Jaw problems often due to ligament damage

OUCH: 19th century engraving of a dislocated jaw. PICTURE / GETTY IMAGES

A couple of weeks ago I had the privilege of standing up in front of a group of dentists in Wellington, a veritable dragons' den if you will.
I pitched to them the idea that the problem with the jaw is more ligamental as anything, rather than the teeth, or the muscles, and that it is not mental to think outside the square.
As I prepared my powerpoint slides, I discovered more amazing facts and truths about the ligaments which were too good to save up for your next ligament injury.
Firstly we should be clear on what a ligament is. All of you will be familiar with Gray's Anatomy. The Gray's Anatomy that I refer does not have chapters on the Islets of Meredith, or the Foramen of McDreamy. This is the classic text that the TV series Grey's Anatomy is making money off, probably for free due to a swap out of A for E in the title.
All ligaments are tough, inelastic and unyielding. They are support structures. However they also exhibit an elasticity, or a pliability that allows the joint they support to move with freedom and creativity. To injure a ligament is called a sprain. This is exclusive to ligaments. Strain is for the muscles. Contusion is mostly for the muscles. Fracture is for the bones, and so on.
The ligaments can be external to the joint, or part of the structure, either strut-like or emulating a 'brassard'. I am quoting from the 1953 version of the tome. A brassard is like the captain's armband in a sports team, so it's a wraparound structure.
The jaw joint is an example of what happens to a ligament that has been injured and left to heal without some expert advice or input. Maybe you sprained it playing rugby, or the airbag deployed on your face in a car accident, or perhaps you had to have your wisdom teeth out which causes your jaw to be severely tested. Whichever the mode of force delivery, the ligaments can be sprained and then begin a longer season of healing.
Traditionally jaw sprains are managed with a very conservative approach, but the ligaments are largely left to heal on their own without much intervention. Muscles are massaged and strengthened but it isn't enough to restore a joint to its former abilities. The ligaments must be directly treated. If this doesn't happen in the healing season, then the ligaments can heal less than fit for purpose. It may take years to come to light, but a ligament poorly rehabilitated can cause trouble years down the line in jaws, and in other joints as well.
It comes down to the issues in the tissues. Healing tissue is different to original tissue. It is known as scar tissue and it is a blank canvas. You can take the blank canvas as-is, and hang it on the wall, or you can do something with it and turn it into a work of art. Perhaps you could contract an artist to work on your blank canvas, for example a physiotherapist!
So what has changed from original ligament to repaired ligament? Firstly the microscopic bands that run the length of the ligament become smaller. Collagen, which is the building material, which was nicely organised, becomes disorganised. Think combed hair versus bed hair. The collagen, once aligned and densely packed together, now has more spaces in between. In between the fibres of collagen are small linkages holding the structure together and giving it resistance to pulling forces across the ligament. These cross links become fragile and are a cheap replacement. The collagen of bone, tendon and ligament is called type one collagen. Very structural and fit for purpose. Scar tissue has less of this.
It sounds like healing tissue is a raw deal, however the hand you are dealt post injury can be improved. You could just hold on to your cards, but the chances of reinjury or ongoing problems will be quite high. Think of the avid sports participant who rolls their ankle and would walk over hot coals to play again in a few days. They might strap up the injury, slap on a brace and take a bunch of meds, and this may seem to pay off. How many people do you know who do this and then have their annual ankle sprain, or have a bad knee that they cannot trust?The faulty jaw is an example of years of misuse on scarred ligament structures.
Eventually the clicking starts, or you suddenly hurt to yawn. You can't bite an apple, maybe.
In all these cases there are things we can do after ligament injury to come close to having a pristine original ligament.
All of these things are encapsulated in what physios do. Returning the ligament to its best possible strength and length, and in the case of ankles and knees, putting them through strength and balance challenges to be able to guarantee you get to enjoy a full season of sports.
The catch is you have a sacrifice to choose. Time off play. Time on rehab.
Ligamental as anything might have their own song called Heal it Up: "how can you play looking at those tears (ligament tears come in three grades from minor grade one to full ruptures at three) don't you know it's worth the wait to heal ... hey there you with the injured face, come up to my clinic and heal it up ... you on the sideline, give up your pride, fine let's heal it up." [Very clever: Ed]
As for the dragons den(tists), I emerged unscathed and won the approval of many and have seen two Wellingtonians already.
I think our town can benefit from medical tourism! Think of the catchphrase surgeons: Whanganui, well worth the gurney ...
Greg Bell is a physiotherapist practising at Bell Physiotherapy. www.bellphysio.co.nz