Wellness Archives - Catalyst Physical Therapy & Wellness Mission Valley San Diego

Do you get jaw pain, clicking, and popping every time you open your mouth? Does it lead to pain every time you eat, brush your teeth, and yawn? These are clear signs of a temporomandibular disorder (TMD). TMD is classified as dysfunction of the temporomandibular joint (TMJ), your jaw, or your muscles of mastication (the muscles you use to chew). TMD affects 33% of Americans, but lucky for you, physical therapy is an excellent form of treatment for these conditions.

Common Signs and Symptoms of TMD: restricted mouth opening, chronic facial pain, headaches, and clicking and crackling at the jaw. Causes of TMD include hyperactivity of the muscles of mastication, stress, anxiety, trauma, sleeping disorders, and even dysfunction of the cervical spine (your neck). But how does the TMJ and your neck relate? The trigeminal nerve, a nerve that innervates your upper cervical spine, also innervates your muscles of mastication. This means that a tight and immobile neck can be contributing to TMD symptoms. All of these signs and symptoms can truly affect activities of daily living and cause unnecessary stress to our lives.

TMD has two main classifications:
1) Myofascial Temporomandibular Disorders (MTMD)
2) Disc Displacement

The first classification, MTMD, pertains to pain in your jaw originating from your chewing muscles: masseters, pterygoids, and temporalis. MTMD can result in pain every time you eat or open and close your mouth.

The second classification, Disc Displacement, pertains to disorders of an articular disc that glides forward and backward between your TMJ as you open and close your mouth. Disc displacement can lead to that clicking and popping when opening and closing your mouth.

So how do you know what kind of TMD you have? Below are a few quick tests you can perform at home with just two popsicle sticks! It is also important to note that both muscles and joints can be impaired in cases of jaw pain.

Self Assessment A: Lateral Deviation Test

1) Look in front of a mirror

2) Open Jaw as wide as you can

3) Look between your two front teeth (central incisors)

Does your jaw deviate to the Left or Right?
- If yes, this is likely more of a joint/disc dysfunction
- If no, this is more likely a muscular issue
Does your jaw click and pop?
- If yes, this is likely more of a joint/disc dysfunction
- If no, this is more likely a muscular issue

Self Assessments B: Bite Test

1) Bite test- chew on two popsicle sticks (along teeth)

If biting causes more pain, your chewing muscles (muscle of mastication) could be the issue

2) Bite on one popsicle stick

If pain is on the opposite side of the mouth, the TMJ is more likely the issue

Physical therapy can also provide a more extensive examination of the mouth with specific measurements of mouth opening/closing, jaw deviation, and biomechanics of the TMJ. Once it is determined what type of TMD is present, manual therapy from a physical therapist has been shown to greatly improve TMD symptoms. A physical therapist can help you with body work on those painful muscles of mastication, treating those tight muscles of your neck, improve that forward head posture, and facilitate proper mechanics at the TMJ to improve mouth opening and closing to allow you to eat pain free!

1) Masseter Self Release

Start with your fingers about one inch in front of your ear lobes toward your cheeks. Palpate back and forth like it’s a guitar string. Does it feel tight and tender? If so, you’ve found a great spot! Apply pressure and hold until the discomfort/tenderness starts to subside. Repeat this process 3-4x along the muscle.

2) Medial Pterygoid Release

The medial pterygoid is another muscle that is overactive and can result in jaw pain/limitations. For this release, you will have to enter the mouth and press toward the back of the teeth, just past the molars. Move your fingers about a centimeter toward your cheek and shift your fingers up and down until you feel a taut band of muscle that feels tender to the touch. Apply pressure on the tender point until the pain starts to dissipate and continue moving up and down that area for up to 5 minutes. This can be done once every 2-3 days or as needed to relieve pain. Avoid sharp pain!

3) Chin tucks

Perform 2×15 x 3 second holds at the end of every hour when sitting at work! You should be feeling the muscles under your jaw working to help stabilize your neck!

4) Upper Trap Stretch

Tight neck muscles that get worse from sitting and using your phone and computer? Dysfunction at the neck has been shown to have direct correlations with jaw pain! Start by holding the bottom of your chair and gently pull at the temple with your other hand to stretch that tight upper trap. Hold 3x30s and can be performed 2-3x per day.

5) Levator Trap Stretch

Another great stretch to perform when sitting to stretch out the back of your neck. Start by tucking your chin to your right armpit and with your right hand gently apply pressure in a 45 degree angle until you feel a stretch to the left side of the back of your neck. Repeat on the opposite side! Hold 3x30s and can be performed 2-3x per day

—THE TOP 3 THINGS EVERY YOUTH ATHLETE NEEDS —

Sports participation is on the rise with an all-time high of an estimated 45 million participants in youth programs in 2019 [1].This increase in participants has led to the formation of more and more leagues, and additional pressure on athletes to compete more frequently. Let’s face it, youth leagues are making good money and there’s very few central organizations controlling how they roll out their schedules and coordinate with neighboring groups. Year-round competition has quickly become the new normal for sports, and kids are being pressured at earlier ages to keep up. With no down time and poor skill development forced into the diet of these youth athletes, there is bound to be a higher injury rate and early burnout [2].

It’s staggering that roughly 8 million of the youth athletes will be seen by their physicians, or report to emergency rooms annually with sports-related injuries [3]. The incidence of ACL injuries has increased over the last 20 years with peak occurrence taking place in high school female athletes [4]. With the overuse injuries on the rise and sport specialization trending at a younger age, we must pay close attention to our kids’ developing bodies and minds. Not only has early sports specialization (playing one sport for an entire year) shown a direct link to overuse injuries, but it’s also leading to an early burnout and eventual drop from participating in organized sports.

Research conducted by the National Alliance of Sports has shown that 70% of children drop out of organized sports by the age of 13.

This is scary considering a large number of parents are quick to up the training regimen for their children in hopes of forming the next superstar the second they show an ounce of talent or affinity for a specific sport. Don’t get me wrong, I completely understand how exciting it is to see your child naturally excel at riding a bike, kicking/throwing/hitting a ball or climbing a wall. If your child shows a natural talent for kicking a ball and wants to be the next soccer superstar at age 10, it’s natural to think you should enroll them into the elite organizations offering year-round competition. But at what price? Would you still do that if I told you they were much more likely to suffer from a knee injury at the age of 14 or 15 that could put their career in jeopardy?

There’s no arguing that children need to be protected from early damage to their bodies during their formative years and puberty. The wrong dose of running, jumping, cutting, hitting, throwing can injure your child for the season, and threaten their long-term development. Being on the front lines of the physical therapy field now for over a decade, I’ve seen ACL sprains, growth plate injuries, and strains/sprains showing up in younger and younger athletes. This has me nervous because according to research, this likely won’t be the last time the majority of these kids are seen in a clinic setting. Getting injured early in life has also been shown to cause a myriad of other problems, like decreased bone mineral density, skeletal deformities, higher re-injury rates, and even increased likelihood of chronic pain in adulthood [5].

— If it looks ugly, chances are it’s not a matter of if but when their body will break down —

Repetitive movement patterns with faulty mechanics will lead to overloading (too much stress) in the growth plates, ligaments, tendons, cartilage, bones, and muscles comprising our skeletal system. It’s the simple fact that when you tell 10 kids to kick a ball, they’re going to do it 10 different ways. No coach can conjure perfect form for all of their athletes, but they must be able to recognize when poor mechanics need correcting to prevent irreversible damage to their athletes’ bodies. For example, take a 10-year-old, tall girl that has excessive shoulder mobility but poor core stability and tight hips from growing too fast. If you ask her to go up in the air and deflect a ball over the goal, or block a shot, there is good chance she’s going to drive her knees excessively inward upon preparing to jump, arch her back to ensure her hand gets in front of the ball, and fail to slot her shoulder correctly when blocking the shot. This may not always be the case, but if not corrected, it will undoubtedly lead to increased stress across the ligaments or growth plates in her knees, excessive force across her lumbar spine, and possible rotator cuff or labral injuries in her shoulder down the road.

So, are coaches to blame? Absolutely not! It’s the system that needs revamping. Each organized league must be held accountable to take the child’s development seriously. That can’t happen without pressure from the parents and health care field. We all must strive to pick out ways to assist the kids with movement training and coordination development.

So How Do We Fix The Broken System?

Here are three of the most important ways I’ve found to develop youth athletes:

Get screened by professionals to assist with proper physical development
Increased time with cross-training to overcome their weaknesses
Insert “down time” into the annual schedule to recover properly, and rebuild

I’ll go into detail on each one of these below:

ATHLETE PERFORMANCE SCREENING

Athletic performance screening can help identify the individual challenges each athlete faces throughout the different stages of development. Why is it that we see the dentist every 6 months to assess our oral health, but physical health takes a backseat? Truth is, we should be giving our body the same focus and attention that we give our mouths. Annual physicals are not designed to thoroughly look at a child’s physical development. Rather than waiting for a child to report pain, we can get ahead of injuries by performing detailed assessments or screenings more regularly to ensure the movements they routinely perform are done correctly. This screening must mimic the common actions in the sport they play, and assess the areas of the body that research shows are often injured.

The screening can be performed for each athlete individually in a controlled setting, like a gym or clinic, or out on the fields. The goal of these screenings should be to identify the body’s weak spots and determine a corrective exercise program to promote proper athletic development. When completed on the team level, athletes can be categorized into different groups based on their physical abilities and given corrective exercises, drill work, and appropriate sports performance guidelines to allow coaches and trainers to better prepare the teams for the rigors of competition.

CROSS TRAINING

Cross training is often thought of as choosing a lower impact activity to insert in place of your main sport. For example, a soccer player might choose cycling or swimming instead of running to keep up their endurance levels between their heavy periods of competition. While this is one form of cross-training, it’s also important to consider the benefits of what a solid gym or weight training program can do for a developing body. Resistance training is commonly thought of as bad for youth athletes. This simply isn’t true. While I don’t condone spending 5 days a week in the gym following a strict strength training regime, I do believe the right corrective exercises inserted into a routine for kids can make all the difference when it comes to preventing injury. The trick is to make these exercises challenging, well-rounded, and fun. This will allow our youth athletes to form healthy movement habits, and develop coordination and efficiency that will protect the commonly overused areas of their bodies.

PROPER RECOVERY

Recovery is all too often an afterthought for developing athletes. While I’ll forgo the detailed description of how recovery affects our bodies both mechanically and metabolically, I will say that stress across muscles and joints must be monitored and controlled to avoid developing overuse injuries. Most professional organizations are aware of this theory now, and utilize different ways to monitor and alter training loads for their athletes based on the demands of the position they play and the competitive match/practice schedule. These organizations are taking note of how each athlete’s recovery for their body differs and charting ways to assist them in balancing their training bouts to allow for ample performance. Basically, they’re not just asking how the athlete feels anymore, but are now monitoring how their heart rates and body movement (e.g. range of motion, strength, blood chemistry) are adapting to the physiological stressors. This allows them to tailor the weekly workouts and guidelines for recovery for each athlete individually. This isn’t to say your 10-year-old athlete is also in need of this, but a simple rating of perceived exertion (RPE) and an awareness of down time each year (or directly after large amounts of competition) is warranted to ensure your child is not damaging their vulnerable areas and in risk of long-term injury.

In closing, I hope you understand that not all athletes move the same, and the demands of each sport differ. It’s not the coaches job to identify the movement inadequacies and implement a corrective exercise program. Rather, it’s the organization and parents job to promote the health at all times of the youth athletes. This comes through education and strategic alliances with organizations that can help deliver proper warm ups, exercise guidelines, and physical screenings. By paying more attention to the quality of the movement early on in our kids’ development and creating healthy habits, we’re giving them the gift of longevity in becoming a life-long participant. Whether they go to the big leagues or not, having a young athlete learn the principles of healthy movement and balanced training loads will prove it’s worth over time, and cut down on the early drop-out rates that are trending in our current era.

If you’re interested in learning more about ways to get our professionals involved with your athlete or organization, please fill out our questionnaire (athlete performance questionnaire) or check out the athlete performance section of our website to learn more (Read More).

Brian Wilson, MPT

DOWNLOAD ATHLETE OVERUSE PDF

REFERENCES:

[1] State of Play 2019: Trends and Developments in Youth Sports. The Aspen Institute/Utah State 2019 National Youth Sport Survey. 2019 Sept; 3: 1-32.

[2] Difiori JP, Benjamin HJ, Brenner JS, Gregory A, Jayanthi N, Landry GL, Luke A. Overuse Injuries and Burnout in Youth Sports: A Position Statement from the American Medical Society for Sports Medicine. British journal of sports medicine. 2014 Feb 1;48(4):287-8.

[3] Pinyao R, M.P.H., Ashman JJ, Ph.D., and Akintunde A, M.S.P.H. Emergency Department Visits for Injuries Sustained During Sports and Recreational Activities by Patients Aged 5–24 Years. National Health Statistics Report. 2019 Nov 15; (133) 1-15.

[4] Beck NA, Lawrence TR, Nordin JD, DeFor TA, Tompkins M. ACL Tears in School-Aged Children and Adolescents Over 20 Years. American Academy of Pediatrics. 2017 Mar; 139 (3).

[5] Fulton J, Wright K, Kelly M, Zebrosky B, Zanis M, Drvol C, Butler R. Injury Risk is Altered by Previous Injury: A Systematic Review of the Literature and Presentation of Causative Neuromuscular Factors. International Journal of Sports Physical Therapy. 2014 Oct; 583–595 (9).

Are you a yoga teacher, or a teacher in training and searching for common yoga injuries and how to avoid them? Both for yourself and your students? Well, you’ve come to the right place! We’ve been instructing yoga teachers for a few years now on how to teach so that you help to reduce the potential for injuries in your practice.

Common Yoga Injuries

First, let’s talk about the most common injuries we see at the clinic from yogis and long-time yoga teachers. Here’s a quick list:

Lower back pain
Ongoing wrist soreness
Tight hips flexors
Shoulder strains/rotator cuff injuries
Hamstring issues

yoga teacher training

Top 5 Reasons Yoga Teachers Develop Injuries

Second, let’s tackle why we see these injuries in the clinic. Most are not acute injuries by the way. They develop over time from repeating the same postures or poses.

1. Lack of Anatomy Knowledge

Anatomy is one of the most important pillars of any movement professional’s journey into teaching. Now, it’s not necessary to memorize all 650 muscles, 360 joints, and 206 bones. However, it is important to have a good grasp of the relationships the muscles form when interacting with each other. And specifically in this context, from one pose to another, to avoid common yoga injuries.

This interaction needs to happen in a way that allows for healthy movement not overrun with compensation. Meaning, the big guys win and the stabilizers, or the smaller muscle groups, are overpowered.

Achieving balance within the musculoskeletal system will require an understanding of the common signs of tightness, weakness, and even pain, and how they limit normal fluid movement.

Yoga teacher training

2. Focusing on aesthetics instead of function

What yoga teachers need to always ask themselves is, “What is the purpose of this pose, and how will my class achieve it?” Far too often, we see yoga teachers disregard function. Instead, they replace it with beautiful, but challenging poses. Do they want to show off their uber-flexible selves by bouncing from one difficult pose to the next? Perhaps ending the sequence with a graceful inversion or arm balance?

If so, this creates a risk for both the instructor and the student. You are asking the body to perform difficult transitions and this can lead to the common yoga injuries mentioned above.

Understanding that the body faces its largest amount of stress in these transitions means that you as the teacher must strive for proper alignment and control. Especially through the changeover from an eccentric to concentric motion. More on this principle down below.

Ignoring the challenging portions of a flow to simply make things look cooler will ultimately lead to injury. Instead, yoga teachers should pay special attention to developing their ability to provide “bite-sized” cues that allow for safety and success while flowing from one pose to another.

yoga postures

3. Not Enough Self-Care in Between Teaching Yoga

As a yoga teacher or a teacher-in-training, we bet you have a huge heart and want to give back to people to help them live longer, healthier lives. However, you also face the pressure of balancing that giving of yourself with the need to make a living.

As an example, early on in your career, you may be placed in one type of class. This forces you to flow through the same sequence over and over again. Every single day, sometimes twice a day!

Not having the experience or control to vary up your sequences can lead to a beat-up body through repetitive overuse of certain areas. In particular, we see common yoga injuries in the wrists, shoulders, lower back, and neck. Although you may want to grind it out, and push yourself to achieve a higher level of performance, these rigorous practice sessions can have long-term negative effects on your body.

In addition, you may be coming from an athletic background in dance, gymnastics, or acrobatics. Therefore, you may already be prone to rarely slow down enough to allow for the body to repair. Pushing yourself year-round, practicing until near perfection is achieved, often does more harm than good. Self-care baby!

Thus, take the time to unload your body between practices to avoid common yoga injuries. Yes, we realize you may think yoga is low-impact. Especially if you also participate in more intense sports like running, cycling, or rock climbing. However, lack of recovery, coupled with the fact that not all teachers have been shown self-repair techniques, increases the risk of overuse injuries even more.

While stretching and self-massage might not be your main concern, find proper corrective exercise to strengthen weaker areas. Concentrate bodywork or self-massage on the spots being overused.

yoga injuries

4. Flow Speed is Too Quick

The timing established for a flow must match the intention you have for the workout planned. The goal should always be to provide just enough cues to allow people to draw attention to their breath, balanced with a speed slow enough to allow for safety and controlled motion.

Controlled motion is achieved when muscle recruitment is at its peak, and the reliance on passive connective tissue, like ligaments, is low. This keeps the joints and bones from feeling the stresses that ultimately lead to breaking down. In addition, it allows for coordinated movement.

When it comes to coordination, the different types of muscle actions must achieve synergy. Muscles are known to face their largest amount of forces as they go from an eccentric (lengthening) position to a concentric (shortening) position.

So, gaining control of the momentum imposed by gravity during these transitions will never be easy. Especially for your students in your yoga class. Or a teacher struggling to race the clock to finish class on time.

If the speed of the flow increases based on your feelings that you need to perform for your higher-skilled students, then timing becomes the catalyst for some of these yoga injuries.

yoga teacher training

5. Unbalanced Sequencing

Do you often struggle when thinking about what poses to demonstrate in a sequence? Well, think about introducing variation into your “teaching moments”. By creating variation, you will achieve balance among your muscle groups.

As an example, you may get used to showing a few key poses in each class. However, you’re forgetting to include variation in your own sequence throughout the day. This leads to an imbalance in pressures across your body. Then, over the course of weeks and months, you’ll see deterioration at the joint level.

In addition, consider that mental and physical stamina levels are generally lower towards the end of a long day of teaching. So you know it becomes especially difficult to maintain quality and choose a pose that’s healthy for your body over the pose that is simply easy to show.

To combat this, it’s important to plan out YOUR teaching week for YOUR body’s needs, as well as your students. While the scope of this article is not to teach you how to design a flow that balances out the different muscle groups, it is important to understand where your injury-prone areas are located.

Having a good understanding of your postural needs, movement impairments, general flexibility, and strength will help you to select the smartest, most effective poses to demonstrate throughout your teaching week.

yoga teacher training

More Tips to Avoid Common Yoga Injuries

The key to creating a great yoga practice lies in planning ahead. Use this time to remind yourself what poses you need to demonstrate more and insert them into your practice. Then, work on walking the room. Cueing and adjusting the poses you don’t need as much to avoid dangerous repetitive overuse.

Need more help? Well, then book a Wellness appointment where a physical therapist can identify your postural needs to assess flexibility/strength. With this information, we can help you build a foundational practice tailored to you.

Best Practices for Yoga Teachers

The best yoga teachers that go the distance in the profession have all taken time to develop a strong foundation of anatomy, and the proper verbal cueing required for fluid movement. In addition, the secret to remaining injury-free as a yoga teacher requires a strong understanding of the above 5 principles.

Furthermore, they understand when to increase the speed of their flows based on the coordination and challenges presented during class. Finally, they have a good understanding of their own body’s limitations. So, take the time to put into practice the necessary repair work and corrective exercise required for longevity as a yoga teacher.

It’s our mission to encourage all people, healthy and injured, to develop a clearer picture of their body, and the needs they should address when striving for better physical health. If you’re interested in learning more about your body, or find yourself battling any of the topics listed above, we strongly encourage you to meet with a physical therapist soon!

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