Cover Story
Printed with permission from PT & OT Today
Vol. 4, No. 30
July 22, 1996

Temporomandibular joint dysfunction affects large numbers of people in this country.  Over the years, medical professionals have employed various methods to relieve the myriad of symptoms patients experience in the jaw, face, head, neck, upper back and shoulders.  Increasingly, a gentle and noninvasive manual technique called craniosacral therapy is being used to alleviate the pain of TMJ.  This technique offers the hope of lasting relief from pain by addressing the underlying causes of TMJ dysfunction.

Determining the primary cause of the patient's pain represents the challenge of treating TMJ.  John E. UI, DO, OMM, founder of The UI Institute Inc. of Palm Beach Gardens, FL, explained that the core problem must be resolved in order to provide lasting relief to people with this condition.  "The bottom line could be anything from childhood anxiety that perpetuates into adulthood and causes them to clamp their teeth together hard.  Or they could have a little off bite, or they could have a bad low back and that ultimately transfers back up into their head and throws their temporomandibular joint balance off," he said.

UI explained that the pain caused by the core problem surfaces at various times and for a multitude of reasons.
 

"TMJ is going to manifest whenever you have a psychological, emotional or physiological situation that is difficult.  It's like an alarm system going off, and any number of things can cause the alarm to go off."

The Mechanisms of Craniosacral Therapy
When treating people with TMJ, physical and occupational therapists capitalize on the body's innate healing powers.  "We deal with the restoration of function, and that in turn allows the body to heal itself and the symptoms to disappear," UI explained.  "We focus on the dysfunctions that we find, and if those dysfunctions are properly corrected, symptoms dissolve because they are secondary effects."

In addition to enhancing the body's natural healing process, craniosacral therapy balances the autonomic nervous system.  Balancing this system decreases muscle tension and provides persons with TMJ with more rest, maintained Susan Steiner, OTR/L, who is in private practice in Providence, RI.  "You get a physiological response of decreased muscle tone by doing craniosacral therapy," she said.  "Most of the symptomatology [of TMJ] comes from increased muscle tone around the jaw."
 

Court Ruling on Craniosacral Therapy A unanimous court ruling established that dentists in Colorado are allowed to use craniosacral therapy in the scope of their practice for treatment of temporomandibular joint disfunction.  The state Court of Appeals decided in favor of the dentist in the Colorado Board of Medical Examiners vs. W.M. Raemer, DDS, on March 22, 1990.  The ruling stated that, among other things: 1.  TMJ dysfunction can be treated effectively with craniosacral manipulation; 2.  Any treatment which releives pain or corrects a physical condition occurring in the teeth, jaws or adjacent structures constitutes dentistry (based at least on the Colorado statute); 3.  Craniosacral manipulation and the treatment of TMJ dysfunction constitutes the practice of dentistry.

Craniosacral therapy provides fast relief to TMJ sufferers, Steiner explained.  "Most people notice improvement within two sessions.  They don't have to invest a whole lot of time before they see results."  In addition, she added, PTs and OTs arm patients with techniques they can use at home to continue to decrease muscle tone around the jaw.

According to Steiner, patients notice a change in their everyday activities soon after receiving craniosacral therapy.  They begin to forget to wear their dental appliances, or are able to eat foods they haven't been able to eat for a long time, she explained.  In addition, most patients are able to significantly cut back on the number of therapy sessions they attend.  "After 8 to 12 visits, their condition is pretty much under control," she said.  At this point, some patients don't need additional therapy, while others are advised to continue to receive therapy on a maintenance level to avoid acerbating their condition.

The fact that craniosacral therapy is not invasive is another attribute of the manual technique, Steiner pointed out.  "We use 5 grams of light touch.  It's a very gentle technique for someone who's in a lot of pain, vs. other modalities where [therapists] actually enhance pain by poking, prodding and pressing in a painful area,"  she noted.  "We go in non-invasively with light touch to decrease pain in a gentle way."

Craniosacral therapy has psychological benefits as well.
 

SomatoEmotional Release SomatoEmotional Release is a therapeutic technique used in advanced forms of craniosacral therapy at the UI Institute in Palm Beach Gardens, FL, to help rid the mind and body of the residual effects of trauma. Work done by John E. UI, DO, OMM, and Zvi Karni, PhD, DSC, revealed that the body often retains the effects of physical and emotional trauma in what is called an energy cyst. UI and Karni discovered that clearing negative memories and emotions, while helpful in resolving disturbances, did not always lead to complete rehabilitation.  Adapting to an energy cyst requires effort, even for a healthy body.  The body may then need additional energy to perform normal functions.  The adaptive pattern of the body becomes less effective over time.  As a result, symptoms begin to surface, and with time, become more difficult to suppress.  SomatoEmotional release is used by therapists to help release adaptive patterns from the mind and body of patients.

Because TMJ pain is often present in the mouth, people with the syndrome may not be able to fully use this part of their bodies.  Steiner maintained that returning function to this body part is important for a patient's emotional state.  "A lot of people with TMJ haven't been speaking up.  They're withholding something, or there's something about expression that's being clamped," she noted.

Helping people to become whole again is another psychological benefit of craniosacral therapy.  "It allows someone to become more integrated and more comfortable with themselves and the world around them,"  Steiner maintained.  "It's one of those kinds of benefits that you can't get on a doctor's prescription."

Treating the Whole Person
A holistic approach is followed in craniosacral therapy.  "We look at the entire person, emotionally as well as physically,"  Steiner commented.  "That means from their feet to their head no matter what their symptom is."  It is important to remember that a person seeking treatment for TMJ dysfunction is often dealing with a number of problems from pain, muscle imbalance and physical misalignment to emotional issues around the chronic pain, she added.

The holistic nature of craniosacral therapy, Steiner believes, unites the modality particularly well with occupational therapy.
 

"Craniosacral therapy has a strong connection to the profession of occupational therapy because our mission is to improve independence for the whole person."

Any type of therapist administering craniosacral therapy may be called upon to meet the emotional needs of TMJ patients.  UI explained that there are two psychotherapists on staff at the institute.  However, in most cases, the therapist helps patients deal with the emotional aspects of their condition.  "If the therapist simply becomes a listening post and helps patients ventilate, they will ultimately solve their own problems," he pointed out.

Patients should understand that they may experience emotions when receiving craniosacral therapy.  "When somebody receives gentle touch and has to lay still for an hour, they have to be with themselves for that hour.  It may bring up something for people in their own personal discovery that is a bit surprising or is some kind of reality check for them," Steiner said.  She believes that personal exploration is a positive component of craniosacral work, but acknowledges that it makes some patients uncomfortable.

The therapist should avoid being frightened by the emotional aspects of craniosacral work.  "If [a patient] is in a session and he or she begins to ventilate a huge emotional discharge and this scares the therapist, then that fear will broadcast into the patient," UI said.

The therapist is also advised to practice caution concerning the patient's medical status.  "We're changing fluid pressures inside the skull at a very subtle level," UI said.  Therefore, therapists should avoid performing craniosacral therapy on patients who may be negatively affected by changes in the hydraulic forces in the skull.  Patients recovering from a brain hemorrhage, for example, require special care from the therapist to avoid reinstituting the hemorrhage process, he cautioned.

Opening the Mind to TMJ
The bias of the medical professional affects the way that person interprets symptoms.  According to UI, this thought process perpetuated the belief that TMJ syndrome did not exist, and to some extent, still affects the way people with these symptoms are diagnosed.  "No matter what your specialty is, if you reach far enough you can come up with a reason why [the symptoms are present]," he maintained.  "But that doesn't make it true, it just makes it plausible to somebody who's noncritical."

To challenge this mind-set, UI developed the TMJ Evaluation & Treatment Plan poster and accompanying booklet titled A Holistic View of Temporomandibular Joint Syndrome.  Speaking about the educational materials, UI said they are "meant to cause a holistic thought process in the therapist.  No matter what your profession is, you should have your mind open to [the causes of TMJ]."

Being open to working with other medical professionals is also recommended.  UI explained that the therapists at the institute often work in concert with dental professionals.  "There are some TMJ dental specialists who work with craniosacral therapists.  A lot of dental work may result in craniosacral system dysfunction which then contributes to the ongoing problem of TMJ."

Steiner's TMJ clients may see a variety of other medical professionals while they are under her care.  These include chiropractors, acupuncturists, massage therapists and psychologists.

While awareness of craniosacral therapy is growing, some medical professionals still need to be informed about the manual technique's beneficial effects.  "We're still at the grassroots level in getting the work out," Steiner pointed out.  "We're still in the mode of educating doctors and dentists about [this treatment]."

UI agrees that expanding medical professionals' knowledge of TMJ is helpful.  "TMJ is a very widespread syndrome.  People need to recognize that it can have a multiplicity of causes," he said.

Reminding therapists of the importance of craniosacral therapy is also a key issue, Steiner maintained.  "I think it's really crucial that manual therapy modalities have a role in the therapy professions because they are a very successful way of preparing the body for function."