THE BITE 1
The following is a description to help gain an understanding of the effect of dental occlusion (relationship of the maxilla to the mandible) and its direct and indirect biomechanical interaction with the cranium, cervical spine, thoracic cage, pelvis and the feet.
Dental occlusion plays an extremely important role in the kinetic chain that determines the postural system. Chronic dysfunction of the system will affect the central nervous system and health in general. The stability and proper function of the occlusal structure is determined by the balance between the tensional and compressive forces on the hard and soft tissue of the maxilla, mandible, head, neck and shoulders. The balance between the counteracting forces of tension and compression is called tensegrity. In living organisms the continuous tension between its parts creates awareness of posture. This is referred to as proprioception and tensegrity drives proprioception. It is the result of tensegrity that a change of tension in one part of the structure produces a chain reaction of changes throughout the structure. The principles of tensegrity apply at the molecular level with the interaction of amino acids, fatty acids, proteins and cells as well as at the skeletal level involving muscles, tendons, ligaments and bones.
By recognizing and understanding the genetic and environmental background of different facial types and cranial divergencies of individuals, appropriate functional orthopedic devices can be utilized in a growing child to ensure optimal functional occlusion is achieved. Proper occlusion in turn will positively affect the biomechanical function of joints, which in turn will create normal reflexes, correct posture, gait and equilibrium.
Over the past several decades due to human intervention in environment, food quality and dental treatments (both preventative and invasive) dental structure has been affected and this has affected the Righting reflex. The Righting reflex is primordial. It enables an animal to maintain its body in a definite relationship to its head by keeping the eyes focused on the horizon. This in turn preserves equilibrium and balance. It is for this reason that the Righting reflex is a primary mechanism for survival. A distorted maxilla with a roll, pitch or yaw will influence the entire cranial mechanism, which will also affect the visual field. The central nervous system via cranial nerve XI (accessory) sends signals to contract the trapezius or sternocleidomastoid muscles to correct the head position in order to keep the eyes focused on the horizon. Extended periods of incorrect posture will create musculoskeletal pathologies such as nerve entrapment, trigger points in the musculature and uneven wear of the dentition. The distortion of the head whether it is roll, pitch, yaw or a combination, will alter the level of the shoulders, which in turn will change the level of the hips and finally will affect leg length and stride. The neck and thoracic cage positions will also be indirectly influenced which introduces a host of neurological and structural symptoms.
Primary proprioceptive areas in the body are C1, atlas / occiput, TMJ capsule, head of first rib, sacroiliac joint and subtalor joint. The proprioceptive system is designed to keep the head, shoulders and pelvis level. Whenever there is distortion, the nervous system sends signals to the musculature to contract in order to correct the alignment of the skeletal system. This in turn can cause such problems as scoliosis, lordosis, rotated pelvis, mandibular shifts, Achilles tendonitis and sciatic lesions to name a few.
The vertical dimension (height of the bite) of the dental occlusion and the anterior posterior location of the mandible has a direct effect on head posture. A loss in vertical dimension forces the position of the head forward in relation to the coronal plane which creates a kyphotic thoracic spine and a lordotic neck thus creating pain in the cervical spine, the low back and the coccyx region. The location of the pain is also related to the foot structure. A person with high arches who walks on the balls of their feet will experience pain in the lower back, usually towards the coccyx. A person with a retruded mandible due to malocclusion accompanied by a loss of vertical dimension will encounter cervical pain, upper thoracic pain and or upper lumbar pain. If this same person has feet with flat arches causing them to balance on their heels then the back pain will most likely be experienced in the upper lumbar region. There are many possible scenarios of pain as a result of the relationship between dental arch development and the arch of the foot. In addition to dental arch and foot arch evaluation, the genetic makeup of a person should also be considered. It should be mentioned that repetitive activity due to sports and other activities will obviously have an effect on the foot arch development. It is also notable that different activities such as ballet, skating, running, horseback riding etc. not only affect the structure differently but will manifest pain in a different area of the spine. Therefore it is crucial when addressing neck, back and pelvic pain to consider both the dental arch and the arch of the foot in the diagnosis and the treatment.
The relationship between dental occlusion and the cranial sacral mechanism is well known and understood in the field of osteopathy, specifically the correlation of the maxilla to the sphenoid bone and the mandible to the temporal and the occipital bones. In a situation where there is a dental malocclusion, the cranial lesion cannot be corrected or stabilized until the maxilla and mandible are properly aligned. For example, in a left side bend situation the mandible is driven back and to the left while the maxilla is rotated downwards and to the right. A loss of vertical dimension on the left side is seen and the head tilts to the left. In a child the tongue rests between the left molars for support and the right central incisor overerupts. This particular cranial lesion will only be corrected with proper orthopedic / orthodontic treatment. The occlusal scheme, the vertical dimension and the anterior posterior relationship of the maxilla to the mandible all strongly influence the articular mobility of the cranial bones. This in turn affects the fluctuation of the cerebrospinal fluid and the mobility of the intracranial and intraspinal membranes. Osteopathic principles are based on proper distribution of the cerebrospinal fluid which acts as a carrier of nourishment that is vital to the central nervous system’s metabolism.
THE PAIN
What functional pathologies are typically associated with pain? Depending on one's individual approach any or all of the following may be pursued: joint dysfunction, trigger points, or muscle imbalances. Different functional pathologies are screened for in the hope that a "key link" will be found. Such a key link gives the clinician a foothold in the management of pain syndromes related to dysfunction. believes that there is a pivotal dysfunction which if found and treated will help alleviate pain.
Such an approach is important for treating pain because dysfunction is the primary cause of pain in the motor system. Even with structural pathology the critical difference between symptomatic and asymptomatic structural pathology is most likely due to dysfunction. A patient's recovery is contingent on restoring function in the motor system.
Assessment of structural pathology or disease is important for ruling out "red flags" for urgent or emergency referral. But the vast majority of patients do not have clinically significant structural pathology (90 percent). In these patients it is the assessment of function/dysfunction of the motor system which is paramount. Since functional pathologies are present in everyone we must identify "chains" of functional pathology which are related to a patient's symptoms or decompensation. Most importantly, our assessment should identify the key link in a patient's dysfunctional chain which either reflexly or biomechanically has the most significant effect on the the motor system. Such a key link is the starting point for efficient, efficacious treatment.
Chain reactions involving pathokinesiology and abnormal arthrokinematics occur commonly. Gait is the classic example of an activity occurring as part of a kinetic chain. Faulty gait often results from forefoot instability (i.e., hyperpronation) during mid-stance to toe off. This can travel up the chain and lead to knee, hip and low back problems. Another example of a kinetic chain involves the muscles, joints and motor program for reaching, grasping, carrying, or prehension. A dysfunction of the sternoclavicular or glenohumeral joints or muscle imbalance of the scapulothoracic muscles will result in a loss of the normal scapulohumeral rhythm. In the end the patient may develop wrist/elbow repetitive strain syndromes or myofascial syndromes of the head and neck. One should think of the craniomandibular system as being part of a kinetic chain responsible for mastication. Masticatory muscle dysfunction may affect the temperomandibular and cervicocranial joints resulting in jaw, facial, head or neck pain. Interface between muscles and joints is the rule rather than the exception in the motor system.
Chain reactions linking various dysfunctional tissues involved in a task occur as a normal consequence of soft tissue overload. Muscles being the active component of the motor system adapt and may eventually fatigue. Panjabi says, "the muscles and tendons ... are the means through which the spinal system generates forces and provides the required stability to the spine." Bogduk and Twomey say, "such processes may underlie what might otherwise be called 'fatigue' in a ligament or capsule. After prolonged strain, ligaments, capsules, and intervertebral discs of the lumbar spine may creep, and they may be liable to injury if sudden forces are unexpectedly applied during their vulnerable, recovery phase."
The goal of rehabilitation is to achieve a level of functional restoration so that the patient can safely manage the "demands" of their occupation or lifestyle.
All too often the chiropractic approach suffers because it does not adequately rehabilitate the motor system
Normalize Joint Function
Relax and/or Stretch Hypertonic Muscles
Facilitate and/or Strengthen Inhibited Muscles
Reprogram Coordinated Movement Subcortically
Successful manipulation to a key link will have a distant effect throughout the kinetic chain. It has the potential to not only reduce a local fixation, but to have a reflex effect on hypertonic and inhibited muscles related segmentally or functionally. But if there is cerebellar involvement, peripheral treatment with manipulation is unlikely to reach deep enough into the central nervous system to reprogram subcortical movement patterns. the central nervous system controls motor responses, "the neural subsystem receives information from the various transducers, determines specific requirements for spinal stability, and causes the active subsystem to achieve the stability goal. proposes propriosensory treatments such as balance training as the mainstay of subcortical training. Sensory motor stimulation from the soles of the feet (rocker/wobble boards or balance shoes) or pelvis (gymnastic balls) can increase the speed of activation of inhibited muscles and decrease the irritability threshold of hypertonic muscles on a subcortical or semi-automatic basis.
Mastering the evaluation of functional chains (gait, prehension, mastication, etc.) and finding a key link amenable to manipulation is the first step. Then, it is necessary to search for extrinsic factors which can be addressed through education and ergonomics to reduce exposure to harmful stress and strain. Finally, specific rehabilitation goals must be established such as relaxing overactive muscles, facilitating weak muscles, and improving the quality of basic movement patterns (i.e., gait, lifting, carrying, etc.). Education and exercise are the keys to preventing reinjury and recurrence.
THE WHY
Postural ontogenesis entails maturation of body posture and related human locomotion. Postural muscle function ensures all possible positions in the joints determined by their anatomical shapes and has a strong formative influence on bone and joint morphology. Postural muscle activity is genetically predetermined and occurs automatically during CNS maturation. During newborn stage, bones and joints are morphologically immature. For example, the shape of the plantar arch is not well defined , the chest is shaped like a barrel, the posterior angles of the lower ribs are situated anteriorly relative to the spine, the ribs appear to be more horizontal than in adulthood, and the spine is maintained in kyphosis as the spinal lordotic curves have not yet developed. As the CNS matures, purposeful muscle function increasingly occurs. Muscles controlled by the CNS subsequently act on growth plates influencing the shape of bones and joints. Every joint position depends on stabilizing muscle function and coordination of local and distant muscles to ensure “functional centration” of joints in all possible positions. The quality of this coordination is crucial for joint function and influences not only local but also regional and global anatomical and biomechanical parameters starting in the early postnatal stage.
Ontogenesis demonstrates a very close relationship between neurophysiological and biomechanical principles, which are important aspects in the diagnosis and treatment of locomotor system disorders. This relationship is very apparent in cases where there is a CNS lesion and muscle coordination is affected. The disturbed muscle coordination subsequently alters joint position, morphological development, and ultimately posture. Postural function and motor patterns are not only the indicators of the stage of maturation, but can point to the fact if the CNS development is physiological or pathological. Posture is a term very closely related to early individual development. The quality of verticalization during the first year of life strongly influences the quality of body posture for the rest of a person’s life.Today, 12:2
THE EYES
Photographic and video analyses show that the primary position of the eyes is a natural constant
position in alert normal humans, and the eyes are automatically saccadically reset to this position from
any displacement of the visual line. The primary position is not dependent on fixation, the fusion reflex,
gravity, or the head position. The primary position is defined anatomically by head and eye planes and
lines that are localized by photography, magnetic resonance imaging, and x-rays of the head and neck.
The eyes are in the primary position when the principal (horizontal) retinal plane is coplanar with the
transverse visual head (brain) plane (TVHP), and the equatorial plane of the eye is coplanar with a
fixed orbital plane (Listing's plane). Evidence is presented to indicate an active neurologic basis for the
primary position instead of passive mechanical forces. A different understanding of the primary position
and the conception of the TVHP may be valuable in analyzing oculomotor defects.
meaning eyes muscular system built posture by cns perception , if eye are wrong in term of tracking left to right in false synchronisation , one shoulder or jaw or head will tilt to compensate , injury might occur later on in life
it a postural imprint it not genetic , it environmental genetic , body is resilient
tracking synchronization learn in autonomic instinct pre standing pre identity breastfeed th mom
if this not occur most will have esotropia from one eye , with close object at less then 4 inch
eyes synchronization create great bodybuilder
THE FOOT
The foot core system: a new paradigm
in·trin·sic mus·cles of foot
muscles fully contained (origin, belly, insertion) in the foot and toes.These muscles are arranged in four layers; all are innervated by the plantar branches of the tibial nerve. Although they may be capable of producing the actions described under their individual entries, as a group the primary function of the intrinsic muscles of the foot is to provide dynamic support of the longitudinal arch of the foot, resisting those forces that act momentarily to spread the arch during walking and running.
The foot is a complex structure with many articulations and multiple degrees of freedom that play an important role in static posture and dynamic activities. The evolutionary development of the arch of the foot was coincident with the greater demands placed on the foot as humans began to run. The movement and stability of the arch is controlled by intrinsic and extrinsic muscles. However, the intrinsic muscles are largely ignored.
Important function – Balance, proprioception, gait
In addition, the intrinsic muscles of the foot must fine-tune the stability and support of the foot as it moves through the heel-touch to toe-off phase of the gait pattern, modulating the amount and position of force placed over the architecture of your foot as you move from standing to walking, propelling you forward from the toes when in toe-off.
Many different elements contribute to the support of the arch. Among these are the small muscles on the underside of the foot known as the intrinsics. Very little research has been done looking at the role the foot intrinsics play in the dynamic stability of the arch. So much attention is given to footwear and orthotics that we often ignore the fact that the bottom of the foot is filled with muscles. These muscles provide both stabilizing forces to the foot in standing, and resistance to the collapsing of the arch with movement.
the foot is considered to be a rigid body. The human foot is composed of the arch structure, which is characteristic in every person and deforms with aging. Foot arch structure is assumed to effect postural control.
Panjabi brought forward a revolutionary concept for spinal stability and proposed that the spinal stabilizing system consists of three sub- systems, the passive, active and neural control. It has been proposed that if the passive system is impaired for any reason (e.g. post macro or micro-trauma), maximizing the contribution of the active and the neural control systems may enhance stability and reduce related pain. Although this clinical concept was originally proposed for the spine, it may be transferable to any joint in the body including the foot and ankle complex.
The abductor hallucis muscle plays an important role in maintaining arch height as well as controlling excessive pronation. Strengthening this muscle can aid in treating and preventing overuse injuries. We should view it no differently than the posterior tibial muscle and tendon.
Neurologie of the Plantar Foot
The hairless skin of the foot sole has a great number and variety of neuro-receptors: Ruffini, Krause, Vater, Pacini, Meisner, free nerve endings, etc. They all have special functions, but many of them are also sensitive to pressure. We call them mechano- or baroreceptors. Kennedy et al identified a total of 104 mechanoreceptors in the hairless skin of the foot sole, active only when the foot was loaded. Yet, when the foot is in an unloaded position no discharge activity in any of the cutaneous receptors was found, especiallyin the absence of intentionally applied stimulation. These findings suggest that skin receptors of the foot sole behave differently from those receptors found on the hairless skin of the hand. This may reflect the role of foot sole skin receptors in standing balance and movement control
The passage of blood upward from the feet against gravity depends on a complex array of valves and pumps. Muscle pumps of the calf and foot provide the motive force for venous return
THE FASCIA N BIOTENSEGRITY
Tensegrity describes a structure containing alternating regions of tension and rigidity that maintain optimal alignment and integrity of the structure. Thus, a structure that possesses tensegrity is both adaptable and resilient to deformation. The human body is an example of this tensegrity model where the myofascial system serves as the tension generator and connects to rigid levers (bones). When functioning optimally, the myofascial system works to virtually suspend the body in the upright position while maintaining "tension and integrity" within the system. More specifically, tensegrity enables the maintenance of erect posture and smooth, coordinated movement. Maintaining erect posture and smooth, coordinated movement under a relative minimal energy expenditure and without compensation is the hallmark of an efficient strategy. When tensegrity is compromised secondary to injury, inflammation, development of muscle imbalances, etc., the nervous system compensates by significantly increasing muscle activity to help maintain posture and movement control. These compensations lead to inefficient strategies and are a direct cause of postural alterations and movement dysfunction
Mental/emotional traumas and fatigue also influence the fascial system as emotions and moods alter our energy systems and in turn affect posture. If the emotional states continue, poor posture begins to form a habit and so stress is placed on the system, thus causing constriction. This is an important component because it basically means that our emotional and mental states have a powerful affect on our body’s structure. Fascia is really is an edifice of our emotional, as well as physical, well-being. The body truly is an amazing machine. The physical and mental/emotional components are so tightly interwoven that their affect on performance is even greater than what traditional wisdom recognizes.
All afferent systems, including vision, hearing, vestibular, proprioceptive, and exteroceptive information, are integrated in these global patterns of stabilization and stepping forward/supporting extremities’ function. In addition, the orofacial system takes part in these complex movement patterns. For example, during a throwing action, the athlete automatically places the extremities in a reciprocal position, the eyes and tongue turn toward the same direction as the stepping forward (throwing) arm (eyes preceding the arm movement), enhancing further facilitation and performance of the throwing movement. The athlete depicts how all his orofacial muscles are involved in movement, to enhance maximum strength and performance. If the athlete is asked to look in the opposite direction or turn his tongue against the direction of the stepping forward arm movement, it will significantly decrease his sports performance. These principles can be powerfully used in athletic training.
Activation of the stabilizers is automatic and subconscious (the “feed-forward mechanism”) and precedes every purposeful movement. Any purposeful movement influences global posture and this posture subsequently influences the quality of phasic (dynamic) movement.
If all the activity of the human body’s six hundred skeletal muscles were consciously
controlled, very little would get done. Despite its enormous computing capacity, the
brain would not be able to handle the task of evaluating all the possible ways of
carrying out every action and deciding on the best one. The marvellous speed,
versatility and flexibility of human activity is only possible because most of it relies
on reflex muscle actions.
It joins your thigh to your calf; your hand to your arm; your breastbone to your clavicle. As you move, it allows your muscles to glide past one another. It acts like a net suspending your organs and a high-tech adhesive holding your cells in place while relaying messages between them. Connective tissue is one of the most integral components of the human machine. Indeed, one could draw a line between any two points of the body via a path of connective tissue. This network is so extensive and ubiquitous that if we were to lose every organ, muscle, bone, nerve, and blood vessel in our bodies, we would still maintain the same shape: our “connective-tissue body.”
THE BREATHING
expansion meaning clavicle stay stable , expansion !!!! expansion of ribcage not elevation of ribcage
https://www.youtube.com/watch?v=l7I_-Etmo3c
This little tip off leads me to take a closer look at their respiration. I often notice the same person breathing primarily through the mouth, rather than the nose. I lay them on their back, have them remove their shirt (when appropriate) and cue myself in to the pattern of their inhalations and exhalations.
Not surprisingly these giants of neck development, are often the same folks who are stuck in inhalation, or a state of hyperinflation. They have poor function of their diaphragms, and generally take the form of our usual “over-extended” individual. In many cases, they present with a lack of shoulder flexion because their lats are constantly “on.”
shouderflexion
They take shallow, frequent breaths, which never allow for full exhalation. To take a page out of the Postural Restoration Institute’s respiration manual, hyperinflation does the following:
- Increase sympathetic “fight or flight” responses and anxiousness
- Impairs nerve conduction
- Vasoconstricts peripheral and gastrointestinal vessels
- Restricts circulation in cerebral cortex
- Shunts blood flow peripherally
- Impairs coronary arterial flow
- Promotes fatigue, weakness, irregular heart rate, etc.
- Impairs breathing and weakens diaphragm contractility
- Increases overuse of “thoracic breathing”
- Enhances peripheral neuropathic syptoms
- Enhances sympathetic adrenaline activity and hypersensitivity to lights and sounds
- Increases phobic dysfunction, panic attacks, restless leg syndromes, heightened vigilance, etc.
- Facilitates catastrophic thinking and hypochondria
As you can see, this simple observation leads us to a series of additional questions, and more times than not, the discovery that someone’s ailments are the cause of their respiratory dysfunction. Their autonomics are dictating much of their dysfunction, even voluntary movement dysfunctions.
This is an important assessment because acknowledging this discord means we can intervene. Including breathing drills to correct respiratory function can help to restore many of the qualities we aim to improve (i.e. movement patterns, recovery rate, performance qualities, etc.).
If you are keen to excessive tone in the accessory musculature, you can begin to dig deeper and more closely observe their respiration, as well as ask them about different conditions listed above. If the pieces fit together, use some of the following drills to help them correct the dysfunction.