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Breathing Dysfunctions, Sleep Apnea, & TMJ Disorders
An whole-body approach to helping chronic airway, head, and neck problems
 

Little girls sleep in bed. One is snoring hard, sister is plugging her ears with pillow. .

The head, face and mouth, and neck together make up some of the most complex and interconnected areas of our body.  Over and above the familiar role these areas play with food intake and communication, they can be a major source of interference to the rest of the body causing a whole slew of problems like breathing difficulties and postural problems. 

 

Our body, just like other living organized systems, has priorities.  Once blood flow to the brain is taken care of, it's second job is to maintain the airway and create efficiency with how we breath.  The mouth has a significant role in both airway maintenance and making sure this process remains easy, however, along the way this process can create compensations.  In physical therapy, we help to identify some of these compensations and provide support to the body to make this process easier. â€‹â€‹â€‹â€‹â€‹â€‹â€‹

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Temporal Mandibular Joint Pain (TMJ):  TMJ pain is quite common and affects close to 12% of our adult population.  This condition also occurs in children but often there is a higher  prevalence seen in women ages 35-45.  Often only 5% of those that have TMJ pain will actually seek out treatment. 

 

Symptoms of TMJ often include a dull ache that occurs in the jaw joint or muscles around the face, but given the significant role the jaw plays in breathing, eating, an communication, there can be many other symptoms that include:

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  • Pain that spreads from the face or neck

  • Headaches

  • Difficulty chewing or biting

  • Complications with breathing

  • Jaw Stiffness

  • Limited Jaw opening or locking

  • Clicking, popping, or grinding heard in the jaw

  • Earaches

  • Ringing in the ears

  • Hearing Difficulties and Loss

  • Disruptions to sleep

  • Sleep Apnea

 

 

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Tooth Sensitivity Concept. Unhappy girl suffering from toothache, touching cheek, blue stu
Clenched jaw in sleep, a sign of stress; the intimate side-view shot. Highlights bruxism c

Bruxism (Grinding/Clenching of Teeth):  Bruxism is a condition where a person grinds, clenches, or gnashes their teeth.  This can occur during the day, but often is found to occur more at night.  In many cases, this behavior can lead to jaw muscular tightness, pain in the jaw, earaches, pain with eating, tinnitus, or difficulty opening the jaw.  Some researchers also believe that bruxism, or grinding of teeth at night, can also occur as a result of malocclusion. 

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More recently, researchers also suggest that this behavior of grinding and clenching may actually aid in allowing us greater airway efficiency at night by decreased tension in our pharyngeal muscles.  So in some cases, it may be easier to breath when we clench our teeth.  This trade often comes at a cost however.  Physical therapy can help not only reduce some of the tension caused in the fascial area, but it can also help address underlying breathing dysfunctions that may be also play a role in why clenching occurs in the first place.​​​​​​​​​​​

Respiratory Conditions and Throat Tissue Stiffening:  Respiratory conditions like bronchitis or asthma, sinusitis, and other viral infections can occur for many different reasons causing difficulty in how your child breathes.  Often these require additional testing outside of physical therapy for proper diagnosis.  However, difficulty breathing, whether a respiratory condition is present or not, can also be a result of tightness or movement limitations in the pharyngeal musculature and visceral connective tissues that are located above AND below the diaphragm itself. 

 

Pharyngeal muscles are a group of circular and longitudinal muscles that form the pharynx and are responsible for working together to move food into the esophagus and then into the belly.  Visceral organs are often considered some of the "softer" tissues of the body and include the organs of the digestive (including soft palate and esophagus), heart, lungs, excretory, and reproductive systems.  All of these organs contain an interconnected deep fascia and autonomic nervous system, and when disrupted at either level, can affect the way we breath as well as cause problems in the musculature behavior of the head, neck, and face.

 

New research suggests that when muscles in the neck and fascial areas are tense, overactive, or disconnected due to trauma or chronic stress, the jaw muscles will work in opposition to try to help offset this tension to bring greater ease and efficiency in breathing and swallowing of food.  Overtime if left untreated, this can result in further disruptions to swallowing and breathing, postural problems, as well as TMJ pain and other sleep dysfunctions.  

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Child's crooked teeth. Young man showing crooked growing teeth. The child needs to go to t

Malocclusion and Teeth Crowding:  Malocclusion, or what is often called a "bad-bite," typically happens when your teeth are crowded - or are crooked.   In many cases, a "bad-bite" or teeth that become crooked, can be a result of soft tissue compensations in the jaw and face.  These soft tissue compensations often occur because of behaviors that are adapted in response to the modern environment and can be addressed through physical therapy.   Malocclusion can be a main source of fascial, neck, and TMJ pain because of the stress and strain on the muscles and ligaments as well.  Mouth breathing, difficulty speaking, voice fatigue, and difficulty chewing, can all be additional symptoms of malocclusion.  Physical therapy can help to support the surrounding muscles and connective tissues that are often directly affected by malocclusion.

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Physiotherapist, chiropractor is doing an activation of the diaphragm. Massage to a man pa

​Spinal Injury and Diagram Stiffness:  In some cases, the diaphragm itself may be restricted in it's movement due to overuse from sports or exertion, lack of movement or exercise, or chronic lower back pain.  Just like any other muscle, the diaphragm is also subjective to becoming tight, overused, and overfatigued.  In some cases, it can be over worked when there is ongoing pain to the spine.  The diaphragm helps to provide support and strength to the back when there is a problem or when the back is trying to avoid moving.  However, an in such cases like chronic lower back pain, the diaphragm can become shortened and stiff which can lead to all types of problems throughout the body. 

 

Neck pain, as well as any other injury that involves the nervous system in the cervical region, can change how the diaphragm functions.  The diaphragm is innervated by the phrenic nerve (C3, C4,and C5), so any pain or injury at these levels of the spine can easily cause problems with breathing.  Many symptoms of a tight diaphragm can include: 

  • Inability to take a full breath

  • Low blood oxygen levels

  • painful sides when coughing or sneezing

  • Sore neck and shoulder muscles

  • Hiccups

  • Indigestion

  • Shortness of breath with exercise

  • A "stich" or cramp in side when exercises​

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Snoring and Sleep Apnea:  Even though it is normal to have periods of life where we may not sleep well, , disrupted sleep regularly can be a sign of other underlying problems of fascial disorders.  The cessation of breathing at night, shallow breathing, or reduced airflow due to snoring, all contribute to difficulty breathing.  

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The tongue is a muscle and can play a significant role with snoring and sleep apnea up to 60% of the time.  In many cases, the tongue and the muscles in the back of the throat can become weak or loose their appropriate tension or tone, causing obstruction to occur.  When this happens, breathing is limited, or stopped completely.  If this occurs often enough, it can lead not only to the inability to get a good nice sleep, but also other symptoms such as daytime fatigue, headaches, TMJ pain, sore throats, and more can start to occur.  In addition to weak tongue muscles, changes in the soft tissue structures and bones of the face (such as having a higher roof of your mouth or smaller jaw) can also contribute to sleep apnea.  â€‹â€‹â€‹â€‹â€‹

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Overuse of Speaking, Singing, and Instrumentalists:  Our voice, even though is generated through the movement of vocal folds in the throat, is a process that works with the entire body.  When there is pain, poor posture, muscular weakness, fatigue, or other types of problems that cause our body to not be at ease when talking, our vocal muscles can work overtime.  At some point, like any other muscle, they can fatigue and will rely on other nearby muscles in the throat, neck, or even trunk to help keep the show going.  We help develop programs that not only help reduce tissue restrictions developed from prolonged and often uneasy singing/speaking, but we also finding working with breath re-education through a whole body approach to be very helpful when working with voice difficulties from overuse. 

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Abdominal and Trunk Stiffness:  Injuries at birth, C-sections, failure to thrive, injuries during early developmental, early neglect, as well as other early childhood injuries such as broken bones, respiratory infections, viruses, or inner ear problems, can all cause the child's autonomic nervous system to undergo significant stress changes to organs and viscera in the belly area - all of which can lead to movement problems and/or deep core fascial tissue restrictions that directly affect respiratory and breathing functioning.  When this happens at an early age, this can have significantly impact how a child develops and matures.   

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​Core Weaknesses:  Core weaknesses, just like core stiffness, whether from poor fascial integrity surrounding the neck and lower back or underlying nervous system trauma that has caused an inability for the body to sense, and as a result control itself, can lead to compensations in the diaphragm and overuse of the extremities (especially the arms and legs).  Often there can be early symptoms and even chronic injuries in the arms and legs that begin to develop in a child's life almost without good logic explanation other than chalking it up to "You must have slept on it wrong."  Often this can lead to difficult and sometimes confusing problems that often continues to show up in different ways every 3-6 months (sore neck, belly aches, loss of hamstring stretch, .

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 â€‹Premature, Birth Traumas, and Early Childhood Injuries:  Injuries at birth, C-sections, failure to thrive, injuries during early developmental, early neglect, as well as other early childhood injuries such as broken bones, respiratory infections, viruses, or inner ear problems, can all cause the child's autonomic nervous system to undergo significant stress changes which can lead to deep core fascial tissue restrictions that directly affect respiratory and breathing functioning.  When this happens at an early age, this can have significant impact the process of how a child develops and matures.  Identifying and helping integrate underlying unintegrated reflexes, such as Fear Paralysis and Moro reflex, that could be involve in disruptions to breathing mechanics can help in many ways.

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How Physical Therapy can help these Conditions::

  • Safe and Sound Protocol  

  • Myofascial mobilizations:

  • Neurogenic Tremoring

  • Addressing Unintegrated reflexes

  • Breathing Reeducation

  • Fascial Fitness

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© 2023 Creative Pathways Physical Therapy, PLLC. 

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