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1 14 C O M M U N I T Y M A G A Z I N E S M A Y / J U N E Oh,

2 my aching head NEW DOCTOR TEAM ADDRESSES CHRONIC HEADACHE PROBLEMS SEVERE HEADACHES IN THIS COUNTRY ARE A LEADING CAUSE OF DISRUP- TION AT WORK, as well as home, school and social life. Four Newton practitioners, working as a team of specialists, offer fresh promise for certain kinds of cases. The team consists of Dr. Stephen Bader, a dentist with extensive training in Temporomandibular Disorder (TMD) and bite related disorders; Dr. Robert Gensler, a chiropractor, with over 25 years experience in non-directional low force manipulation using only gentle manual manipulation; Marianne Moore, a massage therapist who concentrates on deep tissue as well as craniosacral therapy; and Cynthia Rowe, a licensed physical therapist with success working with head and neck problems. According to Dr. Bader, this team approach leads to greater success for a patient than could have been achieved by a patient seeing each specialist separately. He also contends that many people with neuromuscular problems are misdiagnosed. Bader cites a 33-year old woman whom he treated for TMD evaluation. She had over 15 years of severe headaches,tmj pain, and postural problems that affected her neck and back. He says that another dentist had suggested that she had TMJ problems and made her a standard night guard, which was not successful. In addition, she was taking daily medication to prevent headaches, plus medication when a headache started.these medications, in combination with her headaches, were interfering with her ability to care for her seven-year-old son. She found herself in emergency rooms about once a month for injections of narcotics when her headaches got worse, despite regular medication.after starting neuromuscular occlusal therapy, she saw both Dr. Gensler and Marianne Moore on a regular basis. Over a six month period, the intensity and frequency of her headaches were greatly reduced. She rarely needed any medication, and did not have to visit the ER.Today, she continues combined therapy while orthodontics is being used to correct her bite imbalance. C O M M U N I T Y M A G A Z I N E S M A Y / J U N E

3 Bader cites another case of a 39-year old woman whom he saw with complaints of daily headaches, ear pain,tmj clicking and neck pain. She took headache medication five times weekly on average. She felt her bite was uneven.after treatment by Rowe PT and neuromuscular occlusal therapy, she reported complete relief of her headaches, has discontinued her headache medication, and has no neck pain, he said. Her dental treatment included minor adjustment of the biting surfaces of her teeth. She still wears her orthotic at night to reduce grinding of her teeth. Some people may be suffering from TMD, a complex syndrome of neuromuscular problems, that can affect the head, neck, shoulders and jaw joints, according to Dr. Bader. He suggests that many TMD patients do not have any measurable problems with their actual temporomandibular jaw joint (TMJ).The most common musculoskeletal symptoms of TMD include frequent headaches of any type, jaw joint pain, jaw joint noises, ear pain and congestion, dizziness, ringing in the ears, clenching or grinding of the teeth, facial muscle pain, neck pain, postural problems, and difficulty sleeping. Frustrated patients often seek a variety of opinions from primary care doctors to ear, nose and throat, neurology and headache specialists. Dentists, chiropractors, physical therapists, massage therapists as well as acupuncturists, naturopathic doctors and other practitioners may all be consulted and sometimes will offer conflicting diagnoses. Patients diagnosed with tension headaches and migraines can often have causes related to TMD. Dr. Bader, a graduate of the Harvard School of Dental Medicine, studied Neuromuscular TMJ Therapy at the LasVegas Institute for Advanced Dental Studies (LVI) where he has completed every patient care program in advanced esthetic dentistry and TMJ disorder diagnosis and treatment. Dr. Gensler, a chiropractor with more than 25 years of experience, also incorporatesyoga in treatment for many headache patients. Marianne Moore, a nationally licensed massage therapist, concentrates on deep tissue, Swedish and sports rehabilitation massage as well as craniosacral therapy to relieve longstanding muscular issues. Cynthia Rowe established Rowe Physical Therapy Associates in 1986 and is a licensed physical therapist with success working with head and neck problems. Both Moore and Rowe have studied Craniosacral Therapy at the Upledger Institute in Florida. Each practitioner performs a detailed analysis of symptoms, posture, spine and neck alignment and muscular symptoms to determine the best combination of therapies for individual problems. 16 C O M M U N I T Y M A G A Z I N E S M A Y / J U N E The team: Dr. Robert Gensler, Marianne Moore, Dr. Stephen Bader and Cynthia Rowe

4 Four illustrations of the pathways of pain (shown by arrows) referred from facial muscles to other areas of the head and neck. Coordinated therapy can eliminate pain at the source. Your total evaluation AN EXAMINATION BY DR. BADER begins with a one hour examination of teeth,tmj, occlusion (the way your teeth bite together), tooth and jaw alignment, and the muscles of your face, mouth, forehead, neck and shoulders. Key signs of TMD problems are unusual tenderness of muscles in your mouth, forehead, neck and shoulders, abnormal alignment of your teeth and jaws, and noises or pain in your TMJ area.the alignment of the mandible, the lower jaw, has a profound impact on head and neck posture. Even a small constant imbalance of the occlusion and mandible can set up a constant tension on head and neck muscles which can create chronic muscle spasm impacting your posture, the blood flow to your head and neck, and ultimately severe frequent headaches. Detailed measurements of muscle tension in the head and neck muscles using computerized electromyography, followed by electronic measurement of the natural movements of the lower jaw, and a sonograph evaluation of thetmj area complete the evaluation. Each practitioner performs a detailed analysis of symptoms, posture, spine and neck alignment and muscular symptoms to determine the best combination of therapies for individual problems. Treatment options DR. BADER POINTS OUT THAT no one solution fits every patient. Each member of the team can be a primary contact. Dr. Gensler will often see patients where neck pain is the worst symptom. Dr. Bader most frequently sees patients with jaw, ear or headache pain. Marianne sees many patients with neck and shoulder pain, while Rowe Physical Therapy sees patients referred by their MD for treatment of head, neck or shoulder pain. Ultimately, the treatment is coordinated between the team members. C O M M U N I T Y M A G A Z I N E S M A Y / J U N E

5 Dr. Bader focuses on finding a muscularly balanced lower jaw position using ULF- TENS therapy to allow gentle relaxation of all the muscles that control jaw movement. Sophisticated electronic measurements can then be used to create a removable orthotic appliance that is adjusted to a position determined by your own relaxed muscles, rather than an arbitrary position based on forcing your jaw muscles into place.this is called neuromuscular occlusal therapy. Since the muscles are often in spasm, creating an orthotic without relaxing the muscles first often does not help patients with the worst TMD and headache problems. It can take several months of refinement before the muscles completely relax to a normal position and relief is felt. However, some patients feel relief almost immediately as years of muscle tension are resolved with combined treatment. Dr. Gensler works to gently align both the vertebrae and other bony joints over a series of short visits. Rowe Physical Therapy reports a combination of gentle manual skills, combined with myofascial release and craniosacral therapy, is used to identify and treat all underlying contributions to symptoms. Because of the intimate interconnections of the body systems, it is crucial to address restrictions in the fascial core layer (a band of connective tissue binding together internal organs or parts of the body) of the body that are often far from the area with symptoms. Moore uses her knowledge of anatomy and physiology to identify specific muscles, tendons, nerves and fascial restrictions that are causing symptoms. Through a combination of Swedish massage strokes (gentle strokes to the effected area designed to warm up the tissues and increase blood flow), followed by deeper tissue massage (strokes with increasing intensity as the tissues begin to open up), myofascial release, deactivation of trigger points, followed by gentle stretching, craniosacral therapy, and energy healing to remove blockages in the energy pathways of the body, she continues the process of relaxation of muscles towards the goal of the healing of pain. You may reach Dr. Bader at or Dr. Gensler at , Marianne Moore at , and Rowe Physical Therapy at C O M M U N I T Y M A G A Z I N E S M A Y / J U N E

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