Dr. Glenn Frisch

Hello June!  Where has this year gone?  With personal outdoor activities beginning to peak, I felt it appropriate to return to a more 'structure & function' format for this issue.

We are at a disadvantage in Minnesota.  We enjoy our four seasons, but we are limited by them as well.  Our muscle structure and demands vary depending on the season.  Snow shoveling uses different muscles  than water skiing.  Thus, as the seasons change, so do our bodies.  This transition of both activity and body structure puts us at risk for injury.

Our bodies hate change!  The body likes a nice state of equilibrium.  Any change of physical demands or injury and the body responds the only way that it knows how.....spasming and structural shifting.

None of us are spared from body shift and change.  It is as natural as breathing.  What we do when the injury occurs is more important than what we think we should do.  The body has certain rules regarding healing.  In this issue of E-News I hope to give you information you may not have seen or heard before, as well as reviewing some information you already know.

Enjoy the start of your summer!!!

Dr. Frisch

P.S. Eileen says that the next three months will feature seasonal desserts.  I guess she's sticking with summer fun as well!

IT HURTS WHEN I CHEW!

TMJ (temporomandibular joint) pain can have many causes.  One of the most common reasons to have jaw pain....ready yourself... IS A NECK PROBLEM.

Not too many people would associate jaw pain with a neck injury or dysfunction., but it is one of the most common reasons.  There are direct structural and neurological relationships between the jaw and your upper neck.  The 'electrical wiring' of the jaw organizes itself in the cerebellum and brainstem.  This is the same area that receives 'electrical wires' from your upper neck, primarily, the first three cervical nerves.  The jaw and neck could be considered 'siblings'.  What happens to one, often affects the other.

The TM joint has some basic rules that it follows.  First, we must remember that  the TM joint is a 'hinge' that opens and closes with the aid of gravity and two       primary muscles of chewing called the masseter and     the pterygoid.  When we open our mouth, the jaw       should open smoothly and evenly.  It should not           deviate to one side or the other.  If when you look in  a mirror and open your mouth, you notice your jaw deviate, you have an imbalance with your TM  joint.  A TMJ problem is often NOT PAINFUL in the early stages, but with time, the pain becomes a dull      constant pain that steadily increases in severity. 

The second component of a TMD ( Temporomandibular Disorder) is that of the cervical spine.  The cervical spine has a 35-45 degree curvature which acts as a 'spring' for the head.  The head is heavy.  It weighs between 8 and 16 lbs.  This amount of weight requires both strength (muscles) and stability (ligaments) to allow the neck and skull to function correctly.  If the structural and motion mechanics of the neck and skull are impaired, nerve stimulation to the joints and supporting musculature is incorrect.  This leads to joint dysfunction, weight-bearing imbalance, arthritic degeneration and chronic pain.

I believe that you can now see why the TMJ syndrome is difficult to treat.  There is more than one component involved.  Taking a purely "oral" approach with mouth guards and splints or even having the teeth shaved, is ineffective.  Ignoring the mouth/jaw and treating just the cervical spine can be just as ineffective.  What works the best is a combination of cervical spine correction/stability and mandibular balance of motion.  Incorporating specific exercises and adjustable splints (when needed) are also effective at resolving a painful TMJ disorder.

Recent research supports my suggestions for care.  Stiesch-Scholz, Fink and Tschernitschek recently reported:

" ...'silent' functional disorders of the cervical spine occur more frequently in patients with internal derangement of the TMJ than in the control group.... As functional disorder of the cervical spine may tend to extend the duration of temporomandibular dysfunction, it seems reasonable to treat cervical spine disorders as part of the interdisciplinary collaboration with Physical Medicine. "

Journal of Oral Rehabilitation 2003;30:386-391.

If your jaw has been 'clicking and popping' or causes you frequent pain, it is to your benefit to have it evaluated as soon as possible.  Once the syndrome starts it needs to be managed or it will get worse with time.

                          (* Picture obtained from Body-Mind Publications)         

27% GIDDY ?

One of the more unique things I have seen in nearly two decades of treating whiplash injuries is the variety of symptoms that go along with the traumatic injury. 

SYMPTOMS

• Dizziness
• Nausea
• Imbalance and difficulty walking
• Vision changes including 'blurriness'
• 'Brain Fog'.  This is hard to describe, but it is a lot like trying to think through fog.  The thoughts aren't clear and recall is slow at best.
• 'Woozy' feelings when changing positions.
• Constipation that alternates with Diarrhea
• Wetting the bed (As an adult)
• Buzzing sensations throughout your body
• Insomnia
• Radiating pain and numbing
• Headaches

I could easily continue this list over several pages.  Recent studies continue to confirm these type of symptoms as legitimate and real occurrences.  In previous years, people complaining of 'odd' symptoms after an accident were thought to be making up pain for a lawsuit or other personal gain.  We now know they were likely telling the truth!

A recent study by Treleaven, Jull & Sterling reported that of 102 whiplash patients studied:

•  76 reported dizziness or unsteadiness.
• Whiplash patients with dizziness had higher scores on the neck pain index than whiplash patients without dizziness.
• Whiplash patients had higher 'joint position errors' than controls.
• 17% of the of the patients reported delayed symptoms of pain. ( The 'Late Whiplash Syndrome' has been averaged at 20-40 %. so this study is not far off the average)
• Headaches (56%), decreased concentration (35%), nausea (40%), blurred vision (38%) were all common findings.

Journal of Rehabilitative Medicine 2003;35:36-43.

These findings indicate that much of the 'weird' symptomatology that people suffer with after an accident is directly related to the neck trauma and neurology imbalance that results.  Chiropractic treatment of these injuries is highly recommended to regain the integrity of the joint complex and allow for proper healing and long-range stability.

(27% of the people in the study also reported symptoms of 'giddiness' that was not normal for them!) 

CRASH FACTORS

 I have discussed in earlier issues of ENews, the significant and often overlooked factors involved in seemingly simple automobile accidents.  The pain of injuries may vary.  There may be severe, initial pain that seems to go away, only to return at a later date.  There can also be no initial pain, but with time, pain and numbing steadily increase to debilitating levels.

Here are some simple tips to help lessen the likelihood you will be involved in an accident and to reduce the trauma if an accident should occur.

• Wear your seatbelts!  I can't stress this enough.  Seatbelts are not always comfortable to wear and they may contribute to added neck and upper back trauma with an accident, but they will stop you from being ejected from the car.  They increase your chance of survival.  Wear them!
• Pay attention to the road when you are driving. Talking on the phone, fiddling with the radio and worrying about the French fries you just knocked over, all increase your chances of being in an accident.
• Be considerate of other drivers.  We all see acts of stupidity on the road every day.  We do not have to be told that cutting off another driver is wrong or that tail-gaiting puts the other driver's life at risk as well as our own.
• RELAX!  Just because the speed limit says 65 mph, you don't have to do 70-80 mph!  You will not save more than a couple of minutes in any metro area by speeding.
• Clean your windows.  This doesn't just mean clean the glass itself, but also 'get the stuffed toys' out of the windows.  Hanging things from your mirrors and loading up your car windows with garbage is foolish.  If you want to decorate your room go ahead, but you share the road with other people.  Blinding your view of other drivers endangers them and you!
• RED means STOP!  I have noticed an increasing disregard for stop signs and stop lights.  Stop signs/lights are there to make traffic run smoother, lessen the congestion and the reduce the risk of accidents.  It is a total disregard for other's lives when you run a light or don't stop for a sign.  I don't care if you are 20 minutes late for work, 'don't see anything coming', or didn't feel like stopping.  If you hit and kill someone, your life will change forever!  Use your head.  Stop lights aren't a punishment, they are there to keep you safe!

A recent Swedish study of 3704 auto accidents revealed some interesting facts.  It found that women sustained the highest degree of trauma with accidents (55%), regardless of the type of impact.  It was also noted that women sustained a higher risk of injury than men when they were in the driver's seat ( 69%).  The reason for gender differences may be muscle mass, height or even spinal curvature prior to impact.  Because women may sustain a higher risk of serious damage in an accident than men, they need to be even more careful.

Berglund, Alfredsson, Jensen, et al. Occupant and crash-related factors associated with the risk of whiplash injury. Annals of Epidemiology 2003;13:66-72. 

Eileen's Corner

This summer is all about desserts.  This is a wonderful pie recipe.  It comes from John Schumacher, the noted chef and owner of Schumacher's restaurant in New Prague, MN.  Glenn adores this pie and I think you will too!

    STRAWBERRY-RHUBARB PIE

1 Prepared pie crust (with top crust) or your favorite recipe

3 cups fresh rhubarb, cut into 1/2 inch-thick pieces

1 1/2 cups of slices strawberry pieces

1 1/2 cups of sugar

1/2 cup packed brown sugar

1/4 cup all-purpose flour

2 Eggs

2 Egg yolks

3 tablespoons half-and-half

1 teaspoon vanilla

1.  Preheat the oven to 350 degrees F.  Line a 9- inch pan with the pie crust.
2. Arrange rhubarb and strawberry pieces in bottom of pie crust.
3. In a large bowl, combine eggs, egg yolks, half-and-half and vanilla.  Combine sugar and egg mixtures; whisk until smooth.  Pour evenly over the rhubarb-strawberry blend.
4. Place top crust (or lattice) on pie and be sure to make 'slits' so the pie doesn't 'bubble over'..
5. Bake 55-60 minutes or until the crust is golden brown and toothpick inserted near the center comes out clean.  Cool on a wire rack.

This makes 6 servings.  Prep time is 10 minutes .

* Do not use frozen rhubarb as it becomes mushy and stringy.

*If you only want rhubarb pie, add 1 additional cup of rhubarb and eliminate the strawberries.

*This recipe comes from John Schumacher's  most recent book; "Today's County Cooking".  It is available in Barnes and Noble and many other locations around the Minneapolis/St. Paul area.

This book is especially fun around our house.  John and Glenn are both from the same small, western Minnesota town (Wheaton) and Glenn grew up eating many of the same recipes!  It is a beautifully done book with colored pictures and it is hard-bound as well.  It would make a nice gift for anyone!

Enjoy!

Eileen

Knock On Wood

If I had a nickel for every time someone said to me " You're a Chiropractor?  Knock on wood, I've never needed one!", I would have retired long ago.  The truth of the matter is, they didn't know that they did need a Chiropractor!

When we buy a car, it is understood that someone else will be maintaining it and keeping it running well.  A vehicle is an investment that needs to be maintained.  We, on the other hand, are 'trained' by media and pharmaceutical companies to believe we are healthy until we have pain.  Then we need to see the doctor or take an over-the counter drug to be healthy again.  That would be akin to driving your car until it breaks.  Do you see the analogy?

Your body is an asset.  It is valuable.  You should treat it as such.  You can walk in any mall in this country and observe people and their physical impairments.  A limp that 'sways', a rotating hip, an arcing shoulder or a 'forward head position' are just a few of the things that I regularly see with people.  My wife says that I am no fun to 'people watch' with because I observe and vocalize problems that they should be fixing, but likely aren't.  Because problems 'adapt' with time and often develop slowly,  those people may not yet have pain and would think I am soliciting them for business, rather than being concerned for their well being.  

Do you want to know why a doctor or dentist doesn't openly expose your problems to you?  First you probably wouldn't listen.  Secondly, by openly telling you about your 'ailment' you will interpret their concern as a promise to cure!  A smart doctor realizes that you work with what you are presented and sometimes only 'stability' is possible.  A long-standing degenerative injury may not be 'curable', but the problem will likely get worse if left untreated or not maintained. 

The person who feels 'solicited' can and often does get upset if their problem is not cured.  It is an unfair situation and most doctor's would rather not deal with the headache (no pun intended).  That is why doctor's don't like 'party talk'.  They know that the person asking them questions merely wants free advice.  They know that if they show concern for the person, once the information is gleaned, that person probably won't take care of the problem anyway.  For that reason, "How about those Twins?" is a more common statement from a doctor than, " I couldn't help, but notice your limp".  If people were more concerned with REALLY taking care of themselves, they would see more doctors wanting to give free advice.  It has nothing to do with money.  It is about personal responsibility and commitment.

In that light, here is some free advice.  We own a body that has a spine, 100's of muscles and thousands of nerve connections and need a chiropractor to maintain it.  That is a fact.  Structure and function 'symmetry' determines how well we age.  We will notice how well we took care of ourselves later in life, not at the beginning!  By the time we realized we have ignored our body, damage has been done and sometimes it is too late for recovery.

RULES FOR HEALTH

1. If your pain is physical or headache related, call your CHIROPRACTIC DOCTOR.  Their specialty is 'structure and function'.  This means muscle and ligamentous injury, discal injury, bone trauma and nerve related problems.
2. If your problem is caused by trauma to the head, loss of vision, balance or organs are involved (vomiting, diarrhea, bleeding), call your MEDICAL DOCTOR.  M.D.'s are specialists in 'chemistry' and surgery.  Medical doctors alter your body's chemistry with drugs to alleviate infection, stop pain and alter hormonal chemicals.  Their other option for care is surgery to remove or repair.

These two very simple rules can save you a lot of 'tail-chasing' in resolving a problem.  Your chiropractor doesn't want to treat your heart problem and your MD doesn't want to treat a discal injury. Neither is very good at treating the other.  It is not what they are best at.  You as a consumer need to know 'who does what' and who to call with your problem.  Do not rely on the media to give you this information, they have a profit motive with advertisers.  Be smart!

 I hope you have enjoyed this issue of ENews.

See you next month,

Dr. Frisch