Have You Been Saddled with a Garbage Can Diagnosis? Part II

This is the second part in a series that focuses on “garbage can diagnoses” (see Part I for a more detailed description of what constitutes a GCD.)

TMJ: (properly known as temporomandibular joint disorder) “My doctor/dentist says I have TMJ.” Gawd, I wish I had a dollar (nickel adjusted for inflation) for every time I’ve heard this one. Of course, they never follow up this statement with how it’s being treated, because most practitioners don’t know what to do with this condition besides give you a mouth guard. Great, now I can play hockey without losing my teeth, but my jaw still hurts. This GCD could include everything from jaw clicking, locking, joint pain, and nighttime clenching and grinding.

The importance of the jaw in overall health can’t be overstated. Because of the intense concentration of nerve receptors in the jaw that monitor proprioception–the body’s ability to sense where it is in space–proper alignment of the jaw is essential in maintaining balance and a decent center of gravity.

More importantly, the TMJ is one of the linchpins of the skeletal system (along with the sternum and pubic joint), meaning that if it’s out of alignment it can easily take out your whole skeleton. This can cause chronic muscle and joint conditions to flare up, inner ear problems, chronic headaches, sensitive teeth, ringing in the ears, and make you more prone to injury because of compromised balance. What causes the TMJ to be out of alignment? Intense dental work, serious injuries such as car accidents, giving birth, and gum or tooth infections are some of the most common causes.

Chronic pelvic pain: I could build a practice based on this GCD alone. I’ve listed this right after TMJ because the pubic joint and the jaw joint are inextricably linked. When the TMJ is not aligned properly, then the pubic joint also misaligns itself in order to balance the skeleton out as much as possible, and keep the body upright in space. And, the reverse is also true–if the pubic joint is misaligned, the TMJ follows suit. I’ve seen this relationship to be true 100% of the time.

A misaligned pubic joint can result from many factors, but a few common ones are: pregnancy and childbirth, acute injury such as car accident, abdominal or pelvic surgery, bladder or reproductive system infection or inflammation, dental work, and bodice-ripping sex.

A chronically misaligned pubic joint can cause a whole host of problems, such as: migrating pelvic pain involving the hips, tailbone (sacrum), genitals, and sometimes the groin or front of the hips; chronic urinary system infections; chronic vaginal or prostate infections; frequent groin muscle strains; and knee joint instability.

Do you see a chiropractor, physical therapist, or osteopath, but he/she just can’t seem to get your pelvis and hips to hold their adjustments? Quite likely they either don’t know how to recognize a misaligned pubic joint or they don’t know how to adjust it. If your pubic joint is misaligned and your therapist adjusts your hips or sacrum without adjusting the pubic joint first, then any other adjustments will not hold for very long. The third possibility, of course, is that your therapist simply doesn’t want to go there. At one clinic where I worked I was known as “the pubic joint guy,” which was something of a dubious distinction. But hey, everyone needs a niche, right? And this is one that badly needed to be filled.

If you take anything away from this series, it would be the critical importance of the jaw and pubic joint in both musculoskeletal and systemic health. It’s frequently missed because it’s rarely a consideration in the medical model, and it was also given scant emphasis in my chiropractic education.

Leg Length Inequality: This is more commonly known has having a short leg. The two most blatant symptoms are talking like a pirate and involuntarily walking in circles.

There are two types of short leg, anatomical or functional. An anatomical short leg means that the bones of one leg, either the femur or tibia, are literally shorter than the other side. A functional short leg is caused by structural imbalance in the pelvis, which results in one leg appearing to be shorter because of dysfunctional muscle patterns that are attempting to right things.

In 12 years of practice I can count on one hand the number of people I encountered with an anatomical short leg. It is extremely rare. Generally, it’s either due to a congenital condition such as a malformed hip joint on one side, or a nasty hip/leg fracture that healed in a less than ideal manner. Functional short legs, however, are more common than dirt. Just from your personal history you’d likely know if you had such a congenital condition and certainly would’ve remembered a bad fracture that didn’t heal properly.

I can’t say this more emphatically: If you don’t have an anatomical short leg and your therapist wants to prescribe a heel lift for you then they simply do not know how to adjust your pelvis to even out your legs, in which case you need a new practitioner, or they need to prove the need for a heel lift by virtue of full skeleton x-rays. If you’re given a heel lift for the “short” leg only and you don’t have an anatomical short leg, it can screw you up for life. If the therapist tries to convince you that a heel lift is not a big deal, then run, don’t walk, out of that office.

Because a functional short leg is a compensation for an imbalance in the pelvis, using a heel lift does nothing to correct this imbalance and in fact encourages one’s body to accept this imbalance as normal. This will create even more layers of muscular dysfunction over time, and can even cause secondary problems in the neck, upper back, and shoulders.

Carpal Tunnel Syndrome: This is the GCD for which I’ve encountered the most failed surgeries simply because it is so easy to misdiagnose. The actual carpal tunnel is a bony trough in the wrist that is bordered by two of the carpal bones. A variety of tendons, nerves, and blood vessels pass through this area. Generally, you have to really beat the crap out of your hands for a very long time in very repetitive ways for the actual carpal tunnel to be the source of the symptoms of numbness, tingling, pain, muscle weakness, and muscle wasting.

More often than not, however, the symptoms leading to this diagnosis do not originate in the carpal tunnel. Hence, the number of unnecessary and unsuccessful CTS surgeries. More commonly the symptoms originate from the upper back, neck, shoulder joint, collarbone, elbow, and the muscles, nerves, and disks in these areas. Even inflammation of muscles in the forearms can mimic CTS. A major problem with being diagnosed with CTS is that if you don’t improve with conservative treatment such as rest, splinting, and stretching, then you’re likely on a track for surgery.

It goes without saying that you need a second or even third opinion if you receive a CTS diagnosis, before you go down the road of a treatment plan designed around it.



2 thoughts on “Have You Been Saddled with a Garbage Can Diagnosis? Part II

  1. Elene

    That heel lift thing especially yanks my chain. It’s so easy to fix uneven leg lengths, there’s no excuse not to!
    I have seen exactly two patients ever who actually had different leg lengths, that is bones of different lengths, and in one of those it was obvious because of an accident surgery in her youth. Everyone else was just out of line functionally and didn’t stay that way. Some of those had been prescribed heel lifts. Just sad.


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