Bio-Mechanichs of Dystonia

EXECUTIVE SUMMARY

In this post we will describe 10 bio-mechanical derangements, impairments and misalignments. Patients suffering from Dystonia (and other neurological movement disorders such as Parkinson’s and Tourette’s) tipically present some or all of the 10 described bio-mechanical impairments. 

We end the article by discussing how mainstream treatments for Dystonia recommended by  academic and clinical Neurology  are compatible and complement bio-mechanical treatments. 

For a complete bibliography of peer reviewed scientific reesearch papers, case studies and FDA approved clinical trials, please refer to the RESOURCES page of this blog. 
 
  

 

1) Cranial collapse and derangement

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Collapse and derangement of cranial bones can be graphically understood by thinking of a baloon loosing air. The skull collapses unevenly onto itself and affects the alignment of bones like the sphenoid, temporal and occiput. The palate gets narrower.

Cranial collapse results in the axis of the plane of dental occlusion being out of alignment with the axis of the skull and the spine. As a result, the forces that the mandible delivers on the skull are not at a right angle.

 And this is an MRI that shows clearly what cranial derangement is.

 

2) Twisted and side-bent sphenoid bone

The sphenoid bone is the key to cranial alignement. It sits in the middle of the skull and is connected to 20 different cranial bones.

Displacement of the sphenoid, occiput and temporal bones can be detected even just by the trained eye. As an example: the facial features described in the next picture.

The photograph of the patient’s natural head posture shows a significant amount of tipping to the left. In the right side of the picture, head tip has been corrected to make a more accurate description. 

The patient exhibits several facial features showing distortion which reflect the cranial base relationships. The left side of the face is visibly narrower than the right. The left eye is lower than the right. The left ear is lower and more flared than the right ear. The upper facial midline deviates to the right and the philtrum of the upper lip is also off to the right. The mouth angles slightly upward on the left. The chin is off to the left and the gonial angle is higher on the left compared to the right.

 
 

3) Postural collapse and lateral-frontal sinking skull

image

The human body is inherently unstable. Its mass is distributed as an inverted pyramid: the heaviest part is the head at the top. To stand and to support the head, the body uses hundreds of bones connected by movable joints and muscles, fixed in place by ligaments. 

In order to stand and support the head, the body uses a combination of many simple levers. Bones, joints and muscles act as the arms, fulcrum and force of a combination of many simple lever machines.  

When the fulcri are out of alignment, the result is a forward head posture, twisted spine, rotated pelvis and one hip higher than the other. 

A twisted mandible and dental occlusion during the act of swallowing plays a key role in the mis-alignment of this combination of simple levers that support the head over the shoulders and the spine. Swallowing is an isometric and progressive contraction of all postural muscles centered around dental occlusion that occurs as the mandible closes in the position of Maximum Dental Intercuspation. 

 

4) Subluxation and misalignment of upper cervical vertebrae

image

The first two cervical vertabrae C1 (Atlas) and C2 (Axis) are subluxated and out of alignment with the base of the skull and the rest of the spine.

The Axis and Atlas allow the skull to move: forward, backward, left, right, up, down, sideways and tilt. When they are subluxated (out of their physiological position), the skull can not move freely and center its weight on the cervical spine. 

Moreover, the Axis acts as the pivot point of the rotation of the mandible.

Courtesy of Dr. Lee. Functional Treatment of Dystonia

A twisted mandible caused by uneven dental occlusion will push the Axis and Atlas out of position every time teeth clench or chew. 

And the following is an RX evidence of subluxation of Atlas and Axis. 

Courtesy of Dr. Lee. Functional Treatment for Dystonia

 
 

5) Unstable Centric Dental Relation shifted midline and tipped teeth

image

The midline of the upper and lower dental arches is shifted and the mandible does not find a stable position to close when swallowing.

The teeth are tipped in and out of alignment with the vertical axis of the skull.

The above picture shows the dental consequences of the sidebend pattern from an anterior view. The molar position, facial and dental midlines, occlusal cant and palatal slope are shown in this sketch. The maxilla is to the right and mandible to the left of the facial midline. The upper left molar is more vertical and closer to the midline. The lower left molar is tilted lingually as a consequence of the opposing dentition’s internal rotation. The lateral occlusal plane is shown canted upward on the left.

 
 

6) Twisted Sutures of the Palate

 

Sutures are the connections between the bones that make up the palate and the maxilla. They are marked in blue in the picture above.

In the picture you can clearly appreciate how sutures are twisted, asymmetric and form asymmwtric slopes on the two sides of the palate. This situation is often a result of orthodontic treatments, specially in adults.

 
 

7) Displaced condylar disks

The TMJ is the joint that connects the mandible to the skull. Each TMJ has a disk that covers the condyle, the upoer part of the mandible bone.

In people suffering from Dystonia, these disks are out of their normal physiological position. In particular: ONE CONDYLAR DISK IS ANTERIORLY DISPLACED and the OTHER IS POSTERIORLY DISPLACED.

image

 
 

7) A pathologic ocular tilt reaction

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Resulting in asymmetric input to the central nervous system and a tilt in the subjective visual vertical perception.

image

 
 

8) Scoliosis and deformed rib cage

A sinking and twisting skull will, over time, cause deformation of the spine and the rib cage, scoliosis and a reduced lung capacity.

This postural collapse usually evolves progressively in 4 phases described above.

 
 

9) Compression and twisting strain on the brain stem

The brain stem is the upper part of the spinal cord. It is the connection of the spinal cord with the brain.

When upper cervical vertebrae are out of their physiological position and the skull sinks and twists, the brain stem gets compressed and undergoes twisting strain.

Here is what twisting strain on the brain stem looks like in MRI scans:


 

10) Herniation and twisting of cerebral mass

Cranial derangement and twisting strain on the brain stem and postural collapse will, over time, produce herniation and twisting of cerebral mass.

 Here is what torsion and hernyation of cerebral mass looks like on MRI scans.


 
 

Treatment: combining bio-mechanical with bio-chemical/electrical

What came first? The chicken or the egg?

Mainstream academic Neurology approaches Dystonia as a neurological disorder with physical movement consequences.

From a bio-mechanical approach, Dystonia is a combination of physical impairments that produce neurological consequences.

The approach of mainstream clinical neurology can be described as bio-chemical/electrical: aberrant function of a part of the brain called the basal ganglia is believed to produce faulty electrical messages from the brain to the muscles that makes them contract in an uncoordinated way. Prescribed treatments include: botox injections to inhibit muscle activity; Deep Brain Stimulation surgery to implant electrodes in the brain that produce balanced electrical currents. The cause of the misfiring of the basal ganglia is not understood and research deals with possible genetic correlations.

A bio-mechanic approach to dystonia prescribes a treatment that addresses and corrects the 10 above mentioned derangements, impairments and misalignments. It considers these derangemenets as the cause of neurological symptoms. 

Even though the bio-mechanical and the bio-chemical approaches stem from opposite principles, it is important to understand that:

Bio-mechanical and bio-chemical/electrical treatments are compatible and complement one another. 

It is possible to carry out splint therapy while receiving botox injections, DBS surgery and any drug treatment. 

On the other hand, often and in many cases, a bio-mechanical treatment results in discontinuance of neurological symptoms and makes it unnecessary to use prescription drugs. 

This bio-mechanic approach has been around for decades with proven results. It is not mainstream because of the way medical academia organizes research and teaching in separate systems.

From a bio-mechanic approach, the treatment of Dystonia sits between Traumatology, Dentistry, TMD, Orthopedics and Neurology. It is considered a combination of several physical injuries of the upper cervical, lower cranial area.
For a detailed description of the treatment, please read the Protocol for the Bio-mechanic Treatment of Dystonia that we developed. 

The protocol we developed does not invent anything new. In the Resources section of this blog you can find 100 downloadable peer reviewed academic research papers, case studies and FDA approved clinical trials that deal with the biomechanics of neurological movement disorders.

The basic tools that are used to treat and correct the above described 10 postural, cranial, occlusal, vertebral and neurological derangements are the intra-oral appliances shown in the picture below:

  1. Maxillary ALF dental appliance
  2. Mandibular Gelb-Rectifier dental splint

    A bio-mechanical treatment of Dystonia can be long but remarkably inexpensive and effective. And it can improve the quality of life of patients to the point that they do not need lifelong drug treatments and can live a normal active, working and family life. 

     
     

    How can mechanical derangements cause neurological symptoms?

    The short answer is: the Trigeminal Nerve.

    The trigeminal nerve is the largest of the cranial nerves.  It is a nerve responsible for many functions, including sensation in the face and the activation of all the muscles of biting and chewing. 

    Its name (“trigeminal” = tri-, or three and -geminus, or twin; thrice-twinned) derives from the fact that each side of the trigeminal nerve (one on each side of the body) has three major branches connected to:

    • the eyes
    • the maxillae
    • the mandible

    Another important connection of the Trigeminal nerve reaches the ears, where the organs of balance are located.

    Its mandibular and maxillary branches are the ones that get anesthetized by dentists to avoid pain during dental procedures. Teeth play an active role in the sensory function of this nerve.

    Sensory information from the two sides of the trigeminal nerve is processed by parallel pathways in the central nervous system.

    Without entering into a complex analysis (which goes beyond the scope of this article), it is clear that this nerve feeds the brain with two sets of electrical signals (from each side of the body) related to balance, the horizon, verticality and the position of the skull with respect to the mandible and the body.

    In order to reach alignment of the body, the electrical impulses that come from both sides of the body to the brain through the trigeminal nerve have to be coherent and symmetric. The brain will adjust the body with involuntary muscles movements until it reaches coherence and minimizes discrepancy between the signals received from the two sides.

    Asymmetric cranial darangement and asymmetrical mechanical impairments of the TMJ, mandible, maxillae and teeth have a direct impact on the coherence of the electrical input the brain gets through the trigeminal nerve. 

    Lack of coherence in the electric signals received through the trigeminal nerve have the ability to trigger involuntary asymmetric muscle contractions. In short, they can trigger Dystonia

     
     

    Navigate Through this Blog

    To further understand our reasearch, approach and method, please read:

    A Bio-Mechanical Approach to Dystonia
    An introduction to the theory and analysis that support the pilot research project to use an adaptive intraoral appliance to treat and possibly cure Secondary Idiopatic Cervical Dystonia.

    Principles of Splint Therapy
    A description of the principles on which we base our protocol for the treatment of Cervical Dystonia and other occlusion realated movement disorders with varying degrees of neurological symptoms (from Tourette’s, to postural collapse, Parkinson’s and Generalized Dystonia).

    Protocol for the Treatment of Cervical Dystonia

    A step by step description of the 3 phases of the DIY protocol that we have developed for the treatment of Cervical Dystonia.

    The Molar Lever

    Our analysis of the bio-machinics of the Molar Lever and how dental occlusion is related to posture and skeletal allignment.>

    Phases of Lateral Postural Colapse

    Our analysis of the descending skeletal and postural effects of a collapsing and twisting skull that does not find adequate support in the dental arches.

    The Rectifier

    A description of the adaptive intra-oral aplliance -dental splint – that we use to treat Cervical Dystonia and the orthopedic forces that it produces by progressively pushing the mandible in retrusion, maxila in extrusion and elevating the skull by stretching and aligning the cervical vertebrae.

    Resources

    Bibliography and links to scientific research on the treatment of Dystonia and other neurological movement disorders with a bio-mechanical approach.

    Postural Colapse and Dental Arches

    A set of animations that present grafically the type of skeletal and postural effects that we intend to produce over a few months by modifying occlusion and the direction of forces between the skull and the mandible.

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