Do you really need a byte or orthotics?
When a health professional prescribes both a byte and a pair of orthotics run away quickly!!
This is usually because the result will only be a compensation of a compensation of the original problems. Initially it will give a feeling of well-being then, in the long term it will create new symptoms and more real problems.
This is because it will make the muscles hypertonic and this will be interpreted by many as a feeling of strength. Health professionals often do not know the phenomenon of muscular hypertonicity or do not know how to test for it and what the consequences might be for the patient’s health.
(Muscular hypertonicity: that is, a previously weak or normal muscle gives the feeling of having returned strong or become very strong. In reality this muscle has an excessive tension or tone, and therefore with time it extinguishes itself at the metabolic level creating serious and difficult problems to locate, because they may be far from the spontaneous pain that the patient reports.)
There are very skilled “professionals” in convincing an aching, confident patient to get orthotics and/or bytes.
With the orthotics there is the possibility of feeling better initially, then usually after 3 to 6 months the patient starts having back pain, often at the dorsal and cervical level. And unfortunately, they do not put these pains in correlation with the orthotics.
Certain orthotics (especially those made of plastic or with hard material) immediately create a weakness in the cervical muscles, others interfere with the walking pattern.
With the Sanrocco method we always test the patient with and without orthotics at three levels: the static posture behind the plumb line, the cervical muscle strength and the effect on walking.
We also carefully check on the podoscope if the feet are really flat as the patient has been told (in 30% of the cases it is not so because many “professionals” rely only on the shape of the Achilles tendon and the loading of the heel).
Only the set of these tests allows a complete functional evaluation of the orthotics and any benefits or damages.
With children we should not intervene before they are 7 to 10 years of age as previously the bones of the foot are not yet well defined and also because the legs go through different natural shapes (from birth till six -seven years) with which we never should interfere.
The byte instead has become a fashion and unfortunately in most cases it is not indicated, in fact it is often harmful for the patient not only at a postural and muscular level but also economically.
The luckiest have headaches right away or an increasing of their symptoms and understand that the byte is not good.
With the Sanrocco method we have extensive experience, because we were the first in the world to carry out a clinical research, with the help of dentists, university professors, doctors, neurologists and podiatrists on more than 3,000 patients over a period of 10 years (from 1982 to 1992). This research has revealed that sometimes the temporomandibular joint problems interfere with the corrections made by us chiropractors and vice versa that a problem for example of the foot can create a malocclusion. This information, which is integrated into the Sanrocco method, also gives the possibility of identifying 90% of all jaw problems that can give rise to lumbar and cervical problems, posture and muscle strength and allow us to know when there is a need of a dentist to resolve the situation. On the basis of this research we have developed several simple tests to perform, but which require a great deal of experience on the part of the interpreter to understand whether it is an ascending, descending (= in the mouth) or mixed problem. Dr. Meersseman, together with the Sanrocco team and many dentists, after five years of testing many patients, completed one of these tests in 1987. Here follows the protocol of the test that took his name.
Over the years this test has been (unfortunately) copied and modified by various professionals, some of whom have passed this research as their own by giving another name for the test.
In some osteopathic schools in Italy they don’t give credit to chiropractors and they make believe to the students that they invented this methodology. Unfortunately for them they also copied the errors we had included on purpose in the first publication!!!
- A) Initial exam
– plumb line analysis
Take note of the structural imbalances and deviation as seen behind the plumb line (antero-posterior and lateral).
If possible do a stabilometric exam.
– Motion palpation
Take note of the sacroiliac fixation side and palpate for pain points of the sacroiliac and first rib.
Check passive motion of the cervical spine (lateral flexion and rotation of the head).
– Supine position
Note the side of the short leg side.
Palpate for pain points (medial, lateral knee; upper, lower fossa).
Check difference in passive internal rotation of the legs.
Check passive mobility of coxofemoral articulation (degree of abduction).
If doing A.K., check for indicator muscles ( strong as well as weak muscles in the clear).
Palpate occiput-atlas-axis area and note the pain points.
B Procedure in the mouth
Depending on what you see in the mouth, you have to put cotton rolls or thin paper cardboards between the teeth.
- Monolateral mastication and crossbite.
You need to augment one side more than the other, from last molar to first premolar.
2) Open bite, short frenulum.
Close open space with cotton rolls, blocking the tongue.
- Incisor contact.
Put paper cardboards from last molar up to first premolar bilaterally, augmenting the vertical dimension till there is no more incisors contact.
- Lack of vertical dimension (overbite, missing teeth, etc.)For missing teeth fill up the space with cotton rolls and/or augment the vertical dimension.
C Have the patient walk and swallow
Swallowing is the first real voluntary muscle function of a human being, although it is basically an involuntary mechanism. This appears so, since it occurs at least fifty times during sleep and 350 times unconsciously during the day. It starts already around the third month of pregnancy and lasts a lifetime with a frequency of about 800 times a day. Most of the muscles of the stomatognatic system (including SCM and Upper Trap.) are involved in swallowing. The force created between the upper and lower dental arch is about half of the maximum force that you can obtain by clenching your teeth.
The oral cavity, which consist of the tongue, palate, dental arches and saliva, is the main switch for the superficial current generated by the gait mechanism.
First, the tongue serves as the contact point between the GV and CV meridian circuit.
Second, the palate and upper dental arch form one end of the circuit, while the tongue and the lower dental arch comprises the other end.
A closed circuit is established between the two meridians during the process of deglutition. In such a mechanism, the tongue with its rhythmic deglutition would serve as an autonomic CV/GV switch.
The swallowing process consist not only of the tongue being thrust upwards against the palate but the concealment of the oral cavity by the occlusion of the upper and lower dental arches.
Further, it also comprises the closing of the lips and the contractions of the associated surrounding oral musculature. This process forms a semi-enclosed fluid (saliva) cavity in which electromagnetic energy can be carried from one end to the other end, completing the CV/GV circuit.
This superficial circuit is energized by the gait mechanism, which is dependent upon the coordinated activity of the neuromusculoskeletal system. Consequently, the switch mechanism would include a feedback communication with the general muscle groups of ambulation.
This apparatus was first alluded to by G. Goodheart, in the clinical discovery of the phenomenon of “neurological tooth” . His diligent and courageous work in this unknown field showed that each tooth or dental socket was generally related to a postural skeletal muscle.
Further he demonstrated that occasionally, tooth pathology could create disturbances in its associated muscle, “neurological tooth” . To substantiate these findings the clinical research by Italian dentists, such as Zucchi, Guaglio and Stefanelli has shown on numerous occasions this unusual connection.
- Walking will reset the program by changing the negative sensory input (if it is a descending problem). The engram, which corresponded with a certain phase of the gait will unlock and normal muscle physiology will be restored.
- During gait, as the head turns slightly towards the forward arm, the mandible will slightly deviate in the same direction.
This phenomenon is based upon the reactive muscle patterns between the internal pterygoid (IP) with the sternocleidomastoid (SCM) and the external pterygoid (EP) with the upper trapezius (UTZ). For example, as the right arm and left leg go forward, the mandible will slightly deviate to the right. This induction is provided by the contraction of the left SCM and right UTZ, which elicit a minute reactive contraction of the left IP and right EP respectively. Consequently, the sequential contraction of these TMJ muscles will cause the mandible to deflect in the direction of both the forward arm and the direction of head rotation (i.e., right). Therefore, the phasic interchange between right and left stride lengths will causes the mandible to rhythmically deviate left and right respectively.
Clinically, this becomes of great interest since ascending problems such as foot dysfunction can block the body in one of the phases of gait while at rest. This could yield an apparent malocclusion, secondary to the dynamic muscle chains of gait. Therefore, correcting the malocclusion without considering the ascending problem can cause recidivism or exacerbation of clinical symptomatology .
Dr. Crisera noted that the arrangements of the muscles associated with the teeth or dental socket were in a configuration that conformed to those founded in gait.
For example, the right lower third molar is related to the right psoas muscle, which is activated during the step forward motion, “flexor”. Its paired antipode, the upper right third molar, is related to the right mid trapezium, which is activated but in the opposite direction, “extensor”.
Therefore, the organization of the teeth forms a cross crawl pattern, which is congruent with the gait mechanism.
Consequently, certain forms of gait disturbances can arise as a result of dental pathology or certain forms of malocclusion. Many of these types of disorders are usually subtle in nature and would not create muscle dysfunction in the static posture. However, their manifestation could result under dynamic situations, especially during ambulation.
For example, an athletic swimmer may note a loss in race time, due to a deviation toward one side of his lane (not swimming in a straight line). Upon clinical dental evaluation of the athlete, it is noted that the tooth related to the right latissimus dorsi is missing (right first upper molar). Upon clinical kinesiological evaluation, the involved muscle appears normal in the static position. However, testing the muscle in the right step forward gait position and swallowing, suddenly elicits its dysfunction. Sequentially, with the correction of the neurological tooth, there is reestablishment of normal gait dynamics of the right latissimus dorsi. The athlete now reacquires proper coordinated muscle dynamics, and returns to his normal potential race time.
- D) Recheck initial findings
- A majority of the findings from the first exam have improved. This is a descending problem. The patients needs to see a dentist before beginning chiropractic treatment.
- Findings essentially unchanged from the first exam. This is an ascending problem. The patient should proceed with your chiropractic treatment.
- Some findings improved, others the same or changed but not for the better. This is a mixed problem.
The patient can go ahead with your chiropractic treatment. Keep in mind that the patient may need to see a dentist sooner or later in order to have maximum improvement.
A few observations on the Meersseman test and why at times it has been unjustly criticized:
1) If one is to do the test correctly and obtain results, he/she must have a significant amount of experience and capacity to precise observation, a deep knowledge of anatomy, physiology of movement, postural analysis, static and dynamic palpation of the pelvis and the cervical vertebral column, gnathology, and of the principal types of dental/occlusal problems.
Therefore the test has often been incorrectly performed and interpreted by persons who simply did not have the necessary level of knowledge, experience, or understanding of the subject at the expense of the patient’s health and billfold.
2) Secondary hypertonicity was not checked in the original test, and has lead to a lot of secondary problems created by bites.
3) The test requires only a couple of paper, cardboard, or cotton spacers, so there are no economic interests from companies or pharmaceutical houses to invest or propagandize the test.
4) The basic concept, that there is a direct interdependence between the stomatognathic system and the rest of the musculoskeletal system ( from head to feet and vice versa), not only complicates the work of many health professionals (dentists, orthodontists, orthopedists, physiatrists, podiatrists ,chiropractors, medical legal experts, university professors, etc. , and even insurance companies ), but increases greatly their responsibility, and for these reasons many prefer to negate the existence of this correlations so life is much easier for them.
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