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TROUBLE IN A JOINT LIKE THIS TMJ, A JAW DISORDER, MAKES MILLIONS SUFFER

LYNN DERRY saw nine doctors and specialists before she found one who could help her.

By then she had spent eight years in pain from a condition that few understood and fewer thought could be relieved.

It's called TMJ, which is short for temporomandibular joint disorder. TMJ is commonly described as a disorder of the jaw where the joint may be strained or misaligned, causing a range of symptoms. People with TMJ may suffer jaw-clicking, headaches, earaches, toothaches and pain in the jaw, neck or back.

This is not an obscure problem. Of the estimated 45 million people who suffer serious headaches, 10 million may be able to blame their jawbones, says Paula Mackowiak, a physical therapist in Hamburg who has just published a book on TMJ.

Some doctors and dentists don't understand the condition and may tell patients they will just have to live with the pain, Ms. Mackowiak says. They see TMJ primarily as a difficult dental problem.

But Ms. Mackowiak, who was the specialist who finally helped Mrs. Derry to feel better, has a different approach to TMJ.

"TMJ is not a dental problem," she says. "It's rebellious of me to say, but it's the truth."

Many experts disagree with her.

"Her viewpoints are extremely controversial," says Dr. Norman D. Mohl, a professor of oral medicine at the University at Buffalo.

"There's no question her point of view has a role in this field. But the first referral should be to a dentist who is trained to diagnose temporomandibular disorders."

Ms. Mackowiak believes most patients diagnosed as having TMJ are suffering from muscular or skeletal problems that can be relieved through physical therapy. The jaw is supported by the spine, and if that support is altered even slightly it can set off a chain reaction of symptoms, from headaches to lower back pain.

Proper posture and skilled massages can go a long way toward easing the pain, she says.

"It's often not a jaw problem at all, even though the pain is there," Ms. Mackowiak says.

While much of the literature on TMJ comes from dentists, Ms. Mackowiak's paperback book, "Relief of Pain From Headaches & TMJ" (Manhattan Printing, $11.95), is one of the first accounts from a physical therapist, offering an account of how TMJ relates to the whole body.

Mrs. Derry, 35, a vice president of a local store chain, says her TMJ took the form of muscle spasms in her neck and head, a burning feeling in those muscles, a feeling her ears were plugged and headaches that would last for months.

A dentist diagnosed her condition, but his treatments over two years did nothing for her headaches, she says.

TMJ patients report dramatic disruptions of their lives. Some say they can't eat, sleep or work the way they used to. Some are reluctant to plan trips or major family events for fear they will be laid up in bed when the time comes. Pain medication often doesn't help.

Most TMJ patients are women; scientists can't account for the disorder's gender bias. Ms. Mackowiak suggests women may use certain strategies more than men for coping with stress, such as clenching the jaw or shoulders, and these have been linked to TMJ.

Mrs. Derry says her headaches began to disappear shortly after undergoing Ms. Mackowiak's care, and she says she hasn't had a headache in seven months. But, Ms. Mackowiak cautions, TMJ may never be erased completely. "We don't cure this," she says. "We manage it."

Moreover, physical therapy can't be used in a vacuum. TMJ's chief characteristic is its complex array of symptoms, and dealing with the disease may depend on finding the right combination of treatment.

Treatment by dentists, physicians, chiropractors, oral surgeons and biofeedback experts may be necessary, Ms Mackowiak says.

Often Ms. Mackowiak finds that a traumatic incident, such as a car accident, may have set off the disorder. As the body compensates for the shock of the accident, it makes subtle adjustments of muscle and posture that can blow up into TMJ, Ms. Mackowiak says.

But the origins can be much more mundane, she says. A stressed office worker who slouches, grinds his teeth and lifts with his back, not his legs, may be a candidate for the longest headache of his life.

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