Introduction: Assessment of leg length is a part of the diagnostic process  for several professions, with the field of chiropractic commonly using functional leg length (leg lengths that are essentially anatomically the same length), assessments to differentially diagnose pelvic imbalance, its affect on global posture, and its change to determine the effectiveness of care pre and post treatment.

An emerging evidence base of literature is developing relating to the relationship between functional and/or anatomical leg lengths and the temporomandibular joint or stomatognathic system’s position and function. While controversial, some studies have found a relationship between temporomandibular joint (TMD) or stomatognathic system disorders (SSD) and body posture. Research has found a close relationship between body posture and temporomandibular disorders suggesting that postural evaluation could be an important component in the overall approach to providing accurate prevention and treatment in the management of patients with TMD.

There are different theories why an interrelationship between posture and TMD/SSD might exist.  One ascending postural theory relates to visual and vestibular as well as plantar mechanoreceptors, all of which are important players in the regulation of static upright posture. A descending postural theory suggests, that tension in the stomatognathic system can contribute to impaired neural control of posture.

Conclusion: The relationship between TMD/SSD, posture and leg length imbalance is closely interrelated with ascending and descending contributions to the kinematic chain of postural influence

Introduction:  The clinical interpretation of leg length inequality (LLI) crucially depends on the distinction between anatomic LLI (LLIa)1-3, wherein the legs are measurably of different length; and functional LLI (LLIf), in which cases the legs are de facto equal in length and yet one has been drawn cephalad in some manner.  Imaging, more specifically scanogram x-ray, is generally regarded to be the reference standard for identifying aLLI, even though its accuracy has been questioned and can be costly in terms of both economically and the potential hazards of ionizing radiation.  The purpose of this commentary is to review the low-tech methods by which an observed short leg can be differentially diagnosed as either functional or anatomical LLI. Low-tech methods, to be reviewed, discriminating aLLI from fLLI include the compressive leg check, the sitting/standing indirect leg check, tape measure methods (TMMs), block indirect method, crest-foot method, and Allis leg check.

Conclusions: An anatomic short leg increases the risk of musculoskeletal problems. The functional short leg well may exist, but little evidence suggests its side or magnitude point toward an appropriate adjustment of either the pelvis or upper cervical spine. Clearly, an appropriate clinical intervention would logically depend on whether an observed short leg is a structural or functional short leg. Since the risk-benefit ratio of scanogram x-ray or CT scan for measuring relative leg length is unclear for most patients, using a combination of the low-tech methods for measuring aLLI is preferred.

Objective/Clinical Features: A 47-year-old female patient presented for chiropractic care with a thirteen-year history of TMJ pain, vision disturbances, deviated septum, fibromyalgia, chronic fatigue, excessive daytime sleepiness, chronic headaches, cognitive impairments, insomnia, chronic myofascial neck and shoulder pain, low back pain with radicular syndromes. She has also taking amitryptiline medication for thirteen-years.

Interventions/Outcome: Examination revealed narrow dental arches with an anterior premature contact, poor TMJ translation, and evidence of clenching and bruxism.  Palpatory pain noted in the muscles of mastication and cranial assessments revealed left temporal bone and spheno-maxillary imbalance. Treatment consisted of eight-SOT cranial dental appointments (over 5-weeks) incorporating SOT intraoral and sphenomaxillary adjustments in conjunction with a lower occlusal dental splint.  Following care the patient reported significant reduction in all symptoms without the need of medication, sleeping 7-hours without interruption, breathing freely, and exercising for first time in 13-years. Sleep studies were performed one prior to instituting care (without a dental appliance) and another 6-weeks after instituting care (dental appliance in her mouth) with the post-study noting a significant clinical improvement.

Conclusion: Greater study is needed to identify the subset of apnea patients with fibromyalgia that could benefit from this approach.

Introduction: A 44-year-old male patient presented for dental care for treatment of long-term OSA he had been using an APAP though still had signs of sleep apnea: heavy snoring, afternoon sleepiness, waking up tired, TMJ disorders, and an AHI of 31.

Method/Intervention: Dental examination revealed a “Class II, division 2” malocclusion with an over-closed vertical dimension, CBCT imaging revealed significantly compromised pharyngeal airway, and severely compromised TMJs. Dental treatment procedures were established to correct the posture of the mandible. Patient was referred for chiropractic care due to his complex presentation and to facilitate the effects of the Alternative Lightwire Functional (ALF) dental orthopedic appliance used to treat the patient’s apnea.   Chiropractic treatment consisted of releasing excessive a sacral nutation restriction, SOT category two treatment, Serola sacroiliac joint support belt, foot orthotics, and SOT TMJ and cranial therapies.

Results: The dental care helped reduce any dental stomatognathic contributions and the chiropractic therapy helped recapture the TM disc and normalize TMJ function.

The post-treatment iCAT view with dental orthotic demonstrated comparatively greater joint stability and improvement in airway, with significant improvement in sleep, less snoring, and less afternoon fatigue.

Conclusion: Integrative dental chiropractic was instituted since beginning dental care the patient had some TMJ flare-ups with restricted opening so was referred for SOT chiropractic and cranial care, which helped reduce any ascending postural kinematic influences as well as help recapture the TM disc to allow the dental care to continue.

Introduction: Two articles on cranial osteopathic manipulative medicine (OMM) were published in the December 2011 issue of JAOA—The Journal of the American Osteopathic Association, and a review of a clinical study reporting the benefits of cranial manipulation appears in the present issue’s installment of “The Somatic Connection.” All of these items bring much-needed attention to the discussion on the validity of the concept and clinical benefits of cranial OMM in the practice of health care.

The Jäkel and von Hauenschild systematic review concluded, “The currently available evidence on the clinical efficacy of cranial OMM is heterogeneous and insufficient to draw definitive conclusions.”  However due to the restrictive inclusion criteria that required only articles that specifically described cranial manipulation be included in their review, a few important papers supportive of cranial OMM were omitted.

Conclusion: Two articles published subsequent to the Jäkel and von Hauenschild systematic review specify cranial OMM and report beneficial outcomes. In the study by Shi et al, cranial OMM produced measurable cerebral oxygenation physiologic effects that contribute to our understanding of possible mechanisms of action for cranial OMM. In the study by Lopez et al, specific cranial OMM procedures were described in the treatment protocol, and data showed improved balance and equilibrium in healthy elderly adults.

Introduction: Osteopathic physicians eagerly anticipate research results that would provide an evidence base for the use of osteopathy in the cranial field (OCF), or cranial osteopathy. Promising research on Osteopathy in the Cranial Field (OCF) includes a study that involves measurement of Traube-Hering-Mayer (THM) oscillation. Physiology texts describe THM oscillation as a complex interaction between the sympathetic and parasympathetic components of the autonomic nervous system with renin-angiotensin on the cardiovascular system and this oscillation phenomenon is considered an integral aspect of homeostasis.

In a 2002 study by Nelson and Glonek they found that palpation of primary respiratory motion (PRM) and THM oscillations had a relationship. Research published in the British Medical Journal (2001) related THM 6-cpm oscillation with enhanced heart-rate variability and baroreflex sensitivity, which could be influenced by meditative type practice.

Conclusion: The appearance of the Nelson and Glonek and European research with THM oscillations as a key ingredient is almost synchronistic. The nature of THM physiology and its relation to OCF and heart-rate variability is a compelling research relationship. If the effects of OCF on rate-to-rate interval variability control are found beneficial, this would constitute the kind of research that supports OCF.

Introduction: A 38-year-old patient presented for care at this office in November 2016 with an array of symptoms (autoimmune disorders, dizziness, obstructive sleep apnea – OSA, etc.). The onset of his condition reportedly began eight years ago following a surfing accident (fell on left shoulder) and removal of his wisdom teeth.  After these events, he began experiencing syncope, brain fog, dizziness, and movement/vertigo, all of which worsened when sitting on soft seats or when hunching over or with his head tilted up or down. Brain fog prevented him from being able to concentrate at work, and he found his condition debilitating, relentless, and life-altering. Prior to being seen at this office he was seen by 28 other physicians and was primarily diagnosed with apnea (OSA), vestibular dysfunction, vascular headaches/migraines, and cervico/thoracic enthesopathy.

Methods/Interventions: Treatment focused on SOT and SOT cranial chiropractic interventions, nasal balloon methods for craniofacial sinus expansion, and supplementation with B12/methylated folic acid (to facilitate red blood cell oxygen uptake).

Results: The patient was treated from November 15, 2016 through March 24, 2017.  By early 2017 his eight-year bout with dizziness was reduced and he could function in most activities of daily living.

Conclusion: This patient’s condition had not been stable for eight years prior to the specific care rendered at this office. It was difficult to directly assess what aspects of his presentation were genetic, macrotrauma-induced, or the result from microtraumas, though the care rendered appeared effective regardless.

Objective/Clinical Implications: A 28-year-old, Caucasian female that presented with a primary complaint of chronic right-sided TMJ pain and dysfunction that had gotten significantly worse as a result of a car accident a few months prior to her appointment. Her visual analogue scale (VAS) for her TMJ pain was 7/10 on average, with pain getting as low as a 2/10. The pain was described as mostly dull, which turned to a sharp pain when she spoke too much, ate chewy foods, or traveled. For the last few weeks she’s had to restrict her diet to mostly liquids and soft foods, as her symptoms became worse post accident.

Intervention/Outcomes: The patient was treated using sacro occipital technique (SOT) and cranial protocols.  Immediately after the first office visit the patient felt some relief but was still sore and felt limited in her opening and movement. Two days after her appointment she contacted the office to tell us that her pain had significantly reduced to the point where she was almost pain free.

Conclusion: Ideally TMJ related conservative care that is low risk and cost effective is optimal. In this case a patient with chronic TMJ pain and dysfunction responded well to one treatment, and months later was still stable in this regard.

Introduction: Historically, it was thought that muscles did not move the sacroiliac joint (SIJ); instead, axial forces supposedly caused movement during trunk motion. However, recently, muscles have been shown to move the SIJ, yet this concept has attained only minor relevance in association with musculoskeletal syndromes.

The Sacroiliac Joint as our Core Structure: Positioned at the center of movement, shock absorption, and load transfer, the SIJ functions as our core musculoskeletal support structure. As in any joint, the ligaments within the SIJ regulate the muscles that attach to the pelvis. Theoretically the muscles that attach to the pelvis may play a key role in integrating the musculoskeletal system through sacral nutation and counternutation patterns, which may have an influence to the kinematic chain affecting the musculoskeletal system.

SIJ Ligaments Sprain in Nutation: Axial force directed inferiorly through the spine or superiorly through the legs will influence the SIJ into nutation positioning. When the force exceeds the ligaments’ ability to maintain integrity, they will overstretch, be compromised, and subsequently sprain.

Systemic Effects: A SIJ sprain can change coordination patterns in many muscles, which, by their proximal attachments to the pelvis and distal attachments to the spine and lower extremities, may act through various vectors to alter posture and joint angles throughout the musculoskeletal system. Therefore, an SIJ sprain may form the basis for many dysfunctions of the spine, pelvis, and extremities.

Conclusion: The SIJ Nutation Lesion is associated with ligamento-muscular responses that may underlie many musculoskeletal dysfunctions throughout the body.

Introduction: A 48-year-old male presented with complaints of occluded breathing on the right side of his nose rated at 1-2 on a 1-10 scale with full airway function at a 10.  He also presented with right-sided suboccipital headaches, described as migraines occurring once a week and lasting 24-48 hours.  The headaches were relatively unresponsive to medication and rated at an 8 on a pain scale of 1-10 with 10 being most painful possible. Visual inspection of the patient revealed a nose deviation to the left with TMJ static deviation continuing with translation along with crepitus.

Methods/Intervention: The patient’s initial chiropractic care included 17 cranial facial release (CFR) nasocranial balloon treatments, sacro occipital technique (SOT) category two, and a sacroiliac joint support belt.  The dentist prescribed a TMD/OSA night appliance, daytime TMJ repositioning appliance, acupuncture, and cold laser therapy. Since the patient’s headaches were not resolving the dentist/chiropractor referred the patient to a certified SOT cranial practitioner who incorporated SOT TMJ and cranial care along with chiropractic manipulative reflex technique (CMRT) care to facilitate balancing his viscerosomatic reflexes.

Results: The patient responded favorably to care and noted increased/improved breathing with the right side rated at 7 out of 1-10 post-CFR treatment.  While the patient is still under dental/chiropractic care, the prior chronic and severe headaches have been profoundly resolved.

Conclusion: Two chiropractors and a dentist with dual training in dentistry and acupuncture treated this patient with a positive outcome consisting of improved breathing, reduced TMD and headaches.