As you read this, I'm either in surgery or in the recovery room. For those who don't know, I am having lower jaw surgery to correct a severe over (also called "open bite") and cross bite. That being said, blogging might be a bit spotty (more so than usual) over the next couple weeks, but I'm going to do my best. Seeing as this surgery has been on the forefront of my mind for quite a while, I thought I'd share a bit of the physiology connections I've learned over the past year or so. It's actually pretty interesting how dependent the body is on it's collective parts. So dependent that something up in my face affects the rest of my body rather dramatically.  We'll do bullet points because I really like them.

Lesson 1: Pain is sneaky. Sometimes the origin and/or cause is not where you think.

I've known I would need this corrective surgery at some point for quite a while now. About 3 years ago, I experienced severe and prolonged pain in my tempromandibular joint (TMJ), the hinge joint of your jaw that connects the lower to the upper. I didn't have the means to have surgery at the time and the pain receded a bit, so I put it on the back burner. Just over a year ago, I started having migraine/severe headaches in the front of my head that would last for days, even weeks. Medications didn't help. Then I started to have shoulder pain on my right side. This made me think something else was going on since I knew I wasn't doing anything that would aggravate my shoulder.

I popped over to this site and discovered that a tight sternocledomastoid can cause both pain in the head and shoulder. Sure enough, I had knots the size of marbles all along these muscles. Guess what? The SCM connects right up behind the ear, near the TMJ, thus a misaligned jaw (being used for thousands of reps per day) will definitely cause some tension in the poor ol' SCM.

Lesson 2: The suboccipital muscles are really, really important.

I also had pain in the base of my skull on a regular basis, thanks to irritated suboccipital muscles. I trolled around to find some information and perhaps home treatment to help manage the pain symptoms. I came across fellow strength coach, Patrick Ward's post here. Readit, seriously, it applies to everyone. It'll blow your mind how important those little muscles are to your overall health.  Patrick Ward goes into the implications of tight suboccipitals and their effect down the stream, such as posture in general and neural control over postural muscles. I found it interesting that "voluntary trunk control" was one of the muscle functions affected. Guess what? I struggle with bracing my right side. I know that sounds weird, but I can not get as "tight" on the right side without really thinking about it. Might be why I have a collapsed disc to the right side?...

Lesson 3: It's seriously all connected.

Then I came across this paper (you don't have to read the whole thing unless you're super-into-science and research papers) that linked symptoms of TMJ dysfunction and jaw pain with the suboccipital muscles. Check out pages 13 (yup, I have all those symptoms, including impaired vision) I should also note that I've suffered from vertigo since I was 13, so perhaps, once my jaw/bite is corrected and those muscles are no longer strained, I might see a decrease in symptoms.  Page 15 which connects hypertonic (too tight) neck muscles with TMJ muscles dysfunction and pain, and 17 describing short cervical muscles and posture and how they research has found correlations... craziness. Upper cross syndrome, a posture <--- description used by those in the health field, is either a creator of tight neck muscles or the result of tight suboccipitals. It's a bit of chicken-egg questions, but either way, they tend to coexist. So, if you have a hunched posture, try massaging the base of your skull, that might help loosen some things up!

Lesson 4: Pain eventually conquers proprioception

We recently had an in-service where we learned about the neuromuscular implications of injuries in regards to training athletes. The main point I retained was, if muscle tissue is acutely damaged, such as a sprain, or chronically irritated, such as repeated spraining of said ankle, the muscle spindles, which reside in the tendons, will no longer respond accordingly, much like Ariel responding to her father's command to stay away from land... Poorly.

Muscle spindles are proprioceptive organs that control the stretch-reflex, for example when the doctor taps your knee and your leg kicks forward a bit, the muscle spindles are rapidly stretched (when the mallet hits your patella tendon) and they respond by sending a signal to your brain to flex the quads (thus, pulling your knee into a bit of extension).

So, damaged muscle tissue, specifically the muscle spindles and especially chronically damaged tissue ("damaged" doesn't necessarily mean an acute injury, but a chronic posture, like your shoulders slumping and your neck protruding forward as you peer at the computer screen) tend to lose their ability to provide valuable feedback to the body in the form of proprioception (where your body is in space i.e. balance). Instead, pain signals are sent. This is bad on two fronts: 1) it hurts 2) lack of proprioception means loss of muscular control, be it voluntary or involuntary.

I don't know too much on how to restore muscle spindles and transfer them back to being proprioceptive and not pain oriented, but I do know that a) removing the irritaing stimulus (in my case, setting my jaw in the correct alignment) b) improving tissue quality through manual therapy (professional or at home) and c) retraining the muscles to move how they should (i.e. standing up straight instead of slouching, or going back to the ankle example, walking without a limp or favoring the ankle).

Lesson 5: Implications for training.

Another random fact, there's a correlation with a cross bite and scapular winging (the shoulder blade sticking up instead of laying flat on the rib cage). Winging impairs overhead movement, messes up the rhythm of the humerus and shoulder girdle and makes picking and lifting heavy things a bit problematic. I've done just about every exercise under the sun to fix my wing, to no avail... maybe surgery?

Anyway, as a coach, just by looking at my own situation helps me work with our athletes here at SAPT. If at first the basic, usual cues don't fix a problem, like "pulling yourself to the floor" during a push up to fix a winging scapula or "crack a walnut" to prevent knee pain during the squat, then, maybe there's an underlying issue that demands a different approach. Maybe some dedicated soft tissue work is in order to correct a nagging pain or it might be severe enough to refer out to a physical therapist or doctor. Whatever the case, if after working with an athlete diligently doesn't solve the problem, probably time to delve a bit deeper. (and check their bite! Kidding.)