Jaw (Temperomandibular Joint) Physiotherapy

Jaw disorders (also known at temperomanidubluar joint problems) are very common and can cause a lot of pain and discomfort as well as affect your activities of daily living. This can be caused by stress, clenching your teeth, operative procedures, anxiety and dental malalignment problems. We offer specialised physiotherapy to the jaw at Samantha Timcke Physiotherapy and treat conditions such as :

• Locking/clicking jaw
• Painful jaw
• Difficulty opening your mouth
• Post-operative jaw/dental procedures
• Clenching teeth/bruxism/stress related injury to the TMJ
• Trauma/fracture to the TMJ
• Tension headaches

Physiotherapy for the above conditions helps to regain opening of the mouth if limited, reduce pain in the jaw/facial region, and restore function of the mouth as well as the anterior head and neck. The jaw is a complex joint and is very closely related to the neck and head and so we work holistically to treat all aspects of the upper body that may be aggravating the problem. We also work closely with dentists and maxilla-fascial surgeons to ensure that you can be referred on to other health professionals if necessary.

Samantha Timcke has done many post graduate courses including Temperomandibular Joint Disorders, The Anterior Head and Neck as well as the The Upper Quarter course and she is now involved in teaching other health professionals about jaw physiotherapy.. She has many years of experience working together with a dentist with whom she shares her rooms (www.my-dentist.co.za).

Call us on 011 783 5960 / 8984
53a Edward Rubensten Drive, Sandown, Ext. 24

Foot pain (plantar fasciitis)

This is pain felt on the inside aspect of the heel. It is usually an overuse injury that causes inflammation of the plantar fascia at its attachment site on the heel.

CAUSE

Plantar fasciitis occurs as a result of stretching and pulling of the plantar fascia from its attachment on the heel bone. Running and dancing are commonly associated with this. It is often an overuse injury.

SYMPTOMS

The pain is typically worse in the morning with the first steps being very tender until the area warms up. Pain is also worse with high impact heavy weight bearing activities. The site of tenderness is localised to the inside aspect of the heel and is usually described as a dull ache. Over time, the inflammation can worsen with activity and the pain can increase.

Ankle pain (lateral ligament injury – rolled ankle)

A lateral ligament injury usually refers to a tear of one or more of the ligaments on the outside of the ankle. The lateral ligaments consist of three ligament bands which provide stability to the outside of the ankle joint.

CAUSE

The lateral ligaments are injured when they are overstretched (sprained). This occurs when the foot and ankle are forcibly rolled inwards; it is often referred to as a “rolled ankle”. The ankle may be rolled during rapid changes in direction, on uneven surfaces, or treading on a ball or opponent’s foot.

SYMPTOMS

The first sensation felt is pain on the outside and front of the ankle. There may also be an audible snap, crack or tear. Depending on the severity of the injury, the outside and front of the ankle may swell and you may have difficulty walking due to pain. Swelling can be immediate or happen over a few hours. You may also develop bruising up the leg or down to the toes. Your ankle may also feel weak.

Thigh pain (hamstring muscle strain)

A hamstring muscle strain refers to a tear in the muscle which covers the back of the thigh.

CAUSE

It typically occurs when the muscle is contracted with excessive force in a stretched position. This commonly occurs during running or sprinting just before or after the foot hits the ground. In this position, the hamstring muscle group is stretched over the back of the hip and knee joints whilst it is working hard to slow down the forward swinging leg and secondly propel your body forward.

SYMPTOMS

The first sensation you will feel is sudden pain in the back of the thigh due to damage to muscle fibres. At the same time, you may have a ‘tearing’ sensation. With a minor strain, you may be able to continue with participation with minimal restriction. However, as the muscle cools down following activity pain may gradually increase as bleeding and swelling around the injured muscle continues. In more severe strains, these sensations may be exaggerated such that you cannot continue with participation due to excessive pain in the thigh, muscle tightness, weakness and spasm. In these cases, pain may be so intense that you may not be able to walk without a limp. There may also be obvious swelling and bruising as well as a visible defect in the muscle.

Hip pain (trochanteric bursitis)

Trochanteric bursitis refers to inflammation and swelling of the bursa located between the point of the hip (trochanter) and the overlying gluteal muscles. A bursa is a fluid filled sac which allows adjacent tissues to slide over one another without friction.

CAUSE

It occurs when the trochanteric bursa is irritated because of excessive friction on the bursa. Trochanteric bursa works to allow the gluteal muscles to slide smoothly and without friction over the point of the hip. When these muscles are pulled tight, they place increased pressure and friction on the bursa. This increases wear and tear on the bursa, causing microtrauma, which, overtime can result in bursal thickening, inflammation and bursitis.

SYMPTOMS

Trochanteric bursitis causes pain over the outside of the hip. In some instances this pain may radiate down the outside of the thigh as far as the knee. The pain may be aggravated by activities that involve movement of the hip such as walking, running, stair climbing, crossing your legs and getting in and out of the car.

Knee pain (runner’s knee)

Patellofemoral syndrome (runner’s knee) refers to pain arising from the joint between the kneecap and the underlying thigh bone.

CAUSE

Runner’s knee most often results from overuse of the knee. When the knee is bent and straightened, the kneecap slides up and down within a groove on the end of the thigh bone. With repeated bending and straightening, such as during activities involved in walking, cycling, running and jumping, the underneath surface of the kneecap can become irritated.

SYMPTOMS

The main sensation associated with runner’s knee is pain. This is felt behind and around the kneecap which can be associated with grinding noises heard when the knee is bent or straightened, a sensation of the knee giving way and weakness in the knee. The knee may also swell at times.

---

 

Knee pain (Iliotibial Band Friction Syndrome – ITBFS)

The itiotibial band is a band of strong connective tissue which runs from the pelvic bone down the outside of the thigh to the top of the shin bone. Itiotibial band friction syndrome is a condition which describes the rubbing of this band of tissue as it passes over a bony bump on the outside of the knee joint.

CAUSE

This is an overuse injury. When the knee is bent and straightened the iliotibial band slides over a bony bump on the outside of the knee. When this is performed repeatedly or when the band is excessively tight, wear and tear of the band can develop as it flicks over the bony bump. To heal this damage, the body commences an inflammatory response.

SYMPTOMS

ITBFS results in pain felt on the outside of the knee. The pain is often aggravated by activities which involve repeated bending and straightening of the knee such as running. It typically develops gradually. Initially, the pain may begin as a dull ache down the side of the knee which appears near the end of the session and disappears when you stop. However, if you continue to exercise and cause further rubbing of the iliotibial band, the pain may progress to become more intense which may also take longer to disappear when you stop exercising.

Elbow pain (tennis elbow)

Commonly referred to as “tennis elbow”, extensor tendinopathy refers to degeneration and inflammation within the tendons on the outside of the elbow. These tendons connect the forearm muscles to the arm bone and function to lift the wrist, hand and fingers.

CAUSE

This is a common injury associated with activities requiring repetitive use of the wrist and hand, and results from overuse of the tendons on the outside of the forearm. The function of these tendons is to transmit forces produced by the forearm muscles to their origin from the arm bone. Repetitive use of the forearm muscles, and therefore, the forearm tendons can lead to microscopic tears within the tendons and degeneration or breakdown of the tendons. To repair this degeneration, the body commences an inflammatory response.

SYMPTOMS

The primary sensation is pain felt on the outside of the elbow and forearm. Initially it may only be felt following exercise. As the tendinopathy worsens the pain within the tendon becomes more intense and more frequent. In the earlier stages, this pain during exercise may initially disappear as you warm up, only to return as you cool down. However, as you continue to exercise, the tendinopathy worsens and your pain may begin to be present for longer periods during exercise until you are constantly aware of it.

Shoulder pain (rotator cuff tendinopathy)

The rotator cuff refers to a group of four small muscles which run from the shoulder blade to the top of the arm bone. They stabilise and move the shoulder joint. The rotator cuff muscles attach to the arm bones by tendons. Rotator cuff tendinopathy refers to inflammation and swelling within one or more of these tendons.

CAUSE

Rotator cuff tendinopathy results from overuse or injury to a rotator cuff tendon. The most commonly involved tendon is that of the supraspinatus muscle which functions to help raise the arm into the air. Its tendon passes through a small space between the top of the arm bone and the point of the shoulder. In this space the tendon is susceptible to ‘wear and tear’. Repetitive use of this tendon can rub the tendon against the edges of the bony space resulting in microscopic tears within the substance of the tendon.

SYMPTOMS

The most common symptom is pain felt in the top of the upper arm and typically develops gradually. This is usually felt when you try and lift your arm into the air. Initially, the tendon may only be painful following exercise. For example, it may first be felt rising the day following participation. Associated with the pain may be stiffness or tightness in the shoulder. Typically, these initial signs are ignored, as they disappear quickly with use of the arm or applying heat. However, as you continue to participate, the tendinopathy progresses and the pain within the tendon becomes more intense and more frequent. The tendinopathy can worsen until you feel the pain in the arm every time you lift your arm.

Lower leg pain (gastrocnemius/calf strain)

The calf is made up of two muscles at the back of the lower leg that together form the Achilles tendon. The gastrocnemius, provides the sudden explosive drive for the initial ‘take off’ in running. It is the more commonly injured of the two muscles, especially in people in their forties. A strain refers to a tear in this large powerful muscle forming the bulk of the calf.

CAUSE

A gastrocnemius strain typically occurs when the muscle is forcibly contracted whilst in a stretched position. This can occur when accelerating from a stationary position or when lunging forward, such as in tennis or squash. A gastrocnemius strain may also occur following stepping in a pot-hole whilst running. This may cause the heel to drop suddenly, overstretching this muscle. Factors which may contribute to this type of strain include an inadequate warm up, muscle stiffness or tightness, fatigue or overuse, an inadequate recovery period between training sessions, reduced muscle strength and faulty biomechanics.

SYMPTOMS

The first sensation you feel is a sudden pain in the calf which may be associated with a stabbing or tearing sensation. In minor tears, you may be able to continue participating with minimal hindrance. However, as the muscle cools down following completion of participation the pain may gradually worsen as bleeding and swelling around the injured muscle takes place. In more severe tears, you are unable to continue participating immediately following injury due to excessive pain, and muscle tightness. In these cases, the pain may be so intense that you may be unable to walk or correctly weight-bear on the leg.

---

 

Lower leg pain (shin splints)

Shin splints refers to inflammation occurring where a tendon or muscle attaches to a bone.

CAUSE

This injury results from overuse. Tendons and muscles attach to bone via a layer of connecting tissue overlying the bone which is called the periostium. When muscles contract, they pull on their tendons, which, in turn, pull on the periostium overlying the bone. With overuse, poor biomechanics or excessive muscle tightness, this pulling can damage the preriostium. This results in an inflammatory response as the body prepares to repair the damage. Consequently, shin splints is inflammation where a tendon attaches to the bone.

SYMPTOMS

It is typically felt as pain along the inside border of the shin bone (tibia). It is usually painful as you begin exercising; however, as the area begins to warm up the pain may subside. Following exercise, the pain may gradually return as inflammation takes place. The area of tenderness may be painful to touch and you may feel bands of thickened tissue adjacent to the tibia.

---

 

Lower leg pain (Achilles tendinopathy)

Achilles tendinopathy refers to degeneration within the large tendon which joins the calf muscle to the heel bone.

CAUSE

It is a common injury in sports like running and jumping and results from overuse of the tendon. The function of the Achilles tendon is to transmit forces produced by the calf muscles to the heel bone. Repetitive use of the calf muscles and therefore by the Achilles tendon can lead to microscopic tears within the substance of the tendon. To repair these tears, the body commences an inflammatory response. Factors that may contribute to Achillles tendinopathy include a recent change in training, overtraining, poor footwear, incorrect biomechanics and decreased muscle flexibility and joint range of motion.

SYMPTOMS

It results in pain within the tendon just above where it attaches to the heel bone. This pain typically develops gradually. Initially, the tendon may only be painful after exercise. You may experience stiffness or tightness in the Achilles region. These initial signs disappear quickly with walking about or applying heat. However, as you continue to participate, the tendinopathy progresses and the pain within the tendon becomes more intense and more frequent.