In our company, Probility Physical Therapy, we commonly do hands-on techniques called “joint mobilizations”.  These are used for when a patient has a joint that is not moving correctly due to being “stuck”, hypomobile, or out of position (subluxed).  There are also physical therapists who call these techniques manipulations and there is some ambiguity in this.  A Manipulation can be any therapeutic technique that increases the range of motion of a joint or it can be a very specific kind of mobilization – referred to as a high-velocity, low amplitude thrust (sorry for the technical terms, here).  A “thrust” technique is similar to what many chiropractors call an “adjustment”.  In the end, as far as Physical Therapists are concerned, all of these techniques are just trying to get a joint moving more normally so that a person can move their body without restriction or pain.

Joint mobilizations can be done to any joint in the body.  They can be done in multiple directions and with varying degrees of force or speed.  A mobilization can be done where a therapist takes a joint to its end-range barrier and stretches it at that point or where a therapist takes it to the end range barrier and oscillates it (gentle glides the joint back and forth).  It is important to note that joint mobilizations are DISTINCTLY different from stretching a part of the body.  A therapist who takes a part of the body and just moves it through its range as far as it can go and stretches the muscles around the joint is not mobilizing the joint – and often times this type of technique (aggressive stretching of a dysfunctional joint) simply causes compression of the joint structures and pain.

Our belief is that it is best to mobilize the joint to make sure it moves correctly, release / relax the muscles in the areas and then do stretching and muscle retraining to those same muscles.  This is basically a concept that, when a person has a dysfunction that is creating pain, you need to fix/correct the problem before you should stretch or strengthen the area.  After you correct the underlying issues that are creating the pain, then it is perfect to strengthen the heck out of the muscles to make sure it doesn’t come back!

Temporomandibular Joint dysfunction (AKA TMJ syndrome) more commonly affects women than men. Symptoms can include any of the following: jaw pain with wide opening of mouth  (i.e. to bite an apple), pain with chewing (i.e. taffy or a piece of steak), jaw clicking with opening /closing of the mouth, ear pain and/or fullness, ringing in the ear(s), neck pain, headaches.  Many people (including physicians and dentists) do not realize there is Physical Therapy treatment available for these dysfunctions.

The temporomandibular joint can become irritated from activities such as clenching or grinding of the teeth, chewing on pens/pencils, excessive gum chewing, biting fingernails, increased stress levels (which then increases tension in the neck, shoulders, face and jaw), poor posture (the head sits too far forward on the body and this affects the alignment of the neck and jaw), and/or a history of extensive orthodontia work.  The muscles which control the jaw (i.e. used for chewing) are forced to work “overtime” and thus increased stress is placed upon the joint.   There are different joint structures which can become inflamed and irritated (joint capsule, articular disc, ligaments).

Take into consideration the following: the only time our bottom teeth meet our top teeth is when we swallow.  As the teeth meet, the tongue raises up to the roof of the mouth to push the food/water back to swallow.  As we chew, there is asymmetrical activity occurring on one side of the mouth versus the other (i.e. certain teeth come into contact and others do not).  This is important to realize especially for those who clench or grind their teeth.  In both situations, the teeth are coming together for an excessive amount of time and with excessive force over time.  You can then see how this could cause dysfunction to the joint and the surrounding muscles.

If you are clenching your teeth during the day, the first step is to complete “clenching checks” throughout the day to break the habit. If you find yourself clenching your teeth: 1. place your tongue on the roof of your mouth (behind your front teeth) 2. while maintaining that tongue  up position, gently open your mouth about 50% of full opening and then return to a relaxed closed position 3. repeat this five times.  This sequence will help decrease the tendency to clench your teeth.

A mouth guard (usually made by your dentist) can be worn at night to protect your teeth and help reduce tension from teeth grinding.

Physical Therapy can help this situation in many ways.  Treatment focuses on improving joint mobility of the jaw and decreasing tender and trigger points via myofascial release and soft tissue mobilization.  These hands-on techniques help to restore normal joint mechanics and help to relax the muscles of chewing as well as surrounding neck muscles.  Your Physical Therapist (PT) will also educate you on topics such as correct posture, joint protection techniques and exercises to improve jaw motion.  Most often, headaches related to TMJ dysfunction will decrease in frequency and intensity.  In most situations a person with this dysfunction will have to work hard at staying symptom-free.  After working with your PT, you will have a new sense of awareness of your jaw, neck and posture and will have learned how to maintain optimal functioning.  For more information contact abyington@probilitypt.com.

Pilates is an exercise style that has grown significantly in the last 5-10 years and there are many good reasons for this.  It incorporates strength and stretching into almost all of the movements and is different than most other types of exercises in that it builds significant stability into your body – especially in your core – along with strength.

Exercises in Pilates can be slow and controlled or fast but they are all focused on quality of movement.  Any class that you go to should have an instructor who is watching all of the time and giving feedback on where your body is compensating around a weakness that you might have.

Common classes are mat-based but some of the fun of Pilates is the very cool/funky equipment that you may get on to stress your system and finds it’s weaknesses.  The name of some of the pieces is part of what adds to its “coolness”.  Things like the Reformer, the Trapeze, the Barrel, and the Cadillac!  Very cool!

Back to the serious stuff, some specific benefits of Pilates include:

• Improved posture
• Increased muscle tone
• Increased strength
• Increased Flexibility
• Improved overall mobility
• Increased focus on your breathing
• Improved circulation and decreased stress

As far as an adjunct to Physical Therapy, there are few better exercise styles.  Once your therapist has fixed specific dysfunctions in your system that were causing pain and gone through a progression of strength, stabilization and stretching exercises, Pilates is a natural next step.  It is a great way to stay strong or further progress your stability so that the chance of your pain coming back is very, very small.

If you cannot imagine how mere cornmeal can be turned into a tasty meal,then undoubtedly you have never eaten polenta prepared in an Italian kitchen. Once considered peasant food, polenta is now appearing in even the most elegant restaurants. Earlier in this century, polenta was a staple food eaten out of necessity, sometimes two or three times a day. Some families would dump a big mound of polenta onto a board, and everyone would sit around sharing it. It would be flavored with broth, a little sauce, vegetables or sausages. Polenta is still a staple in many homes in northern Italy today, particularly in the regions of Veneto, Piedmont, and Tuscany, although generally considered “home cooking” and not served for company.

Polenta has had a reputation for lengthy and extremely laborious cooking that originates in its Italian roots. Throughout history polenta was cooked over a wood fire in a central hearth or on a wood stove in a traditional curved bottom copper pot with a long handle called a paiolo. Copper was preferred as it conducts heat evenly, and the curved bottom of the pot exposed a greater portion of the cornmeal to the heat which insured there was no corners for the polenta to get stuck in and allowed for even cooking. The long handle of the pot kept the cook a comfortable distance from both the fire as well as the sputtering cornmeal. Constant stirring with a long-handled paddle, stick, or spoon was necessary to keep the polenta from burning. Today, there are very few of us that still cook over a wood fire, and our heavy bottomed cookware and modern stoves that have burners we can maintain at a constant low heat, allow us to let the polenta simmer away on its own with just occasional stirring to prevent lumps.

Polenta can be creamy, served soft with a scoop of sauce, or firm served as a side dish to grilled or roasted meats, or stirred into soups and stews to thicken and add flavor. Whatever way you choose to eat polenta, the basic principles of preparation remain the same. Although you now can buy instant polenta that can be prepared in under 5 minutes, or even precooked polenta ready to be sliced and fried or grilled, I find the effort it takes to prepare polenta the old fashioned way to be the best.

Basic Polenta Recipe

6 Cups Cold Water

1 Tablespoon Salt

1 Cup Cornmeal

3 Tablespoons Butter

2 Ounces Grated Parmesan Cheese

Bring the water to a boil in a medium saucepan. Add the salt and reduce the heat to medium low. As soon as the water begins to simmer, start pouring in the cornmeal in a thin stream, very slowly while stirring constantly with a wooden spoon to prevent lumps. Once all the cornmeal has been added, keep the water at a simmer, and stir frequently. It should take between 25-30 minutes to fully cook the polenta. Once cooked, the polenta should pull away from the sides of the pot easily. Just before it has completely cooked, stir in the butter and the cheese. Once your polenta is finished cooking, you can serve it the following ways:

Soft Polenta: Use polenta directly out of the pot, topped with sauce or vegetables as desired.

Firm Polenta: Once completely cooked, pour onto a wooden board or a greased baking sheet about 2 inches thick and allow to set. Cut into squares and serve as desired.

Grilled Polenta: Cut firm polenta into squares, brush with oil and grill lightly on both sides.

Fried Polenta: Cut the firm polenta into slices and fry in a few inches of hot oil until golden brown and crispy.

Now that you have the basics of polenta mastered, why not try a few recipes? One of my family favorites is soft polenta served with a tasty tomato sauce as shown in the photo below. Sprinkle on some freshly grated parmesan, and you have a hearty meal. You might try cooking polenta with greens as in the popular recipe Polenta Verde Calabrese. Add grilled sausages for a very tasty, filling meal. You can even use polenta in place of pasta in a lasagne-like dish, layered with sauce and cheese in Polenta Pasticciata. If you prefer a simpler polenta preparation, what could be better than grilled polenta and vegetables?

Old Calabrian Proverb: “If you want your polenta to taste good, only add the flour when the water is singing!”

Recipe compliments of Italian Food Forever