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Rehabilitation: Living With Pain, Letting It Go

Alyssa Paul has spent most of her 25 years in pain, ranging from mild to severe. But now, after intensive work over a few months with Dr. Charles Ferzli at the TMJ & Sleep Therapy Centre of Raleigh-Durham in Cary, she is blissfully pain-free.

Dr. Ferzli (left), Clinical Assistant Amelia Fuquay, and patient Alyssa Paul.

“Frankly, I was at my wit’s end,” she says. “I would clench and grind my teeth extremely at night, to the point where I would wake up in the morning and it would be difficult to get my jaw to function. It took a few minutes of intensive massage to get my jaw to work in a normal way. I had been dealing with this problem for at least 10 years.

“In fact, my dentist told me a long time ago that I had ‘an open bite,’ meaning that my front upper teeth did not line up appropriately with my bottom teeth which was causing a lot of painful problems.

“Fortunately, my sister, who lives in Lincoln, Nebraska, convinced me to engage in Postural Restoration with a physical therapist in Southern Pines—she’s part of the network. That therapist, in turn, referred me to Dr. Ferzli who at the time, by chance, was taking classes in postural restoration with them.

Dr. Ferzli conducts part of the motor nerve reflex test, which tests the autonomic system.

“The work with Dr. Ferzli has been amazing” Ms. Paul says. “He explained—after extensive testing, step by step, in great detail—exactly what was wrong with me and exactly what we needed to do to fix an array of problems. He was the first provider to let me know that I had severe TMJ—temporomandibular joint disorder—and I came to understand that I needed to engage in extensive restorative work or I would be stuck with painful, difficult TMJ issues for the rest of my life.

“Bless Dr. Ferzli, after hours of testing, he took the time to explain to me, in plain English, exactly what was going on in my body, head to toe, and what we needed to do to return the entire system to healthy balance.
“He was passionate about continuing my physical therapy exercises, and he encouraged me to see an ENT doctor to make sure that I had healthy function in my nose and throat. I did a sleep study to better understand what was happening to my entire system while sleeping. Dr. Ferzli was not simply concerned about the condition of my jaw, he was interested in my overall well-being, including my diet, in a comprehensive way that was a new experience for me.”

Clinical Assistant Amelia Fuquay evaluating Alyssa Paul.


Notes Dr. Ferzli, “We finally got this person better—with the help of her physical therapist—and successfully addressed issues that included back pain, jaw pain, teeth grinding, and jaw joint noises. We made her orthotics for daytime use and different orthotics for nighttime, because she needed them. Progress was slow. I found out that she liked to go running in the morning, and felt horrible after her run. And she had trouble lifting heavy boxes, which her work required. These are meaningful clues about what was going on in her body.

“Over time, and with treatment, she started feeling better. We came to realize that she was still not breathing properly, and referred her to an ENT specialist for a nasal evaluation. She could not open wide, and we gave her a few exercises to help improve her range of movement. Once we stabilized her jaw, her physical therapist was able to improve range of movement with her neck. The exercises they provided allowed her to feel better longer.

“There are three issues that affect your posture: Your vision, which affects how balanced you are; your jaw joint; and your feet. So we identified that the jaw joint and the feet were affecting her posture and head and neck symptoms the most. She wore a toe spacer for a while, and then she got orthotics and tennis shoes from the physical therapist that overnight changed the way she felt.”

Steady Progress

This becomes the story of a patient with significant issues and therapeutic needs who makes steady progress over time, notes Dr. Ferzli. “Once the healing takes place, we want to see if the patient can do well without the support of appliances—as long as they wear the nighttime appliance to decompress their joints and reduce inflammation during sleep. These are patients who are no longer in a chronic state of pain.

“Once we are able to get this patient to a comfortable place, we can wean her off dental appliances. It’s very much like hurting your knee; you wear a brace until the knee is healed, and then you remove the brace to walk. You don’t keep the brace on the rest of your life. You don’t want to keep a daytime orthotic in place, either. Once the inflammation in the TMJ area was gone, Alyssa no longer needed her daytime dental appliance.

“We try to wean patients off such dental appliances after 10 to 12 weeks. Otherwise there might be some irreversible changes in the jaw joint that would cause the bite to be forever off and the patient would need orthodontic treatment.”