STJ / TMJ connection

Members do not see these Ads. Sign Up.

This one has come up quite a bit in the last few weeks.

In response to A pod now column in which I discussed the claims made for insoles I received the following letter

My reply is in Pod now if anyone is interested.

There were also a few posts on the Prioprioception thread. It would appear that the idea that the STJ can kinematically affect the TMJ is not such a rare one!

Perhaps this is a debate which needs to be started (or is it restarted?)

What is the origin of this theory?

What is its rationale?

Does it have any supporting evidence?

What, in fact, is the link?

Regards
Robert

 

My view in general.

Ouch.

I have a love/hate relationship with the concept of holistic. It is easy to point to cases where holistic consideration is best for the patient where a reductionalist would fail. However it seems to me that sometimes holism is used as a means to crowbar an unrelated specialism into a treatment plan. For example, core stability is a particularly important consideration in Paeds, especially the very young. A worthy example of a holistic approach. Sometimes, however, I see core stability wheeled out as the root of all evil, footpain wise, where in truth the problem can be explained quite adequately closer to home.

A certain orthotics supplier was in the habit of providing their orthotics along with a few hundred pounds worth of homeopathic remedies. Is that holism or something more cynical?

As regards the TMJ / STJ link, I await the evidence.

Robert

 

Maybe this person can present their research to prove their point... I´ll say no more as I´m likely to get banned for abuse and using too many swear words. I´m having a crap day...

Maybe I need a pair of Prioprioception devices Ed can you help me, no I´ll think I´ll swear at the computer or go to the pub it´s after 12.00 in Australia.....

 

The opposite is the case. Its the nutters that make the unsubstantiated claims backed with no research that are damaging the profession.

I have no doubt there is a link, but to go around making silly claims that can not be supported is dangerous.

 

http://www.sciencedirect.com/scienc...serid=10&md5=0d9974f701c68f34617613ac1d3c1862

 

Nice Article! A veritable Forest of hawthorn.

Real shame they didn’t include a control group.

Here’s a study for someone. There is a very basic force plate which rather crudely records postural sway which is well within the price range of the private and interested researcher. Its called a wii fit.

Get a dozen or so people to do the balance test and record their score. The research software will record this in the subject’s mii file. Then apply a change in conditions which is sensible enough to convince your subjects that you’re not just taking the piss, but silly enough that some nerk will not say it actually DID make a difference to their balance and sell your placebo for £££ on the strength of your study. Say, a tin foil cap with wires coming out and LED’s and suchlike. Get them to measure they’re score again.

Notwithstanding that I’m being mildly silly and that the wii-fit is not exactly a standard research tool, such a study might actually produce some interesting results!

Whaddayathink?

 

http://www.scielo.br/scielo.php?pid=S1807-59322009000100007&script=sci_arttext

http://www.ingentaconnect.com/content/maney/tpc/2002/00000014/00000003/art00013

http://ejo.oxfordjournals.org/cgi/content/abstract/cjm071v1

http://cd.inter-uni.net/forschung/d...JOrofacOrthop_Orthopaedie_und_Zahnmedizin.pdf

 

Another:
http://www.springerlink.com/content/w064w35270825850/

 

So, from my brief literature review the work of Valentino appears key to this discussion, the studies performed by this worker are generally weak in terms of the evidence hierarchy. However, the reference above does seem to have used foot orthoses of some kind; it should be helpful if anyone could post a full copy of this paper.

This one used arch index (found no diff) http://www.scielo.br/pdf/clin/v64n1/a07v64n1.pdf

 

Thanks Simon!

I rather liked this one. Its a rather helpful meta analysis

For anyone with a passing interest they found 359 related articles.

Thats a LOT

Of these, only 3 were RCTs. Not blinded mark you, just RCTs.

Of these, the first used CBT and looked at bite

The second used postural training by a physiotherapist and looked at bite

The third used an orthodontic device and looked at the neck... but

The discussion was good

So we have a preponderence of low quality literature, little high (and what there is looks at links well above the waist).

This is all very interesting and posurillogical (a word I just made up) but the middle and both ends is that we struggle to come up with decent evidence for kinematic changes from orthotics much above the waist, much less the jaw.

Can't see the valentino study but we do know from the meta analysis that it is level IV evidence (5 is the lowest) as a

I see the words muscle chains and posturology mentioned A LOT in those articles. Seems to be the in thing on the continent just now. But from that they're still arguing the toss as to whether there is a direct and demonstrable link between posture and the TMJ, much less orthotics and the TMJ!!

 

Yeah, much of it from Italy- where is Brian based?

 

I took this from another thread I thought it fit in well. Hope that it´s not bad forum form. Written by David Wedemeyer Chiro and peodorthist

 

Not when it's such a bloody good post!!

 

As a sufferer from an internal derangement- ie a severe open lock TMJ dysfunction, I can with authority state that it has absolutely nothing to do with my posture or stance and that my feet are completely normal. ( I have in the past stood on a pressure plate at a conference just for the fun of it!) .
I would very much like to know in what capacity does Pat treat patients backs (if not by orthoses) in her role as a podiatrist?
What is this pressing need for practitioners to work outside their scope of practice? Did I seek a pod to help me with my jaw? Of course not, I went to a maxillo-facial consultant.

Cornmerchant

 

Now THAT is a damn good question!:good:

 

Like many ailments given a specific name there can be a variety of factors that contribute to:

1) The primary cause
&
2) secondary influences that perhaps perpetuate the symptoms once they have developed.

I have treated clients with chronic TMJ in conjunction with Physiotherapy. I will only see clients with TMJ if they have been and seen the "jaw" specialists and tried the conventional therapies.

Improving a clients sagittal progression efficiency with a suitably prescribed foot orthoses can, in some cases, have a remarkably positive effect on both posture and symptoms.

Like I said. It is important that these clients have been seen by the respective specialists in this area. However, it can be beneficial to utilize sagittal plane facilitation methods to reduce and improve symptoms in some cases of TMJ. IMAO

Regards

 

Graham,

We have been getting along so well as late and then you go and say:

How are you measuring "sagittal plane progression efficiency"? :drinks

 

I'm not Just a crazy assumption:drinks

 

Graham, if nothing else, I love you honesty- don't ever change.:drinks:drinks:drinks:drinks:

 

Lack of surgical training posts. Seriously.

There is only so much you can do with conservative care until you look at silly things like this. Its like being 1/10th of an orthopaedic surgeon sometimes.

LL

 

Here's another. They looked at centre of pressure and found no relationship.
http://www.sciencedirect.com/scienc...serid=10&md5=b89866ba36fe624be0aff31c801c62f8

 

This is interesting looked at mandible position and gait parameters:
http://lib.tmd.ac.jp/jmd/4804/fujimoto.pdf

 

more:
http://www.drlevinkind.com/images/uploads/publication_consideration-of-whole-body-posture v1.0.pdf

 

Wearing dentures versus not wearing dentures- effect on gait parameters
http://iadr.confex.com/iadr/2003Goteborg/techprogram/abstract_37087.htm

 

Orthoses and TMJ... maybe they're using their orthotic devices to cure nocturnal teeth grinding.

 

Not working. I'm still grinding.

Although the stuff some people claim of their orthoses does make my jaw drop, does that count?

 

TMJ and gait:
http://www.ncbi.nlm.nih.gov/pubmed/18923375

TMJ alters hip RoM:
http://www.sciencedirect.com/scienc...serid=10&md5=8eda4139e7dcc17a9171b284629c4118

 

I went off to read that link and came across these two in my travels which indicate no change, by the same author also from Italy. Can you Imagine a hand waving going on at a conforence when this stuff is discussed.

 

Wearing high heels has an negative effect on TMJ dysfunction:
https://www.thieme-connect.com/ejournals/abstract/physmed/doi/10.1055/s-2008-1078713

Now were getting somewhere: H-reflex for soleus and pre-tibials influenced by teeth clenching:
http://jn.physiology.org/cgi/content/abstract/83/4/2063

cross-bite correlates with limb length discrepancy
http://ejo.oxfordjournals.org/cgi/content/full/29/1/100

 

Maybe you need to heat mould them before biting down...

 

Still searching. I feel the principle of Occam's Razor applies to this subject and that it is at the moment a completely unnecessary hypothesis. It reminds me a great deal of the entire biotensegrity thread. It sounds neat but why is it necessary. Makes me want to slap Deepak Choprah for muddying the pristine waters of the known physical world and generally accepted scientific beliefs.

Hilarious comment fatboy!

 

My head hurts!

All very fascinating stuff! This one

http://jn.physiology.org/cgi/content/abstract/83/4/2063

In particular. Lots of long words. But as David says

Can we (and indeed SHOULD we) use orthotics to improve dentistry?

Oh and BTW I'm toying with starting an journal which is a crossbreed between JFAR and JIR as a tongue in cheek swipe at uncontrolled research and the like!

It could include articles like this one

I'm pretty sure clenching your butt makes you walk differently as well. Shall we start issueing patients with Butt Plugs?! (rhetorical).

Regards

 

Hi Robert

"Shall we start issueing patients with Butt Plugs?! (rhetorical)."

Shouldn't that read Rectal

Ian

 

Apologies. You are, of course, correct. I should have said:-

Should we start issueing rectums with butt plugs (rhetorical).

 

Think I might have misled you robert. "Rhetorical" / "rectal" - sorry bad attempt at a joke. maybe I need a butt plug!!

 

Oh I see

 

It all makes me wish for the simpler times when impotency could be eliminated with insoles...