Agree with much of the above. In addition to other comments; a vertical and anterior compressed AC joint will perputate upper trapezius and sub-occipital tension. If present, treat with an inferior force applied to the acromion in a slightly lateral direction direction also, say 30 degrees. Maintain for 5 minutes. I do this with a folded wash cloth on the shouder and kneel under a table and lift my shoulder into the table. You may add cervical side bending inopposite direction. To move acromion/scapula posteriorly; with folded wash cloth in front of shoulder contact thaanterior portion of the acromion against an outside corner of a wall and lean into the wall for 5 minutes.
Agree with comments re ribs, very critical to test them especially the 1st, 2nd and 3rd as stated earlier the sympathetic chain is fascially attached to the rib heads and sympathetic innervation of head and neck is at those upper segments. The 1st rib can do so much more than is taught. It certainly can get stuck inferiorlyand this is horrible! Can compress medially and this will lock up C7-T1. I evaluate and treat all potential directions if the mobility is impaired and treat both sides and include the manubrium and sternum and costal cartilage anteriorly using standard principles of manual therapy.
I too share the same concern as an earlier clinician regarding the accessory motion of the upper cervical spine. If cleared for unilateral dysfunction, you are then ready to look into bilateral (no-rotatory, non side-glide) mobility impairment, specifically anterior and posterior glide. The mandible can be glided anteriorly on one side or bilaterally. 01, C1, C2, C3 can be glided AP, PA. Stay away from carotid contact! The C2 movement is "paradoxical" in that in flexion it can extend and the opposite is true. It can behave like a circular washer. Test with C spine in full flexion and have client perform anterior glides, posterior glides and if extension has been cleared do same in extension. This is an effective way to treat the paradoxical accessory motion at C2.
I could go on and on but will wrap this up. The upper 3 cervical segments join up with the trigeminal nucleus and trigeminal plexus within the spinal cord, this is called the cervico-trigeminal nucleus. Thus an upper cervical nerve irritation can enhance muscle tension in the masticatory system and evade diagnosis, be misdiagnosed as TMJD, or of course can be concomitant to the TMJD.
In addition to the usual unilateral TMJ mobilization, I treat bilaterally with mandible in varying degrees of opening, treating anterior traction (clasp lower teeth and anterior mandible) or posterior glide (push on anterior mandible) andperform anterior traction to the angle of the mandible bilaterally. That is also a great place to work on myofascial release.
A quick comment on traction to the 01-C1 joint. Contact is on the temples, because that joint is anterior to all the other joints in the neck. Very very gentle traction for 2-5 minutes. An occipital contact will only compress the 01-C1 joints!
All the above comments I hope are additive to the previous commentaries, many good valid points brought up by previous posts. I think there are other professions who can deal with the nightmares better than our profession. Trauma can also deplete the body of micro nutrients, something I learned empirically. Caution is advised though, everyone has advice here, everone is a nutritional "expert" everyone is your best friend when you are ready to buy supplements, etc.
Better go.
Jerry Hesch, MHS, PT
Splintek.com makes an affordable splint, worthy of consideration. Some of the dental splints are immorally priced. I once paid $2,400.00! It was ineffective.