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STJ / TMJ connection

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Robertisaacs, Jan 28, 2010.

  1. Interesting letter from our friend Pat Turnbull in Pod Now today.

    I've reproduced all three letters for the sake of completeness. The last one is her latest.


    This one looks set to run and run! Nice to have sparked an interest.

    What say you?
     
  2. I say:-

    That is an interesting study which proves precisely F*** all of direct use clinically.

    My understanding of the H reflex is not profound. I'll be honest, I googled it. So I gather it is an artificially induced reflex considered analogous to the stretch reflex we see when we hit people with hammers. Feel free to educate me if there is more to it than that (I'm sure there is).

    So lets be generous and say that this study can be extrapolated to mean they found an improvement in overall muscle function in the ankle extensors and flexors as they claimed. Lets be more so and say this can be extrapolated to ALL distil muscles

    Personally I think that is a bit of a stretch from that data, but lets say.

    Does that show that an orthotic will change somebodies bite? No. Does it show that changing somebodies bite will improve their posture? Not really! It shows a CHANGE in distil muscle function with clenching of the teeth. Not necessarily for the better! If it does the same to the flexors AND extensors then so what? It shows a LINK. There's a link between nose hairs and eye watering, doesn't mean crying makes your nose hair grow.

    I've no problem with the concept that there is a link. I applaud the attempt to discover what it is! But I can't see how we get from that to the bite being improved when the STJ is held in "the correct position" (whatever the hell that is).

    Orthotics don't "hold the foot" in any position. There is no single "right position". We don't wear orthotics 24 / 7 and they only exert ORF when there is GRF so forget about any dental improvement when your sitting down. Which most of us do most of the day. And I'm no dentist but I'm fairly certain we don't walk around all day with teeth clenched* so I don't know how braces will affect gait when we are, say, talking. I suspect that is a bit like our static WB exam.

    We have a tiny, tiny fragment of the jigsaw... and people confidently saying they know what the picture is based on it. By all means lets find the rest of the pieces but lets not claim we have them when we don't!

    What do YOU say about this one Simon?;)

    Regards
    Robert

    *That said:mad:
     
  3. Calm down Robert, I'm just pointing out that by clenching of teeth these researchers were able to evoke changes in muscles in the lower-leg. How did that happen? If I have read your critic correctly her contention is that there is a connection between the TMJ and lower limb muscle function, this study appears to support that. I am not saying that we can make clinical sense of this. All I am saying is that for some reason, clenching teeth has an influence over the muscles of the shank. If you wish your discussion with her to "run and run", you may need to answer questions like the one I have posed to you in this reply.

    Stop clenching your teeth now Robert, you'll sprain your ankle. ;-)
     
  4. OK Robert, two minute critique of you critics letter:

    "In response to Mr Isaacs' comments regarding the link between in shoe devices and improved dentistry (letters, February issue), postural asymmetry is vital for correct upright stance. To maintain this, feedback is required from the eyes and ears, but only when the head is straight.

    OK, so "postural asymmetry is vital for upright stance".... really?

    So if my head is not straight, I fall over? Alternative reading of this suggests that feedback from the eyes and ears are only important when the head is straight? If it's not straight do we shut out sensory information from the eyes and ears, why bother with the labyrinth in our ears then? If I tilt my head to the side I'm still getting feedback from both my eyes and ears.

    "Any Imbalance will affect the temporo-manibular joint"

    Really? Evidence please?

    "which could therefore create a descending problem in the same way as the subtalar joint in the wrong position may cause an ascending problem"."

    Potentially- that's my point above Robert.

    "There is literature available on this subject and I agree more research is needed.
    I'm sure an explanation of the muscles in the ankle is not necessary but I do need to suggest that any muscle in its shortened state will not be efficient. This can cause mechanical and/or positional distortion and eventually joint damage."

    Demonstrate that TMJ dysfunction results in muscle shortening in the muscles acting on the ankle.


    "As a member of the BMA Acupuncture society, I know that this treatment is successful for restoring function, thus reducing pain."

    As a member of the U2 fanclub, I know that they are the best band in the world. Non-responsive answer. Look it up, Dennis.

    "I would certainly not treat a diabetic ulcer this way but no mention was made of this condition in the original article!"

    Neither would I, love.
     
  5. :D

    PMSL!!!

    I'll allow that there may be a connection (big of me). I can't swallow that

    Specifically, I can't swallow:-

    ANY imbalance? In what? What affect? What's a lower limb "imbalance"

    What Kind of problem?
    WTF? What is the right position? When? Did I miss that study?

    Again, what KIND of problem?

    Its the overextrapolation which gets to me.

    Anyway. I'm Calm. I'm as calm as calm can be. really I am.
     
  6. Check my reply to the letter above.
     
  7. "In the same way as the subtalar joint in the wrong position"
    The right position is a position at a given point during a given activity that the position of the subtalar joint is such that the stress in the joints tissues and any other tissues is not excessive as a result of the subtalar joint position. A subtalar joint in the wrong position might be one that is dislocated. Be careful.
     
  8. Like your thoughts. Much as mine. Sorry, must have cross posted.

    With you with the dislocation. But Is the definition of the right position as the one in which tissue stress is minimal elsewhere not tautological in the same manner as the STJN Root definition? The right position being the one which is not wrong?

    And is it simply the position of the joint which defines the stress in the joint tissue at any instantaneous point? What if we have two joints in the same position (say end range pronation) and one is just hanging off the deltoid ligament and the other has massive residual moments at the sinus tarsi?

    If we're talking about the position of the joint we're in the realms of kinematic chain theory where the evidence is none too strong. Kinetic chain theory is obviously much more plausible, but then we're mixing positional ideal of the STJ with kinetic chains.

    Thanks for bringing me back down Simon.:drinks Have you noticed when we play other people rarely join in ;)?
     
  9. To be fair, Pat did not mention the right position only the wrong one, it was you that spoke of the right position.

    One will cause tensile stress in the deltoid and the other will cause compressive stress at the sinus tarsi. Both or neither may potentially create excessive stress in the tissues.

    Lets take two feet and apply a pronation moment of X, and 2X to the other- which one gets pathology? Kinetic data in isolation doesn't tell us much does it.

    Let one reach rotational equilibrium at max pronation and the other at the mid-range of the joint, which one gets the pathology? Neither, both, one or the other- right? So position doesn't help much on it's own either.

    Do you think that it would be better to have the subtalar joint functioning within it's zone of optimal stress or outside of it? I think within it, as such there are a number of factors which are significant including the loading and the position of the joint- both are important.
     
  10. CraigT

    CraigT Well-Known Member

    in addition to this, shouldn't it be 'symmetry'?
     
  11. Yep, that's why I highlighted it in bold text.
     
  12. Griff

    Griff Moderator

  13. RobinP

    RobinP Well-Known Member

  14. drsha

    drsha Banned


    Neither is the case and calling those who dream and fantasize and contemplate science, biomechanics and podiatry from the edges "nutters" shows a total disrespect for what a profession is.

    Some of the dreams that you choose to stifle may once refined and tempered come true and change the world. It's not fair that you take the time from your life to dampen dreams that you do not share and only allow yours to potentially harvest.

    You, kind sir, do not understand the dynamics of a profession which is supposed to be expansionist and free thinking while protected by its Centrists.

    You serve as a watchdog in podiatry to make sure that fantasies that are no more than that never rise to an inappropriate acceptance level. You do not serve as more.

    Making you and yours the judges and jury armed with a fixed agenda that places a noose around the necks of dreamers choking their ideas before ever examining them makes you, in my opinion, a "nutter" as well.

    Hurricane Sandy and its existence as a natural disaster will rely on dreamers and innovators and "nutters" to take us out of the storm while the centrists look for evidence powerless to act. A moment like this should help you posture differently as we are all important.

    Dennis
     
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