Tuesday, 26 March 2013

Face Pain - Rosy Cheeks

Good morning and welcome to the forth installment of the Face Pain series.

Over the past two posts I promised different things for today's issue, so I am going with the original: Help for pian around the eyes and cheeks, and then we can go to the throat and neck later in the week. I apologize for the confusion as a couple of people have pulled me up on it, and quite rightly too!

Where Your Masseter Is 

We looked at the Masseter muscle a while back in the Head and Neck Pain series, (if you click the link you will find out about it half way down the page). The Masseter is the cheek muscle that goes all rosy when you are in the cold and the one that gives the face a beautiful rounded appearance when we smile. As it exerts 140 pounds worth of pressure when we bite down I have always seen it as a very powerful little bit of tissue and because of this it needs a lot of care and attention.

Pain Patterns And Case Study

The pain your Masseter produces can give you a false toothache in the back of the mouth, cheek pain and earache, problems in the TMJ as well as issues with opening your mouth. (I have also read that it can cause tinnitus, but it's generally assumed that the main muscle for that is the sternocleidomastoid.) In Clare Davies' book, The Trigger Point Therapy Work Book (second edition), there is a wonderful case study presented on page 67:

Gilbert showing off his cheeks!
The Masseter Muscle. 
"Mary, age twenty-nine, was a dentist who was frustrated in the treatment of some of her patients who complained of tooth pain but had no problems that she could find. She also had a pain in her own jaws and in her own perfectly healthy teeth. She suspected the pain was myofascial but she didn't feel competent to diagnose or treat it. In dental school, they'd been told about  trigger points but hadn't spent much time on them. 
A clue to Mary's own trouble lay in the chronic headaches and neck pain that she had suffered from dental school, caused by leaning over all day and twisting to look into mouths. 
The strain of her work had caused trigger points in her sternocleidomastoid muscles, which in turn were generating secondary trigger points in her masseter muscles. Her headache were coming from her sternocleidomastoids, but the pain in her jaws and teeth from her masseters."

The reason I like this case study about Mary is that it not only tells us clearly where pain is based and how it can be stimulated, but it also shows that pain is rarely just one muscle that is causing the problem; it is a link between the structures that therapists and clients have to address. We need to see the story of the how the body is moving to understand how the pain has developed and where it could be.

If you have face pain that is based around the eyes, then working the masseter may help you quite a bit. One pain path that trigger points produce from this muscle is around the whole eye, under it as well as the actual eye brow. So, if you are constantly trying to pinch your eyebrows or stroking your sinuses under your eyes to try to get the pain to go away, then Clare Davies suggests that you may want to massage your masseter instead.

How to treat it at home. 

Masseter massage goes hand in had with your Pterigoid massage from the first blog.

  • With a clean hand (!) rest the palm of your hand against the opposite cheek so that the fingers are pointing towards your ear. 
  • Slip your thumb into your mouth so it is between the teeth and the fleshy part of the cheek and now close your mouth. (This allows you to massage both the superficial and deep layers of the muscle.)
  • Gentle press the fingers and thumb together, making sure that you can feel the pressure but it's not a pinch. 
  • Now massage around the whole cheek, finding out the where the tender parts are, gently pressing them until the pain dissipates, or the volume of the pain goes down. 
  • Work around the whole area on both sides twice a day and see if it helps the pain you are feeling. 

Thursday, 21 March 2013

Quick Up Date

On the train to Aberystwyth!
Photo taken by Jeremy, my brother. 
Hello, I just wanted to give you a quick up date and let you know that I haven't forgotten you! Over the past couple of weeks I have been traveling around the U.K by train and car and did not take my laptop or reference books. The net result is the fact that I am a week behind writing the next in the series of Face Pain.

The next installment will hit your screens next Monday when we will be checking out how treatment to the area around the neck will not only help pain relating to the face, but also how we can help unlock the tightness that is often felt in the voice.

We shall be hitting trigger points and muscle tightness around the Hyoids and Platysma. So get ready to make monster faces in the mirror, getting to know little stretches you can do at your desk and making sure your muscle based face pain is taken care of!

I look forward to hitting the books with you in a few days time.


Monday, 4 March 2013

Face Pain - Turning A Scowl To A Smile.

There is an interesting phenomena that I see in the treatment room on a weekly basis; that if the 2D effect. 

Clients will often speak in terms of front and back pain, but very rarely do I hear people talk about the 3D aspect of the body where all plains are taken into account. Today we are going to be looking at the front and back of the head and how they can effect stress and pain in the face. 

The next blog we are looking at the sides of the face. 

The first muscle today that we are going to get to know is tiny, but can cause direct pain in the centre of the forehead. It's time to meet your Procerus. 

Procerus is the muscle that brings the skin down the nose and helps to join the eyebrows together. It's the classic scowler!  Procerus is known to many Skin Care Therapists as it is the little muscle between the eyebrows where a lot of our clients worry about deep lines, tension, and facial pain. Massage is often advised around the bridge of the nose, the area between the eyebrows and the forehead to release this muscle. It works together with a couple of others; Corrugator Supercilii and Levator Labii Superioris Alaeque Nasi, which sound funky, but are really very small and tissue paper thin found in your eyebrows and by your nose. 

The irony about facial pain is it is commonly caused by other pain which causes us to wince and scowl. It's very natural to do so when something in the body or mind hurt as we are fighting something that is within us and unseen by others. We are attacking an invader and so our face shows that we are upset about the war we are waging and cross at the fact that we have to do it in the first place. This is the fact that lies behind the reason that people in chronic pain, (whether it be brought on through braking bones, tissue based problems, a bad marriage or a tough time at work) often look cross. In fact, often they are not cross at most of life or the people that they interact with at all, they are simply concentrating on getting through their day as best they can. 

Next up is Occipitofrontalis which is actually four bits of muscle tissue that are connected through the Galea Aponeurotica which is a band of fascia. So, lets break that down a bit. 

Frontalis is on your forehead and when you scowl or crease your forehead up, this beauty contracts and creates the horizontal lines that are common enough to see on any commuter train on a Monday morning! It has a close relationship to the Procerus and the other muscles around there, so they are linked often in the facial pain they create. There are two bellies to the muscle, one each side of the forehead, and they not only help us scowl, but they also bring the eyebrows up in a look of surprise. If you want to use just one, then try bring one eyebrow up as if you are trying to look like Spock! 

The Occipitalis are two muscle bellies at both sides of the back of the scull, being connected with Frontalis through the facial band of the Galea Aponeurotica. If you simply run your hands from the eyebrows, over the head and stop at the bump at the base of your head you are traveling the railroad tracks that create the Occipitofrontalis. 

Personally I find that I have a near permanent crease between my eyebrows and it got really bad last year. I wasn't in pain, I was studying a lot and my concentration levels where quite high. I found that I was creasing up and getting pain in the back of my head (also posture related) and headaches in to my face. One thing that helped to shift it was massage! I did it every evening when I did my night time skin care routine and it did help ease it enough to help me get to sleep. 

This next tip comes form Jacqueline, my Mum, who told me that when she feels her forehead crease this helps to allow the whole face to relax, release and revive: 
  • Lie down so that you are comfortable and allow the whole body to settle. Take a minute or so to stop fidgeting, itching, checking the time etc. Just lie down ... chill out.
  • Now start to breath steadily, but a bit deeper than normal so that you are using your whole lung, rather than panic breathing your life away! 
  • Now think about where your facial pain is. Name it either out load or in your head. 
  • Very gently and slowly start to let the jaw relax and release, let the tension slide away, feel each facial muscle let go of its tension. Tension is not needed and not wanted, so get rid of it! 
  • After a few minutes, maybe around five or ten, allow yourself to think about the pain that you named at the beginning and see if it is less intense. 
  • Here is the gem; allow your muscles to lift your face up slowly into a smile! 
  • Enjoy the feeling of your face and thoughts being up and positive, rather than tense and creased. 
I hope you enjoy some chill out time and that your facial pain eases up. Join me next time as we delve into the muscles around the eyes and cheeks. 

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