial, full or full-thickness tear. It is important to remember that just because a muscle tear is present that doesn’t always mean you will have to have surgery. Signs that a shoulder muscle is torn include but are not limited to pain, weakness, and loss of motion.

A microtraumatic event or repetitive overuse can lead to injury of the muscle by causing minor tears in the muscle fibers. These are small in degree but enough to cause an inflammatory process to occur which leads to pain. Tendinitis is an inflammation of the muscle or tendon. It is not the same as a partial or full tear. The muscle fibers do not actually separate from each other. This type of event can cause significant pain and dysfunction. Signs that a shoulder muscle is inflamed include but are not limited to pain, weakness, and loss of motion.

Another common cause of shoulder pain is bursitis. A bursa is a fluid filled sack that sits between muscle and bone. The bursa is designed to protect the muscle from scraping against the bone, thus it protects it from becoming irritated against the bone. The bursa has a lot of nerve endings in it. When the bursal sac becomes inflamed we call this condition bursitis. Bursitis of the shoulder can be very painful. A bursitis can occur in the shoulder as the result of a macro or microtraumatic event as described above just like a muscle tear or tendinitis can develop. Signs that a shoulder bursa is inflamed include but are not limited to pain, weakness, and loss of motion.

These are three of the most common pathologies that cause pain in the shoulder. You will notice that the symptoms that you may experience as a result of these conditions are very similar. So how do you tell which problem you may have? Well, to determine that you should consult a competent Physical Therapist in your area that specializes in the evaluation and treatment of musculoskeletal and/or orthopedic pathologies. They will be able to successfully diagnose the source of your pain and treat the problem appropriately.

Use ice to decrease pain

Before any neck or shoulder pain can be treated, the reason for the pain must be found out by a professional. It could be caused by nothing more than being in a position that will cause you to overuse certain muscles, working out with weights using the wrong technique, tension, or something more serious. No treatment can be prescribed without knowing the cause of the problem.
The first thing you need to do if you have neck and or shoulder pain is to determine if your position might be causing the problem. If the pain is slight, rest and possibly some heat or ice may be all that is required. You might also try some OTC medication such as aspirin, some simple stretching, or a non-aspirin pain reliever, while resting and making sure to remain as still as possible. If the pain continues or gets worse, you may need to seek a medical professional to determine the cause of your pain.
Once the doctor makes their diagnosis, they will better be able to prescribe a treatment regime for the cause of your pain. The worst thing you can do for any pain is to self-treat yourself with some medication that might be too old or something that some family member was prescribed. Taking any prescription medication that was not prescribed for you by a doctor is never a good idea, although I know people that have done this. It is never a good practice because you may not be aware of any side effects of the medication.
Your neck or shoulder pain may be caused by having your arms raised in an awkward position for too long, with rest, the pain will subside on its own. Tension can cause neck and shoulder pain as well. The treatment for tension might be as simple as resting and massaging the affected areas. While performing some tasks you might begin to notice some discomfort. The discomfort might be telling you that the position you are in is not the proper position for the task. You might also be trying to lift too much weight, which might also cause a strain.
If you think something doesn’t feel right, stop and think about what you are doing and if you are doing it properly. Never overreach or stand with your arms above your head for extended periods, like painting or working at an improper angle. If you are, change your position before you develop neck and shoulder pain.
The best treatment for any pain is not to get it in the first place. This is done by proper rest, proper working angles and never overtaxing yourself. Stress can cause neck and shoulder pain, so try to reduce your stress levels and reduce the tension factor that may cause you neck or shoulder pain before it happens.
If you do develop any pain, try an OTC first and rest. If that doesn’t help you, there might be a more serious underlying problem that will require medical intervention to alleviate the pain.

Use ice to decrease pain