About the Causes of Dystonia

dystoniacause

The line of research that this blog follows is based on the belief that:

The cause of Secundary Idiopatic Cervical Dystonia is strictly related to the biomechanical colapse of the cervical spine driven by the weight of the skull that sinks, falls, leans and gets twisted as it lacks proper support in the dental arches.

According to this theory, the skeletal, neurological, chemical and psycological symptoms that are described by the accademic, medical and scientific literature are consequences of the effort produced by the body to adjust to this mechanical colapse and the mechanical twisting strain on the brain stem caused by the collapsing skull.

As a consequence, we wish to document an experimental treatment directed at curing Secondary Idiopatic Cervical Dystonia (as opposed to merely managing the symptoms and cronifying the desease) starting from:

Reestablishing sound support of the skull on the dental arches that allows the proper function of the involuntary reflex that lifts and alligns the skull during the act of swallowing. This reflex uses a biomechanical lever centered on the molar teeth, which we call the Molar Lever

Final Phase of Postural Colapse

In this blog we will argue that Cervical Dystonia is strictly related to the final phase of a postural colapse driven by a sinking skull that lacks proper bio-mechanical support and comes to produce brain stem compression.

Collapse can be defined as the phenomenon which leads the muscles to give up after years of asymmetry, muscular compensation, and tension generated by the sinking of the skull.

The true and proper collapse takes places all of a sudden, out of sheer exhaustion. The muscles of the neck are tired of trying to keep the skull in its correct position. Thus, they let go, giving way to “postural collapse”.

The following drawing separates 4 different phases of postural colapse driven by a sinking skull.

efectos esqueleticos

For an in depth analysis of the 4 phases, you can visit the page of this blog dedicated to Postural Colapse Driven by a Sinking Skull.

In the final phase, what we call phase 5, structural missalignement causes brain stem compression and torsion.

 

 

Cervical Dystonia: the Final Stage of Postural Colapse Affects the Brain Stem 

When the weight of the head (5-7 kg.) is shifted off the center of the neck and held in that position by tense muscle, the reusult is body inbalance that can produce stress,tension and pressure on the brain stem.

The following pictures is a postural analysys of my situation at the beginning of this treatment. My skeletal structure has all the signs of what is defined as phase 4 of postural colapse.

stage5

Phase 5: postural colapse affects the brain stem with compression and torsion at C5-C6-C7. The body reacts with neurological symptoms to try to ease the strain on the brain stem. They are automatic involuntary reflexes.

 

 

In the Rm scan you can see exactly where the brain stem compression and torsion is taking place: C5-C6-C7. That is where the postural colpase driven by the sinking skull has placed all the weight of the head. From C5 upwords, the cervical spine is rectified.

We can call it phase 5 of postural colapse driven by a sinking skull: postural colapse affects, strains, compresses and twists the brain stem and the body reacts with neurological symptoms. They are automatic unconcious reflexes that do not make it past the brain stem to the conscious brain.

They are the same kind of unconcoius, automatic nervouse impulses that occur when your fingers get burned and your hand and arm moves away from fire or the closing of the eye lids when an object approaches. Those reflexes activate muscles to ease the pressure and torsion of the brain stem and move the head away. That is what in medical terms is called Dystonia: involuntary asimmetric muscle contractions.

 

 

Generalized Dystonia: Postural Colpase Strains the Brain Stem at the Foramen Magnum

The pressure can distort and limit the transmission of the nervouse signals between brain and body.

Picture1

Lee, Young Jun. “FCST (Functional Cerebrospinal Technique).” Lecture 

This distortion which causes subluxation of C1 and C2 can limit the space of foramen magnum (which is an opening at the base of the skull) through which the cerebrospinal fluid circulates. This can negatively impact the body-brain communication and also cause restriction of the jugular foramen, another opening in the base of the skull transmitting veins, arteries, and nerves. Restriction in these openings can mean less efficient brain respiration due to decrease in the cerebrospinal fluid circulation and can also limit proper flow of blood to the brain.

In this 5th phase, Dystonia sets in and produces a wide range of neurological symptoms.

 

 

Biomechanic Approach

While medicine treats the body from the point of view of biochemistry, biomechanics looks at the human body with the eyes and mind of an engineer. According to biomechanics, using simple applications of Newtonian mechanics and of material science it is possible to explain correctly various mechanical functions of many biological systems.

 

 

Dystonia, Occlusion and Posture

According to the theory that I am promoting there is a fundamental relationship between occlusion and posture.

According to this principle, the skull is supported by the dental arches in front as well as by the atlas in the rear (first cervical vertebra). This means that if the dental arches, through which the forces created by the act of occlusion are relieved, do not have adequate dental height, the skull finds no support and tends to sink downwards, as it has nothing to lean against.

The skull can lean, get twisted, then fall to one side, it can sink, or, as what often happens, all these changes can happen at the same time.

Such a relationship between occlusion and posture is not easy to make out. In fact the relationship between teeth (occlusion) and posture is very difficult to make out because the support which the jaw offers at the moment of occlusal contact is only momentary. This contact serves to transfer the shapes to be taken on to the adjacent and underlying musculoskeletal structures. We will analyse this machanism in a later section.

In practice the skull rests on the first cervical vertebra as well as on the dental arches. If one of these points of suport is missing or bio-mechanically impaired, then the skull sinks.

 

 

What Makes the Skull Sink?

That said, we can say that the reason why the skull might come to sink, in the case of a lack of dental support, creating a bad posture, is due to two forces:

1) the force of gravity

2) the muscles of chewing and swallowing, which pull it downward.

Let’s look at this in more detail:

1) The skull, like any other body, is subject to the force of gravity. Whenever it doesn’t find the right support, it tends to fall.

2) The muscles of chewing and of swallowing push the teeth into a forcible contact with one another. Where one dental arch (or both) is not sufficiently extruded or solid, the skull sinks until it finds stable contact.

The failure of the teeth to extrude depends on various factors which we will look at later. For now we can say that teeth that are not adequately extruded do not create sufficient pressure to keep driving the skull upwards during the phase of occlusal contact.

It is evident that, if the skull sinks forward, it loses its center of gravity. To cope with this the human organism looks for compensatory mechanisms in the entire body to bring the weight of the head back in line with the center of gravity.

 

 

An Involuntary Reflex that Lifts the Head

This biomechanical principle (the skull finds support on the teeth) can be understood easily by means of an experiment which posturologists use quite frequently: it requires placing a pencil on the last two molars and then closing the mouth, until the teeth rest on it.

The role of the pencil in the experiment is to create a height that offers a feeling of support for the skull. The individual needs to turn his attention to the way the head feels, and to feel how it is supported before and after the use of the pencil.

This experience should lead to an insight that the skull has a biomechanical system for keeping itself erect, independent of our own volition, for which a simple shimming (an increase in height) on the back molars, by means of the pencil, provides a feeling of elevating the skull.

 

 

Biomechanics of Dystonia

Biomechanically, the masticatory system works in 2 radically different ways depending on its function and the relative position of the tooth contacts. Both are simple bio-mechanical levers.

The function of these two different mechanical levers depends on the fact that the skull has two different supports (the dental arches and the first cervical vertebra) at two particular moments (swallowing phase and occlusion phase). These supports are always present, but according to the needs of the moment, one or the other dominates.

 

Mastication: Class 3 lever

It is a Class 3 mechanical lever

It is a Class 3 mechanical lever

During mastication, it works as as a combination of 2 sets of class 3 simple mechanical levers. As we chew food, teeth come into smooth “kissing” contact between opposing arches, stopping short of applying excessive force on antogonistic teeth. This contacts occur in a position which in dentistry is known as Occlusal Centric Relation. This position is of the utmost importance for the propioceptive nervouse system as it provides sensory information to the brain as to the position of the head with respect to the mandible and programs short-term muscular enagrams (muscle memory) that prevent the muscles moving the jaw from applying a force on antagonistic teeth that could break them.

 

Swallowing: the Molar Lever

When the teeth interlock and fix their position of maximum contact and force between the two dental arches, the masticatory system works as a class 1 mechanical lever. We may call it the Molar Lever. This position of the teeth is referred to as Maximum Intercuspation or Central Occlusion. This interlocking of the teeth happen during the act of swallowing.

Swallowing is that very short (less than a second) and intense phase in which the dental arches stabilize the skull. This phase is important because the skull does not only discharge its own weight, but, with the work of the masseter muscles, comes to produce an average of 30 kg that are discharged and distributed onto the dental arches.

It is extremely important note that swallowing is both a voluntary and involuntary reflex: in our sleep, the nervous system triggers the swallowing reflex authonomously about once every minute.

In the next two pictures tou can se how the Molar Lever works:

image

By applying force with my hand along the same direction that the masticatory muscles do, you can clearly appreciate how -as the mouth closes- the posterior part of the mouth is subject to a stretching force: the white plastic sustainers slide along the rails and the distance between the mandible and the maxilla in the back side of the mouth is raised about half a cm.

image

That is how the lever centered along the molar part of the dental arches stretches the back of the cervical spine and lifts the skull.

image

Thus, the masticatory muscles transfer their grinding force by means of a bio-mechanical lever to the cervical spine,  stretching it and elevating the skull.

image

 

Structural Allignment: the Dental Connection

It is also imporant to note that this whole conplex double lever machine is composed of elements that are all mobile: the vertebrae, mandibles and skull are all connected by joints. The only fixed element is the dental arches when they interlock.

dental occlusion

 

Thus, the shape, inclination and forces of the interlocking of the dental arches is the only fixed element that shapes and alligns the rest of double lever machine. The contact of the teeth – occlusion – serves to transfer the shapes to be taken on to the adjacent and underlying musculoskeletal structures.

If the plane of dental occlusion is not alligned with the axis of the skull and cervical spine, the skull tilts

If the plane of dental occlusion is not alligned with the axis of the skull and cervical spine, the skull tilts

 

 

A Colapsed Skeletal Structure

As stated previously, the stability of the skull depends on correct dental support. If dental support is inadequate the skull tends to collapse. In the event that the skull comes to fall the spine undergoes changes proportional to the extent of the collapse of the skull. As a result there are musculoskeletal compensatory measures of a descending kind.

research-51-728

 

The true and proper collapse takes places all of a sudden, out of sheer exhaustion. The muscles of the neck are tired of trying to keep the skull in its correct position. Thus, they let go, giving way to “postural collapse”. Collapse can be defined as the phenomenon which leads the muscles to give up after years of asymmetry, muscular compensation, and tension generated by the sinking of the skull.

In this phase (so-called “postural collapse”) the skull has already moved a great deal away from the line that passes through the center of gravity.

This means that the body has already been in a state of postural decadence for a good while. In fact, the further the skull moves away from the line that passes through the center of gravity, the harder the muscles have to work and thus, to compensate.

 

Treatment

The muscles of chewing and of swallowing push the teeth into a forcible contact with one another. Where one dental arch (or both) is not sufficiently extruded or solid, the skull sinks until it finds stable contact.

The failure of the teeth to extrude depends on various factors which we will look at later. For now we can say that teeth that are not adequately extruded do not create sufficient pressure to keep driving the skull upwards during the phase of occlusal contact.

It is evident that, if the skull sinks forward, it loses its center of gravity. To cope with this the human organism looks for compensatory mechanisms in the entire body to bring the weight of the head back in line with the center of gravity.

To the extent that dental height is lacking, that much more will the skull tend to sink and that much more will changes in the physiological curvature of the spine increase.

When the colapse affects the brain stem, with pressure or torsion, the body reacts with neurological symptoms.

They are automatic unconcious reflexes that do not make it past the brain stem to the conscious brain.

They are the same kind of unconcoius, automatic nervouse impulses that occur when your fingers get burned and your hand and arm moves away from fire or the closing of the eye lids when an object approaches. Those reflexes activate muscles to ease the pressure and torsion of the brain stem and move the head away.

That is what in medical terms is called Dystonia: involuntary asimmetric muscle contractions.

As a result, according to this theory, typical postural problems derive from the collapse of the skull, which doesn’t have adequate dental support. For this reason the only way to prevent the occurrence of postural problems and treat the cause of Secondary Idiopatic and Cervical Dystonia is by means of an apparatus for the teeth.

In this blog I am applying this theory to the treatment of my Secondary idiopatic Cervical Dystonia. In the next section, I will outline my approach to the Cure of Dystonia

 

Related Posts:

 

“Phases of Lateral Postural Colapse”

“Postural Colapse and Dental Arches”

“Iatrogenic Damage: When the Dentist is a Butcher”

“Treatment of Dystonia”

“Beginning of Treatment”

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