Unlocking Jaw Pain with Leslie Russek, DPT, PhD

[01:46] Jennifer Milner: Welcome back to the Bendy Bodies Podcast, where we strive to improve well-being, enhance performance, and optimize career longevity for every bendy body. This is co-host Jennifer Milner here with the Hypermobility MD, Linda Bluestein.

[02:02] Dr. Linda Bluestein: We are so glad you are here to learn tips for living your best bendy life. This information is for educational purposes only and is not a substitute for medical advice.

[02:12] Jennifer Milner: Our guest today is Leslie Russek, DPT, PhD, Professor Emeritus at Clarkson University, and practicing orthopedic physical therapist specializing in hypermobility syndrome, fibromyalgia, headaches, and chronic pain. Dr. Russek, welcome to Bendy Bodies.

[02:29] Leslie Russek, DPT, PhD: Thank you for inviting me. I'm pleased to be here.

[02:32] Jennifer Milner: We're thrilled to chat with you for sure. So for our listeners who may not be familiar with you and your work, could you just tell us a little bit about yourself?

[02:41] Leslie Russek, DPT, PhD: I am a physical therapist, but most of my career I've been a physical therapy professor at Clarkson University, where I have taught musculoskeletal physical therapy. I'm semi-retired now from the university, but I continue to teach content related to hypermobility, chronic pain, and headaches and TMJ problems. I also treat patients part-time, as you noted, but I only treat patients who are hypermobile. Before hypermobility was commonly diagnosed, my specialty was headaches and TMJ problems. And that's how I got a lot of my hypermobile patients, because headaches and TMJ problems are so common in that population.

[03:24] Jennifer Milner: Okay, so that brings up a good point. You treat TMJ, you treat hypermobility. What exactly is TMJ, and why should people with hypermobility be concerned about it?

[03:36] Leslie Russek, DPT, PhD: Technically, TMJ refers to the temporomandibular joint, and we each have two of them. So everybody has two TMJs. The problem, the painful condition, is more accurately called temporomandibular disorder, or TMD. But a lot of patients know it as TMJ. So people will come in and say, "I have TMJ." It's like, I hope you have two of them. But you may also have TMD, which is the pain. So it's a common problem in hypermobility, although it certainly occurs in other people as well. But it's important because we use our jaw for talking and for chewing. And when your jaw is not working properly, that's a significant functional problem for us.
[04:19] People with hypermobility are particularly vulnerable to TMJ problems for a couple of reasons. For one, we have stretchy joints, and so the joint can move too far, and when it moves too far, it can sublux or dislocate, and that can damage the joint tissue. The TMJ has a disc or a meniscus in it, kind of like we have a meniscus in our knee, and that disc slides as we open the jaw. There are some elastic fibers that hold the disc backwards and that pull it back when we close our mouth. So we open our mouth and the disc slides forward so the jaw can move. And we close our mouth and the disc gets pulled back by those elastic fibers. People who are hypermobile probably have elastic fibers that are too stretchy and they get overstretched. And so sometimes the disc doesn't come back where it's supposed to because those elastic fibers aren't pulling back. So that's a second reason why people who are hypermobile have a lot of TMD.
[05:16] Another reason is that people with hypermobility tend to have poor body awareness or proprioception. A lot of the nerves that tell us where we are in space are in the joints. And if your joint's too stretchy, those nerves aren't giving you the correct feedback. Although the jaw joint itself hasn't been tested for proprioception, we know other joints in the body have proprioceptive deficits — that is, we don't know where our body is. And so it's pretty safe to assume that we don't know where our jaw is either. And that means those two jaw joints may not work in synchrony — one side may go forward before the other, and that can damage the tissue. Also the muscles will lack coordination. We call that motor control. And because we have the two sides of our jaws and they have to work in a coordinated fashion, if those muscles aren't coordinated properly, if you don't know where your jaw is, then you're much more vulnerable to having problems. So those are all reasons why people with hypermobility are much more vulnerable to TMD than the average person.

[06:19] Jennifer Milner: Okay. And jaw pain and TMD — are those pretty much synonymous, or can people have jaw pain from other causes? And if so, what would be some of the other causes of jaw pain?

[06:32] Leslie Russek, DPT, PhD: That's a great question. No, they're not synonymous. So you can have a temporomandibular disorder that's not painful. The disc that I mentioned before can sublux or dislocate. If it subluxes, your jaw tends to snap or crack — it goes pop, pop, pop, pop, because the disc is popping in and out when you open and close your jaw. And that can be painful or non-painful. So some people will have a clicking jaw, but it's not painful. They don't have pain, but they do have a disorder. The disc is not performing correctly. Some people may also have stiffness in the jaw. After an injury, even hypermobile people can get a stiff joint. And so one side of the jaw, once the acute phase is over, it will be stiff, but it may no longer be painful. But if one side is stiff, the jaw will move abnormally, and that'll cause problems potentially on the other side. So it is possible to have problems without pain.
[07:29] Pain without damage to the joint could be due to trigger points in the muscles, or even trigger points in some other muscles that don't connect to the jaw. So it's possible to have disorder or pain separately, but most of the time they do happen together. But some of the structures — like a muscle in the neck, the sternocleidomastoid muscle, which we affectionately call the SCM — it refers pain into the jaw. And so people who have neck problems or neck instability where that muscle develops a trigger point can have problems in their jaw. Trigger points are a common source of pain in general, and particularly with people who are hypermobile, because we tend to tense up our muscles to try to hold ourselves together. So we're using our muscles incorrectly, and so muscles can develop trigger points, which are small areas of spasm that refer pain someplace else. The SCM, for example, refers pain to the ear and the jaw, the forehead, and the back of the head. Sometimes people will come in with jaw pain being their primary symptom, even if the problem is in the neck muscle.
[08:47] Another muscle that's in the jaw, it's called the lateral pterygoid. It actually controls that disc motion. If it has a trigger point, it'll also cause jaw pain. So you could have pain in your temporomandibular joint, but the joint itself could be normal. The pain could be referred from those trigger points. There are a lot of different structures that can actually cause the pain. The joint has a joint capsule which can be inflamed; the disc and those retrodiscal tissues are very highly innervated and vascularized, so they can become inflamed and painful.
[09:31] It's also important to know that some of the jaw structures can refer pain to other places, particularly causing toothache. Some of the jaw muscles — your masseter and your temporalis — when they form trigger points, particularly for people who clench or grind, that can cause toothache. I've had patients who have actually had teeth pulled out because they thought there was a problem with their teeth, but the problem was actually the jaw muscles. And so it's important to know that a problem in the TMJ can refer to the teeth and cause a toothache, and to recognize that there might not be a problem in the tooth at all. So jaw pain is pretty complicated, can involve a lot of different causes, and problems in the jaw can refer to different areas.

[10:07] Jennifer Milner: Wow. So jaw pain is pretty complicated and can involve a lot of different causes. We know that people often have difficulty accessing people like yourself or other experts in this area. In terms of determining contributors a person might have to their jaw pain, are there any ways that a person might be able to sort that out themselves?

[10:35] Leslie Russek, DPT, PhD: Yeah, a little bit of detective work. I recommend to all my hypermobile patients that they become familiar with trigger point patterns because trigger point pain is so common. There are some really good books on the market about trigger points where they show a picture of the pain pattern. People can look through those pictures and go, "Yeah, I have pain there." And then they can read about the muscle, and sometimes they can poke at it and go, "Ooh, wow, yeah, that hurts. I didn't even know that hurt." And then they can read about or learn about some of the contributing factors.
[11:15] I always teach my patients this because it's often not hard to make pain go away. The trick is to make it so it doesn't come back. So, for example, if this neck muscle is causing the jaw pain, we have to look at why that muscle is aggravated. Well, bad posture, a forward head posture, or tipping your head too much can aggravate that muscle. So by learning about trigger points, they can learn about a lot of the sources of jaw pain.
[11:40] The disc itself is a little bit trickier. If the disc is clicking and painful, they probably need to get some advice from a professional. Physical therapists should be trained to treat the TMJ. For some reason, the TMJ has been considered different than all the rest of the joints in the body, and so some physical therapists aren't trained to treat it. But we really should be able to, because it is a joint like all the others. It's a synovial joint. It happens to have a disc. It happens to be in the head, but otherwise it responds to physical therapy treatment as well as any other joint. Some dentists are knowledgeable about TMJ problems and can be helpful, particularly for somebody who clenches and grinds — they may need a dental appliance, something they put on their teeth to prevent them from clenching. And some speech therapists are knowledgeable about temporomandibular joint problems because obviously you have to use your jaw to be able to talk. So those are some sources — both things that a person could look up themselves, and also professionals that they might be able to turn to for some guidance.

[12:54] Jennifer Milner: That's really helpful, because a lot of times people with hypermobility, as I'm sure you've experienced, feel like they do have to be their own detective a little bit, as you mentioned before. And I think the jaw is just something that we don't naturally think of and start talking about when we have hypermobility. People have so many other hypermobility issues. There are so many common comorbidities that go along with being hypermobile. Should people with hypermobility be thinking about the jaw? Should they be concerned about it and how they use it and how it aligns, if they don't have jaw pain?

[13:25] Leslie Russek, DPT, PhD: It's always a matter of prioritizing for a hypermobile person. If they have other issues that are more important, they need to focus on those. So, for example, if they have cervical instability, the jaw is less important than managing the cervical instability. Or if they can't walk because of hip pain. But if they are able to consider overall wellness — if they're not too busy putting out fires — then absolutely.
[13:51] The more you know to take care of your jaw, just like all of the joints, the better. We need to have good body mechanics and joint protection strategies. Often some basic exercising for coordination can be helpful. Knowing how to recognize signs early, before they get to be big problems, can help us to prevent or avoid injury in all of our joints. And so the jaw is no different. Things like having good jaw habits — not clenching or grinding your teeth, not chewing gum, making sure your tongue is on the roof of your mouth, that there's space between your back teeth, relaxing so you don't hold tension in your jaw or your neck, not opening your mouth too wide for dental work or for toothbrushing or for flossing — those are all habits that a person should have to take care of their jaw.
[14:51] One that's less intuitive is nose breathing. It turns out that nose breathing is really important — nose versus mouth breathing is really important for health in a lot of ways that I won't go into, but for the jaw in particular, the shape of the jaw will actually change if you are a habitual mouth breather. And so if you do breathe through your mouth, especially at nighttime when you're sleeping, that's something to work on for health in general, but also for your jaw. So definitely there are things we can do to take care of our jaw, just like we can take care of our other joints. And if you're not busy putting out fires that are more important, thinking about how you can take care of your body is always a good thing.

[15:39] Jennifer Milner: Well, and I was thinking about what you said earlier about how you could have clicking in your jaw and not really have pain with it. And so many people with hypermobility will say, "I have these clicks and pops and it doesn't bother me, it doesn't hurt, so I ignore those and I deal with the other things." But as we commonly remind people, those clicks and pops mean something. So if all the other fires are out, it's great to turn a little attention to those clicking and popping joints and see what's going on. And that includes your jaw.

[16:10] Leslie Russek, DPT, PhD: Yeah. And the clicking is a good example. The clicking usually occurs when the disc is slipping in and out, and that's separate from a clunk, which happens if you actually dislocate your jaw and it gets stuck — usually stuck open. But the clicking, even if it's not painful, every time it's clicking, you're pulling on those elastic bands behind the disc and they're getting stretched out, and that is going to be progressive. And so if you can avoid that, if you can recapture the disc, pull it back where it belongs, and then not open so wide so that it can rest where it belongs, then the tissues that hold the disc in place can hopefully go back to their normal position, and that can prevent long-term problems. So that's a good example of taking care of yourself even if it's not painful at this time.

[17:08] Jennifer Milner: And I was curious to ask about the mouth breathing, because I think that's something that probably a lot of people experience. I know I do. I have sitting right here, actually, my daytime mouthguard, my nighttime mouthguard. I've been in a lot of treatment for TMD. I'm curious how a person can train themselves not to mouth breathe.

[17:36] Leslie Russek, DPT, PhD: It's complicated, but there are a couple of strategies. First, figuring out why you breathe through your mouth. If it's sinus congestion, then you need to be able to clear your sinus congestion. Sinus congestion can be a medical issue — if you have allergies, for example. It can also be secondary to some of these trigger points. The sternocleidomastoid muscle can cause sinus congestion because the nerves that go to that muscle also go to the sinuses. So sometimes mechanically fixing your alignment can help with the sinuses.
[18:09] There are some breathing strategies that are designed to help clear the sinuses. There's a whole science of breathing called Buteyko breathing, and they have a procedure that you can do to open up the sinuses so you can breathe through your nose. I've recommended it to patients and gotten feedback from them that it is helpful. So first you have to be able to breathe through your nose. And then for some people, just being more aware of it during the daytime so that they become a nose breather during the daytime can help at nighttime. It is possible to actually tape your mouth shut, but you'd want to do that with medical guidance to make sure that you're not at risk of any other problems. So it kind of depends on why you're a mouth breather, how to address it, and it can be a multiple-step process.

[19:02] Jennifer Milner: Interesting. And what are some other practical steps that a person who has symptomatic hypermobility could take in order to help reduce their jaw pain?

[19:12] Leslie Russek, DPT, PhD: Well, working on good posture. The jaw is connected to the neck. And so if you have slouched posture, it's going to pull the jaw out of alignment and cause tension around the joint. Relaxation is also important — so you're not storing tension in your jaw. General relaxation strategies such as slow diaphragmatic breathing, mindfulness meditation, things like that can help to calm the nervous system so that we don't store so much tension in the jaw. Those are probably the two things for people who aren't symptomatic now, and they're good in general for a lot of reasons, not just the jaw. So everybody who's hypermobile should probably be addressing posture and muscle tension or muscle guarding.
[20:04] For people who have jaw pain already, there are some other things that you can do. There are some facial self-massage techniques that you can do for the jaw muscles — even for some of the muscles inside the jaw, you can massage those. A warm compress can be helpful either to the joint or the muscles. For people who have pain right in the jaw, especially if that pain is associated with a disc problem — so popping and clicking, or the joint getting stuck — some of the topical analgesics can be helpful. Something that has an anti-inflammatory medication, because the joint is right under the skin there, and so a topical medication can get into the joint and can decrease the inflammation a little bit.
[20:53] Some people would benefit from a dental appliance, like you mentioned, to prevent clenching and grinding. If you do get an appliance, make sure the dentist understands that you have temporomandibular problems, because some appliances are designed for other purposes — for example, to help adjust the teeth — and they can actually make temporomandibular problems worse. Some of the appliances pull the jaw forward, which stretches out that disc and the elastic tissues. So make sure that your dentist knows that you have temporomandibular joint pain and that the appliance will be helpful, not harmful. Don't use the drugstore version that you boil in hot water and mold to your own teeth. That tends to make things worse. So there are a lot of things that people can do that are just part of wellness, and then some things that are specific to the jaw.

[21:50] Jennifer Milner: Excellent. And I know I've heard you speak in a number of other settings and you have some great handouts. One of the handouts that you had included a mnemonic, RTTPB, that was specifically about resting jaw position. Could you explain that a little bit?

[22:08] Leslie Russek, DPT, PhD: Yeah, absolutely. I wish they thought of something a little catchier, but — so R stands for relax. Stop what you're doing. Allow the tension in your body to be released. And for somebody who tends to store tension, take a deep breath in, exhale, and try to let yourself relax while having good posture. So don't collapse, but — you're a marionette and you're hanging from a string, hanging in good alignment.
The first T is for teeth apart. Your back teeth should never touch except when you're chewing. They shouldn't spend more than a couple of minutes per day touching. So if you find your back teeth are touching, even if you're not pressing and clenching, you're holding your jaw tight. People who are hypermobile tend to do this because if we don't have good body awareness, the only way we know where we are is to press the teeth together. If your teeth tend to be touching, say the word "Emma," and when you finish the word "Emma," you'll have a little bit of what we call free space between your molars — a couple of millimeters of space. So your teeth should be slightly apart, and if you're a habitual clencher, it may take weeks for that to become a normal position for you.
[23:29] The second T refers to tongue on the roof of your mouth behind your upper teeth. Some people have tension in their tongue muscle and hold the tongue at the bottom of the mouth. Particularly if you're a mouth breather, you have to have your tongue on the bottom so you can pull your air in, and the tongue down there pulls on all sorts of structures around the jaw, the teeth, and the neck. So the tongue should be on the roof of the mouth — the clucking position.
[23:56] The P is for posture — imagining two strings, one at the top of the head and one at the sternum or breastbone, so not pulling yourself back into posture but lifting yourself so that your body hangs in good alignment. And then the B is for breathing: diaphragmatic and nose breathing, so belly breathing, not chest breathing, and breathing through your nose.
[24:22] So the RTTPB is a good mnemonic to go through a couple of times a day — relax, am I relaxed? Teeth, are my teeth touching? Where's my tongue? How am I breathing? And how's my posture? It's a good checklist of wellness for your jaw.

[24:47] Jennifer Milner: That's great. And I think our listeners all over the place actually probably went through it as you were describing it. Talking about it, I could feel myself doing some of those things. Those are nice, easy little check-ins you can do along the way for everybody to try to make sure that they have good jaw health. So going a little bit deeper than that — who should try the Rocabado 6x6 exercise program for jaw pain, and how is that best done?

[25:07] Leslie Russek, DPT, PhD: Rocabado is a very well-respected TMJ specialist who developed what he calls the 6x6 exercise program for TMJ. In general, I recommend people do it with the guidance of a health professional, but it is pretty safe to do. And for people who are hypermobile, don't do 6 repetitions 6 times per day, because that tends to be much too much for hypermobile tissue structures.
[25:43] It includes 6 exercises, and some of these are going to sound similar to what we've talked about. The first is tongue clucks — holding the tongue on the roof of your mouth and doing diaphragmatic breathing, 6 breaths. That's definitely good, and similar to our RTTPB. Number two is controlled TMJ rotation with the tongue on the roof of your mouth. Keeping the tongue on the roof of your mouth limits how far you can open the jaw. The jaw has a spin phase and a slide phase, and this is just the spin phase — it prevents the jaw from sliding forward and prevents that disc from being slid forward. So holding the tongue on the roof of your mouth and opening only a small range. Some people will benefit from putting their fingertips on their jaw to feel for symmetry, or looking in a mirror to check for symmetry — if you're wiggling side to side or going off to one side, then your coordination is not good. Feeling with your fingertips or looking in the mirror can help you develop that proprioception and motor control to be symmetric.
[26:42] The third one is the one I'm most concerned about people doing without supervision. It's a strengthening or stabilization exercise — with your teeth apart, pushing gently in all directions: right, left, down, up. For people who are hypermobile, definitely be very gentle. I recommend pushing with one or two fingers only, and it should not be painful. If it is painful, don't do it. Get professional advice.
[27:19] The next exercise is a neck exercise called cervical nodding, where you tip just the top of your head forward. This is a good exercise for a lot of people who tend to have a forward head posture — when we have forward head, the head extends on the neck, and so we're reversing that with a very gentle tuck. That one, again, if it causes any discomfort or symptoms, should be avoided. People who have severe cervical instability — sometimes that exercise can aggravate the instability.
[27:51] The next exercise is called lower cervical retraction, where often our head is carried forward, and now we're working on the lower part to straighten it out a little bit — not pulling on the head this time, but just straightening out the lower part of the neck. Again, it should be pain-free.
[28:11] And then the last one is shoulder blades — pulling your shoulder blades back so that you're not hunched forward. So these exercises help with posture, with motor control of the jaw, and with the positioning of the tongue. None of them should be painful. Do them lightly and gently. And for my patients who have TMJ problems, I recommend that they just do one set of 6 per day and definitely not 6 sets of 6 per day as the original Rocabado 6x6 recommends.

[28:46] Jennifer Milner: That is extremely helpful. Thank you for going through those. I know that with a lot of hypermobile people, we have that tendency to push, right? And to try to achieve a certain feeling or try to achieve a certain level of fatigue. And so much of the time, as you said, with our proprioception issues and so much more — less is more. And so one finger, pain-free range of motion, really small, really subtle, is so key.

[29:14] Leslie Russek, DPT, PhD: Yeah. And I always have a progression where the first step is always body awareness. You have to know where you are. It's hard to exercise correctly if you don't know where you are. People who are hypermobile tend to sort of fling their body around so that they can feel where they are — fling to the end of the range. It's like, "Yep, I can feel that I've moved," but it's often a range where we shouldn't go. So proprioception or body awareness first, with posture — you have to be aligned properly before exercises are safe. If you're not in good alignment and you do exercises, you could damage the joints. So posture, body awareness, and then motor control — making sure that you have the control to do the movement correctly — and only then should you do any strengthening or stabilization exercise.
[30:09] What goes wrong with a lot of patients who are hypermobile in physical therapy, or if they go to the gym, is that they try to jump right into doing strengthening exercises or even stabilization like core stabilization. But if you don't have good posture, body awareness, and motor control, then the exercises could do you more harm than good. And that's particularly true in the jaw.

[30:32] Jennifer Milner: We hear some version of that so many times — that before strengthening, so many other things have to come first. Posture, body awareness, proprioception — how much are we feeling it? The body alignment before we can even start to do strengthening. And that's so important. So if people have tried to do some of these things on their own and their self-management strategies are ineffective or suboptimal, how can they find someone to work with?

[31:03] Leslie Russek, DPT, PhD: Yeah, it can be tricky. There are not enough healthcare providers in general who are trained to manage patients with hypermobility, and we're certainly working to train as many people as possible. There are a lot of efforts to train more healthcare providers. If you're looking for a physical therapist, you can look for one who may have knowledge about hypermobility. The Ehlers-Danlos Society has a healthcare provider website where people who are knowledgeable about hypermobility can register, and so you can look to see if there's somebody trained in your area. Also look for somebody with TMJ training, because not every physical therapist — even if they're knowledgeable about hypermobility — will necessarily be TMD trained. Although so many patients who are hypermobile have TMJ problems that most providers who are knowledgeable about hypermobility will also be knowledgeable about TMD. For dentists, asking if they're knowledgeable about TMD is a good approach as well.

[32:21] Jennifer Milner: Those are great suggestions. And was there anything that we should have asked you that you would like to add? And also, can you let people know where they can find out more about you and your research and your work?

[32:36] Leslie Russek, DPT, PhD: Yeah. One other thing to mention is that jaw pain is a frequent comorbidity with some other common hypermobility problems. So headaches in general, migraines — although sometimes what's diagnosed as a migraine is really trigger point pain — and cervical instability, particularly upper cervical instability. I often have patients who come to me with one of those complaints, and when I ask them, "Do you have problems with your jaw?" they say, "Oh yeah." And so sometimes the headaches, migraines, or the instability issues overwhelm the jaw in terms of importance, but always checking to see if the jaw is a problem is worthwhile.
[33:19] Ringing in the ears as well — tinnitus (it's pronounced both ways) is a really common problem, and it's often associated with both jaw problems and problems with some of those same muscles. People who have tinnitus can often learn to manage it through musculoskeletal approaches. So if you tell your doctor you have ringing in your ears, they're going to prescribe medication, which just treats the symptom — it doesn't address the cause. And that's actually true for headache medications as well; they treat the symptom of the pain, they don't treat the cause. And so for people who have ringing in their ears, seeing a physical therapist and checking whether there are issues in their neck or in their jaw that may be contributing to that is worth exploring.
[34:16] People can find out more about me at my web page — that's webspace.clarkson.edu. I have a website specifically for hypermobility, and I run a Hypermobility 101 lecture series which anybody's welcome to attend via Zoom, where I go through a whole series of issues that are important to people with hypermobility, like how do you pick an appropriate exercise program or progress exercises? What are some of the causes of headaches? There are a whole bunch of additional causes of headaches that are more common in people who are hypermobile. People are welcome to view those lecture recordings or look at the slides on my website. I also have a page with handouts that I provide for patients — a lot of my handouts are there, and anybody can download those as well.

[35:17] Jennifer Milner: That is a wealth of information, and personally I can't wait to go to your website and check out some of those things. Thank you — that's really helpful for people who may not have access to a specialist in their own area. That's very generous of you to share all of that.

[35:34] Leslie Russek, DPT, PhD: Definitely.

[35:34] Jennifer Milner: We will have those links in the show notes, so if people are interested in learning more and accessing those handouts and the Hypermobility 101 series — which I'm sure lots of people will be interested in — they can definitely visit the show notes and get more information there.

[35:51] Leslie Russek, DPT, PhD: And I think you'll have the link to — there's a lecture specifically on headaches and jaw pain. And I also have a handout specifically on jaw pain, and another handout on headache trigger points. So I think you'll be including links to those as well.

[36:10] Jennifer Milner: Absolutely. Thank you. Well, you have been listening to Bendy Bodies with the Hypermobility MD, and our guest today is Dr. Leslie Russek, DPT, PhD, Professor Emeritus at Clarkson University, and practicing orthopedic physical therapist specializing in hypermobility syndrome, fibromyalgia, headaches, and chronic pain. Dr. Russek, thank you so much for sharing your time with us today and being on our podcast.

[36:36] Leslie Russek, DPT, PhD: It's been a pleasure talking with you. Thank you for having me.

[36:41] Jennifer Milner: Our audience is going to be so happy with what they learned and going to find this really super valuable, I'm sure. We are very grateful. If you love what you learned, follow the Bendy Bodies Podcast to avoid missing future episodes. Screenshot this episode and tag us in your story so we can connect. Our website is bendybodies.org. Follow us on Instagram @bendy_bodies. Leaving a review, following the Bendy Bodies Podcast, and sharing the podcast helps spread the word about hypermobility and associated conditions. This information is not intended to diagnose, treat, cure, or prevent any disease. The information shared is for educational purposes only and is not a substitute for medical advice, diagnosis, or treatment. Please refer to your local qualified health practitioner for all medical concerns. We'll catch you next time on the Bendy Bodies Podcast.