Sacro Occipital Technique Research Updates Fifth Edition
TECHNIQUE
Charles L. Blum
This is the fifth in a series of articles that will share various concepts of research with doctors in clinical practice. This one relates to chiropractic and dental interdisciplinary care as it relates to temporomandibular joint disorders (TMD).
To better understand how chiropractic and dentistry often can function in an integral manner to treat patients presenting with TMD, it is important to grasp the dynamic nature of how body posture affects dental occlusion, condylar position, and airway space, and likewise how dental occlusion, condylar position, and airway space affects body posture. A couple of recent studies exemplified this relationship by showing how placing a heel lift under one shoe to affect pelvic torsion caused the teeth to contact primarily on the side of the heel lift. Likewise, changing dental occlusion had an effect on the stability of a patient’s posture.1’2
The interrelationship between head and neck position and body posture is affected to some degree by the visual and vestibular righting mechanisms. What goes on below the head and neck will cause the head and neck to accommodate like a gyroscope in order to maintain a horizontal-level position to the horizon for the eyes and ears. If the head and neck are compromised and cannot properly accommodate, then the pelvis and lower spine will be compelled to modify their positions.3
Therefore, it is not unreasonable to find intertwining of body relationships with the body’s kinematic chain from distally, such as between the feet or knees to the craniofacial regions.4"6 Also of importance, the pelvis, spine, and TMJ have also demonstrated functional interrelationships.1’2’7 An association has been found between sleep apnea, airway space, and forward head posture (FHP) that will allow dental chiropractic co-treatment to be viewed from beyond just a pain relief aspect.
While the effect of sleep apnea on public health is becoming well known8, what is not readily understood is the effect of airway space or apnea on head and neck position.9
Studies are finding that the position of the mandible10 affects airway space, tongue position, and can lead to FHP. So, before chiropractors attempt to treat a patient’s FHP, we may need to factor in the question: “Does this patient have TMD-related issues that might be compromising his or her airway space?”11
^Studies are finding that the
position of the mandible affects airway space, tongue position, and can lead to FHP. J J
The following are some studies from the SOT Research Conferences that help illustrate how chiropractic and dental co-treatment might play an effective part of interdisciplinary care of TMD patient presentations.
SOT Cranial and TMJ therapy for unresolved BPPV12
Introduction: Vertigo accounts for about six million clinic visits in the US every year, and 17 to 42% of these patients eventually are diagnosed with benign paroxysmal positional vertigo (BPPV).
“The patient’s rapid response to chiropractic and dental care suggests further investigation is warranted into this method of treatment J J
Case History: A 37-year-old female was seen for BPPV, referred by her allopathic physician for chiropractic care. The patient had two to three months of constant vertigo, unresponsive to medications, and it prohibited her from driving or walking without difficulty.
Methods/Results: Evaluation determined a sacroiliac joint hypennobility syndrome (category two), right temporal bone restricted in external rotation, and significant malocclusion with clenching. Category two protocols for the pelvis were applied along with cranial and TMJ therapies. Dental co-treatment was necessary to sustain the cranial and TMJ corrections. By the seventh office visit (three to four weeks of care), the patient’s vertigo had resolved, her category two stabilized, and TMJ translation had improved without pain.
Implications: Since it is not uncommon for cranial trauma to affect cranial nerve function, it is possible that low-level sustained cranial stress or trauma could contribute to clinical presentations such as BPPV. The patient’s rapid response to chiropractic and dental care suggests further investigation is warranted into this method of treatment for a subset of patients presenting with BPPV or unresponsive vertigo.
TMD - Chiropractic and Dental Cross-Referrals13
Case Report: In conditions where a chiropractor or dentist has reached a therapeutic impasse with a patient’s temporomandibular/craniomandibular disorders (TMD/CMD), co-treatment may be indicated. These two cases discuss two patients with sacroiliac joint hypennobility syndrome (category two) and cervical intersegmental restricted motion that necessitated craniomandibular balancing therapeutic interventions and dental appliance therapy. One initially was treated by the chiropractor and referred to the dentist for co-treatment, and the other initially was treated by the dentist and referred to the chiropractor for co-treatment.
Methods/Results: With SOT and craniomandibular therapies, along with dental appliance therapy, both cases showed a reduction of pain and improvement of TMJ function and/ or symmetrical joint translation without crepitus. General relaxation in cervicocranial and craniomandibular musculature was noted by the patient, chiropractor, and dentist.
Implications: A main obstacle for chiropractic/dental cotreatment is the lack of awareness and knowledge of each other’s professional treatment and diagnostic focus, as well
as terminology. This case report illustrated a relationship between ascending/descending postural dysfunctions and TMD. It appeared that with these cases optimal outcomes appeared contingent upon chiropractic and dental co-treatment.
Complex Patient Presentations and Chiropractic Dental Co-Treatment14
Case History: A 42-year-old female presented with an unsteady Parkinsonian-type of gait diagnosed as psychogenically driven. She also was diagnosed with an atypical version of a complex regional pain syndrome called “complex pain syndrome” due to its whole body generalization as well as her history of migraines.
Methods/Results: Initially the patient was co-treated with a dental nightand day-time appliance, sacrotrochanter belt, and treated with SOT category two protocols, sutural cranial/temporomandibular joint (TMJ) interventions, T8 chiropractic manipulative reflex technique (CMRT), and supportive nutritional modifications to support liver function and reduce inflammation. At the first ofiice visit with the dental appliance, trochanter belt, and category two treatment, all of her shaking stopped when standing and her pain was significantly reduced. This allowed for the patient’s medications to be notably decreased.
Implications: It is interesting that a relationship appears to
“A main obstacle for chiropractic/ dental co-treatment is the lack of awareness and knowledge of each other profession’s terminology and treatment
have been found with this patient’s severe tremors, migratory joint pain, and migraines that appeared to be associated with her pelvis and TMJ function. The patient’s tremors could be eliminated by having a trochanter belt placed around her pelvis and they would return when the belt was removed. The future challenge is developing a predictive group of tests to determine what subset of patient with severe tremors, fibromyalgia, and migraines would be responsive to this type of chiropractic and dental co-treatment.
There is much to learn about interdisciplinary care and how chiropractic and dentistry can function as partners in optimizing patient outcomes. Developing relationships of trust between our professions and knowing when referrals to one another are necessary will be an important first step.15’16 Learning each other’s terminology and how we each view
relationships between the stomatognathic system and body posture, as well as the far-reaching implications of sleep apnea on our patient’s health, will assist chiropractors to better help patient outcomes in the future.
References:
1. Maeda N, Sakaguchi K, Mehta NR, Abdallah EF, Forgione AG, Yokoyama A. Effects of experimental leg length discrepancies on body posture and dental occlusion. Cranio. 2011 Jul;29(3):194-203.
2. Sakaguchi K, Mehta NR, Abdallah EF, Forgione AG, HirayamaH, Kawasaki T, Yokoyama A. Examination of the relationship between mandibular position and body posture. Cranio. 2007 Oct;25(4):237-49.
3. Morningstar MW, Pettibon BR, Schlappi H, Schlappi M, Ireland TV. Reflex control of the spine andposture: a review of the literature from a chiropractic perspective. Chiropr Osteopat. 2005 Aug 9; 13:16.
4. Rothbart BA. Vertical facial dimensions linked to abnormal foot motion. J Am Podiatr Med Assoc. 2008 May-Jun;98(3) : 189-96.
5. Rothbart BA. Prescriptive proprioceptive insoles and dental orthotics change the frontal plane position of the atlas (Cl), mastoid, malar, temporal, and sphenoid bones: a preliminary study. Cranio. 2013 Oct;31(4):300-8.
6. Tecco S, Salini V, Calvisi V, Coined C, Orso CA, Festa F, D ’Attilio M. Effects of anterior cruciate ligament (ACL) injury on postural control and muscle activity of head, neck and trunk muscles. J Oral Rehabil. 2006 Aug;33(8):576-87.
7. Fink M, Wahling K, Stiesch-Scholz M, Tschernitschek H. The functional relationship between the craniomandibular system, cervical spine, and the sacroiliac joint: a preliminary investigation. Cranio. 2003 Jul;21(3):202-8.
8. Sigurdson K, Ayas NT. The public health and safety consequences of sleep disorders. Can J Physiol Pharmacol. 2007 Jan;85(l):179-83.
9. TongM, SakakibaraH, XiaX, Suetsugu S. Compensatory head posture changes in patients with obstructive sleep apnea. J TongjiMed Univ. 2000;20(l):66-9.
10. D Attilio M, Caputi S, Epifanía E, Festa F, Tecco S. Evaluation of cervical posture of children in skeletal class I, II, and III. Cranio. 2005 Jul;23(3):219-28.
11. Blum CL. TMD Functional Integrative Approach: Dental and Chiropractic Approach to Forward Head Posture. Journal of the American Academy of Craniofacial Pain. Fall 2009;22(2): 18,31,39.
12. Bloink T. SOT Cranial and TMJ therapyfor unresolved BPPV: A case report. 1st Annual Sacro Occipital Technique Research Conference Proceedings: Las Vegas, NV 2009:12-4.
13. Blum CL, Panahpour A. TMD - Chiropractic and Dentistry: Two Case Reports. 1st Annual Sacro Occipital Technique Research Conference Proceedings: Las Vegas, NV 2009:15-6.
14. Gerardo RC. Patient with severe tremors, complex pain syndrome, and migraines co-treated with dental and SOT chiropractic care: A case report. 1st Annual Sacro Occipital Technique Research Conference Proceedings: Las Vegas, NV. 2009:34-6.
15. Blum CL, Globe G, Assessing the Need for Dental -Chiropractic TMJ Co-Management: The Development of a Prediction Instrument. Cranio-View. Win 2009-10:29-41.
16. Steigern’aid DP, Maher JH, The Steigern’ald/Maher TMD Disability Questionnaire, Today’s Chiro, 1997;26: 86-91.
Charles L. Blum, DC is in private practice Santa Monica, California, director of research for Sacro Occipital Technique Organization - USA, adjunct research faculty at Cleveland Chiropractic College and teaches the Sacro Occipital Technique (SOT)
elective class at Palmer College of Chiropractic - West and
Southern California University of Health Sciences. Contact Dr.
Blum at 310-392-9795 /www.drcharlesblum.com
