Temporomandibular joint disorder (TMJ) refers to a condition that affects the jaw joint and surrounding muscles. It causes pain and discomfort, making it difficult to chew, speak, and even open or close the mouth. While traditional treatments for TMJ often involve medication or surgery, many people are exploring alternative options such as chiropractic care.
Chiropractors are healthcare professionals who specialize in diagnosing and treating musculoskeletal conditions. They use non-invasive techniques to restore proper movement and function to the spine and other joints in the body. As TMJ is a disorder that affects the jaw joint, chiropractors may be able to provide relief and alleviate symptoms associated with TMJ.
Through manual adjustments, chiropractors can help realign the jaw joint and surrounding structures. They will perform a thorough examination to assess the extent of the misalignment and develop a treatment plan specific to the individual’s needs. Chiropractic care for TMJ aims to reduce pain and inflammation, improve jaw mobility, and restore normal function.
The Role of Chiropractors in TMJ Treatment
Chiropractors play a crucial role in the treatment of temporomandibular joint disorder (TMJ). TMJ is a condition that affects the function and movement of the jaw joint and the surrounding muscles. It can cause pain, discomfort, and difficulty in opening and closing the mouth.
Chiropractic care focuses on the alignment and function of the musculoskeletal system, including the spine, muscles, and joints. By addressing the underlying factors contributing to TMJ, chiropractors can effectively relieve symptoms and improve overall jaw function.
One of the main causes of TMJ is misalignment of the jaw joint or the surrounding structures. Chiropractors are trained to identify and correct these misalignments through manual adjustments. By gently manipulating the jaw joints and surrounding muscles, they can restore proper alignment and relieve pressure on the joint.
In addition to adjustments, chiropractors may also use other techniques such as massage, stretching exercises, and heat or cold therapy to relieve muscle tension, reduce inflammation, and promote healing. They may also provide guidance on exercises and lifestyle modifications to improve jaw function and prevent future episodes of TMJ.
It is important to note that chiropractic care is not a standalone treatment for TMJ. Chiropractors may work in conjunction with other healthcare professionals, such as dentists or physical therapists, to provide a comprehensive treatment plan that addresses all aspects of TMJ.
If you are experiencing symptoms of TMJ, it is important to consult with a chiropractor who specializes in jaw disorders. They can assess your condition, determine the underlying causes, and develop a personalized treatment plan to help alleviate your symptoms and improve your quality of life.
Understanding TMJ and its Causes
The temporomandibular joint (TMJ) is the joint that connects your jaw to your skull. It allows you to move your jaw up and down, side to side, and back and forth, allowing you to speak, eat, yawn, and perform various other functions.
TMJ disorders occur when there is a problem with the muscles, ligaments, or joints in the TMJ. There are several potential causes of TMJ disorders, including:
1. Teeth Grinding
Teeth grinding, also known as bruxism, can put excessive stress on the TMJ. This can lead to pain, clicking or popping sounds, and difficulty opening or closing the mouth properly.
2. Jaw Injury
An injury to the jaw, such as a blow to the face or whiplash, can cause damage to the TMJ and lead to TMJ disorders. This is common in car accidents or contact sports.
3. Misalignment of the Jaw
A misaligned jaw, also known as malocclusion, can put strain on the TMJ, leading to TMJ disorders. This can be caused by an overbite, underbite, or crossbite.
Arthritis, such as rheumatoid arthritis or osteoarthritis, can affect the TMJ and lead to TMJ disorders. This is more common in older adults.
Treating TMJ disorders can be complex and may require a multidisciplinary approach. While chiropractors can help with certain aspects of TMJ treatment, it is important to consult with a healthcare professional, such as a dentist or oral surgeon, for a comprehensive evaluation and treatment plan.
Symptoms and Diagnosis of TMJ
Temporomandibular joint disorder, commonly referred to as TMJ, is a condition that affects the jaw joint and muscles involved in chewing and speaking. While chiropractors are not typically involved in the direct treatment of TMJ, understanding the symptoms and contributing factors can help in its diagnosis. Here are some common symptoms and indications of TMJ:
– Jaw pain or discomfort: TMJ can cause recurring pain in the jaw joint area, ranging from mild to severe. This pain can make it difficult to open or close the mouth properly.
– Clicking or popping sounds: One of the hallmark signs of TMJ is a clicking or popping sound when moving the jaw. This is often accompanied by a sensation of the jaw getting stuck or locked in a certain position.
– Headaches and earaches: TMJ can cause referred pain in other regions of the head, such as headaches or earaches. This can be a result of the interconnected nerves and muscles in the jaw and head area.
– Facial swelling or tenderness: Some individuals with TMJ may experience swelling or tenderness in the face, particularly around the jaw joint area.
– Difficulty chewing or speaking: TMJ can make it challenging to chew food or speak properly. This can lead to issues such as limited dietary choices or difficulties in communicating clearly.
Diagnosing TMJ involves a thorough examination of the jaw joint and surrounding tissues. Chiropractors, although not directly involved in the treatment of TMJ, can help identify if there are any misalignments or imbalances in the spine that may be contributing to the symptoms. They can also refer patients to other healthcare providers, such as dentists or oral surgeons, who specialize in the diagnosis and treatment of TMJ.
In conclusion, while chiropractors may not treat TMJ directly, they can play a role in its diagnosis by assessing the overall spinal health and referring patients to the appropriate healthcare professionals. Identifying TMJ symptoms early on can be crucial in preventing further complications and guiding patients towards effective treatment options.
Chiropractic Approach to TMJ
TMJ is a condition that affects the temporomandibular joint, which is responsible for the movement of the jaw. It can cause pain, stiffness, and difficulty in eating or speaking. While chiropractors primarily focus on treating issues related to the spine, they can also play a role in managing TMJ.
Chiropractic care for TMJ involves a holistic approach that aims to identify and address the underlying causes of the condition. Chiropractors use non-invasive techniques to realign the jaw joint and surrounding structures, relieving tension and reducing pain.
During a chiropractic session, the chiropractor will perform a thorough examination to assess the alignment of the spine and jaw. They may use manual adjustments to correct any misalignments and improve the function of the temporomandibular joint. These adjustments can help alleviate the symptoms of TMJ and improve overall jaw mobility.
In addition to manual adjustments, chiropractors may also use other modalities to treat TMJ. These can include soft tissue massage, stretching exercises, and electrical stimulation to relax the muscles and promote healing.
Chiropractic care for TMJ can be an effective and natural alternative to other treatment options such as medications or surgery. By addressing the root causes of TMJ, chiropractors can help patients find long-term relief from their symptoms and improve their quality of life.
Benefits of Chiropractic Care for TMJ
TMJ, or temporomandibular joint disorder, can cause pain, discomfort, and limited mobility in the jaw. While there are various treatment options available, including surgery and medication, chiropractic care can also provide significant benefits for those suffering from TMJ.
1. Non-Invasive Treatment
Chiropractic care offers a non-invasive, drug-free approach to treating TMJ. Instead of relying on surgical interventions or pain medication, chiropractors use manual adjustments to realign the spine and jaw. This can help reduce inflammation, relieve pain, and improve the function of the temporomandibular joint.
2. Addressing the Root Cause
Chiropractors understand that TMJ may stem from misalignments in the spine or jaw. By focusing on the alignment of the spine and other areas of the body, chiropractic care aims to address the root cause of TMJ. Instead of merely treating the symptoms, chiropractors work to correct the underlying issues that may be contributing to the disorder.
During a chiropractic session for TMJ, the chiropractor may perform adjustments to the jaw, neck, and spine to promote proper alignment and alleviate pressure on the temporomandibular joint. These adjustments can help restore balance and functionality to the jaw, reducing pain and discomfort.
It’s important to note that chiropractic care for TMJ should be done by a licensed chiropractor with expertise in treating the disorder. They can evaluate your condition, determine the best course of action, and provide targeted adjustments to alleviate TMJ symptoms.
Overall, chiropractic care can be a beneficial treatment option for those suffering from TMJ. By providing non-invasive, drug-free treatments that address the root cause of the disorder, chiropractors can help individuals find relief from TMJ pain and improve their quality of life.
Chiropractic Techniques for TMJ Relief
Chiropractors are healthcare professionals who specialize in the diagnosis and treatment of neuromuscular disorders, including temporomandibular joint (TMJ) disorders. TMJ disorders can cause pain and discomfort in the jaw, face, and neck, making it difficult to eat, speak, or open and close the mouth properly.
Chiropractors use various techniques to provide relief for patients suffering from TMJ disorders. One common technique is spinal manipulation, also known as chiropractic adjustment. During this procedure, the chiropractor applies controlled force to the joints of the spine to restore range of motion and alleviate pain.
Chiropractic Techniques for TMJ Relief
Another technique used by chiropractors for TMJ relief is soft tissue manipulation. This involves applying pressure to the muscles in the jaw and neck to release tension and reduce pain. Chiropractors may also use stretching exercises and recommend lifestyle changes, such as diet and stress management, to help alleviate TMJ symptoms.
In addition to these techniques, chiropractors may use ultrasound therapy, heat or cold therapy, and electrical stimulation to provide relief for TMJ. These modalities can help reduce inflammation, improve blood flow, and promote healing in the affected area.
It is important to note that while chiropractic care can be beneficial for TMJ relief, it is not a cure-all solution. In some cases, the underlying cause of TMJ may require additional treatment, such as dental work or orthodontics. Therefore, it is important to consult with a healthcare professional, such as a chiropractor or dentist, to determine the most appropriate treatment plan for your specific TMJ condition.
If you are experiencing TMJ pain and discomfort, consider consulting with a chiropractor who specializes in TMJ disorders. They can assess your condition and recommend the most effective chiropractic techniques for TMJ relief tailored to your individual needs.
Customized Treatment Plans for TMJ
Chiropractors are well-equipped to treat TMJ (Temporomandibular Joint Disorder) and can provide customized treatment plans to address the specific needs of patients suffering from this condition.
When it comes to TMJ, chiropractors understand that each patient is unique and may require different approaches to effectively manage their symptoms. They take into account various factors such as the severity of the disorder, the patient’s medical history, and their lifestyle to develop a personalized treatment plan.
Chiropractic care for TMJ often involves a combination of therapies, including spinal adjustments, soft tissue mobilization, and exercises to improve jaw mobility and alignment. Chiropractors may also recommend lifestyle modifications, such as stress reduction techniques and dietary changes, to help alleviate TMJ symptoms.
During an initial consultation, a chiropractor will conduct a thorough examination to assess the patient’s jaw function, posture, and overall musculoskeletal health. This helps them identify any imbalances or dysfunctions that may be contributing to TMJ. Based on their findings, they will develop a tailored treatment plan that aims to restore proper jaw alignment and function.
Regular chiropractic visits are important for patients with TMJ, especially in the initial stages of treatment. Chiropractors may recommend frequent adjustments to gradually correct any misalignments in the jaw and relieve pain and discomfort. As the patient progresses, the frequency of visits may decrease, and the treatment plan may evolve to focus more on maintenance and prevention.
In addition to chiropractic care, chiropractors may collaborate with other healthcare professionals, such as dentists or physical therapists, to ensure comprehensive and holistic treatment for TMJ. This interdisciplinary approach can help address any underlying dental issues or muscular imbalances that may be exacerbating TMJ.
It is important to note that while chiropractic care can be highly beneficial for many individuals with TMJ, the effectiveness of the treatment may vary from person to person. It is always recommended to consult with a qualified chiropractor to determine the best course of action for managing TMJ symptoms.
Collaborative Care with Dentists
When it comes to treating TMJ, a collaborative approach between chiropractors and dentists can be highly beneficial. Chiropractors are experts in spinal manipulation and can help alleviate the pain and discomfort associated with TMJ. However, dentists play a crucial role in diagnosing and treating the underlying dental issues that can contribute to TMJ.
By working together, chiropractors and dentists can develop a comprehensive treatment plan that addresses both the musculoskeletal and dental aspects of TMJ. Chiropractors can focus on adjusting the spine and muscles to improve alignment and reduce tension, while dentists can address issues such as teeth grinding, malocclusion, or misalignment that may be contributing to TMJ symptoms.
Through open communication and collaboration, chiropractors and dentists can ensure that patients receive the most effective and appropriate care for TMJ. This may involve sharing information about the patient’s symptoms, treatment progress, and any necessary adjustments to the treatment plan.
By combining their expertise, chiropractors and dentists can provide a holistic approach to treating TMJ, addressing both the structural and dental factors that contribute to the condition. This collaborative care approach can lead to improved outcomes and a better quality of life for patients suffering from TMJ.
Myths and Misconceptions about Chiropractic and TMJ
When it comes to treating TMJ, there are several myths and misconceptions surrounding chiropractic care. Here are some of the most common misconceptions:
- Chiropractic care can’t treat TMJ: One of the most prevalent myths about chiropractic care is that it is ineffective in treating TMJ. However, chiropractors can play a significant role in managing TMJ symptoms by addressing misalignments in the jaw, neck, and spine, which can contribute to TMJ pain and dysfunction.
- Chiropractic adjustments can worsen TMJ: Some people believe that chiropractic adjustments can aggravate TMJ symptoms. However, chiropractors are trained to perform gentle and specific adjustments that target the root causes of TMJ, helping to alleviate pain and improve jaw function.
- Chiropractic care is painful: Another misconception is that chiropractic care is a painful treatment option. In reality, chiropractors use various techniques that are gentle, non-invasive, and tailored to each patient’s unique needs. They prioritize patient comfort throughout the process.
- Chiropractic care is a temporary solution: Some individuals believe that chiropractic care provides only temporary relief for TMJ. However, chiropractors focus on correcting the underlying issues contributing to TMJ, which can lead to long-lasting improvements and help prevent future flare-ups.
- Chiropractic care is not supported by scientific evidence: There is a misconception that chiropractic care for TMJ lacks scientific evidence to support its effectiveness. However, research has shown that chiropractic treatments, such as spinal manipulation, can reduce TMJ symptoms and improve jaw mobility.
It is important to separate fact from fiction when it comes to chiropractic care and TMJ. Consulting with a qualified chiropractor can provide valuable insights and a personalized treatment plan to address your TMJ concerns.
Research and Studies on Chiropractic and TMJ
There have been several research studies conducted to investigate the effectiveness of chiropractic treatment for temporomandibular joint (TMJ) disorders. These studies have provided valuable insights into the benefits of chiropractic care in managing TMJ-related symptoms.
In a study published in the Journal of Manipulative and Physiological Therapeutics, researchers found that chiropractic treatment resulted in a significant improvement in pain, jaw movement, and overall function in patients with TMJ disorders. The study concluded that chiropractic care can be an effective treatment option for TMJ-related symptoms.
Another study published in the Journal of Oral Rehabilitation compared the effectiveness of chiropractic treatment to traditional medical care for TMJ disorders. The results showed that chiropractic treatment was more effective in reducing pain and improving jaw function compared to conventional medical care.
A systematic review and meta-analysis published in the Journal of Manipulative and Physiological Therapeutics analyzed the data from multiple studies on chiropractic treatment for TMJ disorders. The review found that chiropractic care consistently led to significant improvements in pain, jaw movement, and quality of life in patients with TMJ-related symptoms.
|Journal of Manipulative and Physiological Therapeutics
|Significant improvement in pain, jaw movement, and overall function
|Journal of Oral Rehabilitation
|Chiropractic treatment more effective in reducing pain and improving jaw function compared to conventional medical care
|Journal of Manipulative and Physiological Therapeutics
|Chiropractic care consistently led to significant improvements in pain, jaw movement, and quality of life
These research studies suggest that chiropractic treatment can be a safe and effective option for individuals suffering from TMJ disorders. It is important to note that each case is unique, and an individualized treatment plan should be developed in consultation with a qualified chiropractor.
Choosing a Qualified Chiropractor for TMJ
When seeking treatment for TMJ (Temporomandibular Joint) disorder, it is important to find a chiropractor who specializes in treating this specific condition. Not all chiropractors have the necessary knowledge and experience to effectively treat TMJ.
Here are some factors to consider when choosing a qualified chiropractor for TMJ:
- Specialization: Look for a chiropractor who has extensive experience in treating TMJ. They should be knowledgeable about the condition and its underlying causes.
- Training and Certifications: Check the chiropractor’s qualifications and certifications. Look for additional training or education in TMJ treatments.
- Referrals and Recommendations: Seek referrals and recommendations from trusted sources such as friends, family, or healthcare professionals. Ask them if they have had success with a chiropractor in treating TMJ.
- Experience: A chiropractor with several years of experience in treating TMJ is likely to have a higher success rate in providing effective treatments.
- Communication Skills: Choose a chiropractor who listens to your concerns and communicates clearly about the treatment plan. They should be able to explain the techniques and procedures they use for TMJ treatment.
- Reviews and Testimonials: Read online reviews and testimonials from other patients who have received TMJ treatment from the chiropractor. Pay attention to their experiences and outcomes.
- Cost and Insurance Coverage: Consider the cost of treatment and whether the chiropractor accepts your insurance. It is important to find a chiropractor who offers affordable options for TMJ treatment.
By carefully considering these factors, you can choose a qualified chiropractor who specializes in treating TMJ. Remember, finding the right chiropractor is crucial for effective treatment and long-term management of TMJ disorder.
Expected Results and Recovery Time for TMJ
When seeking treatment for TMJ, many people wonder what kind of results to expect and how long it will take to fully recover. Chiropractors are one type of healthcare professional who can help treat TMJ and provide relief from its symptoms.
It is important to keep in mind that the results and recovery time may vary from person to person, as everyone’s condition is unique. However, chiropractic treatment for TMJ typically aims to reduce pain and inflammation, restore joint mobility, and improve overall jaw function.
The expected results of chiropractic treatment for TMJ can include:
- Decreased pain and discomfort in the jaw, face, and neck
- Improved range of motion in the jaw
- Reduced clicking, popping, or locking of the jaw joint
- Decreased muscle stiffness and tension
- Improved ability to chew and speak without pain
The recovery time for TMJ can vary depending on the severity of the condition and the individual’s response to treatment. Some people may experience noticeable improvements within a few weeks of starting chiropractic care, while others may require several months of treatment to achieve optimal results.
During the recovery process, it is important to follow the chiropractor’s recommendations and treatment plan, which may include regular adjustments, therapeutic exercises, and lifestyle modifications. They may also provide guidance on self-care techniques and home exercises to promote healing and prevent future flare-ups.
|Factors Affecting Recovery Time for TMJ
Severity of the TMJ condition
The more severe the TMJ condition, the longer recovery time may be needed.
Consistency of treatment
Regular and consistent chiropractic care can speed up the recovery process.
Individual response to treatment
Each individual may respond differently to chiropractic treatment, which can affect the recovery time.
Overall, chiropractic treatment can be an effective option for managing and treating TMJ. Consulting with a qualified chiropractor can help determine the expected results and recovery time based on an individual’s specific condition.
Preventing TMJ with Chiropractic Care
Chiropractors are trained healthcare professionals who specialize in diagnosing and treating disorders of the musculoskeletal system, including the temporomandibular joint (TMJ). TMJ refers to a condition that causes pain and dysfunction in the jaw joint and surrounding muscles.
Chiropractic care can play a crucial role in preventing TMJ by addressing the underlying musculoskeletal issues that contribute to the condition. Chiropractors use a variety of manual adjustment techniques to correct misalignments in the spine, neck, and jaw that can lead to TMJ.
During a chiropractic evaluation for TMJ, the chiropractor will perform a thorough examination of your spine, neck, and jaw to identify any misalignments or imbalances. They will also assess your posture and jaw alignment to determine the root cause of your TMJ symptoms.
If misalignments or imbalances are detected, your chiropractor will employ specific adjustments to realign the affected joints and restore proper function. These adjustments may involve gentle manipulation of the jaw joint, the neck, or the spine, depending on the individual case.
Chiropractic care for TMJ not only addresses the immediate symptoms but also works towards long-term prevention. Chiropractors provide patients with exercises and stretches to strengthen the muscles surrounding the jaw joint and improve overall posture. They may also recommend lifestyle modifications, such as stress reduction techniques and dietary changes, to alleviate jaw tension.
It is important to understand that chiropractic care is just one part of a comprehensive treatment plan for TMJ. Depending on the severity of your condition, your chiropractor may collaborate with other healthcare professionals, such as dentists or physical therapists, to provide the best possible care.
In conclusion, chiropractic care can be an effective method for preventing TMJ by addressing the underlying musculoskeletal issues that contribute to the condition. Through adjustments, exercises, and lifestyle modifications, chiropractors strive to achieve long-term relief and improved jaw function.
Alternative Treatments for TMJ
While chiropractors are often seen as one of the go-to options for treating TMJ (temporomandibular joint) disorders, there are also alternative treatments that can provide relief for those suffering from TMJ pain and discomfort.
Acupuncture is an alternative treatment that involves the insertion of thin needles into specific points on the body. It is believed to help regulate the flow of energy and promote healing. Some studies have shown that acupuncture can be effective in reducing pain and improving jaw function in TMJ patients.
2. Physical Therapy
Physical therapy can be a beneficial treatment option for TMJ. A physical therapist can work with you to develop a personalized exercise program to strengthen the jaw muscles, improve mobility, and alleviate pain. They may also use techniques such as heat or cold therapy, ultrasound, or manual therapy to help relax the muscles and promote healing.
It’s important to note that these alternative treatments should be used in conjunction with, or as a supplement to, traditional medical treatments for TMJ. Consult with your healthcare provider or a TMJ specialist to determine the best course of treatment for your specific condition.
Questions to Ask Your Chiropractor about TMJ
When seeking treatment for TMJ, it’s important to ask your chiropractor specific questions to ensure they can effectively treat your condition. Here are some questions you can ask:
1. Can you treat TMJ?
Not all chiropractors specialize in the treatment of TMJ. It’s important to confirm that your chiropractor has experience and expertise in treating this condition.
2. What methods and techniques do you use to treat TMJ?
Chiropractors may use a variety of methods and techniques to treat TMJ. It’s important to understand the specific approach your chiropractor will take and how it aligns with your treatment goals.
3. How long will the treatment take?
Understanding the expected duration of treatment can help you plan your schedule and manage your expectations. Your chiropractor should be able to provide an estimated timeline based on your individual case.
4. What can I expect during the treatment process?
It’s helpful to have a clear understanding of what the treatment process will entail. Your chiropractor should be able to explain the steps involved and any potential side effects or discomfort you may experience.
5. Are there any lifestyle changes or exercises I should consider?
In addition to chiropractic adjustments, lifestyle changes and exercises may be recommended to support the treatment of TMJ. Ask your chiropractor for specific recommendations that can help you manage your condition.
By asking these questions, you can ensure that your chiropractor is equipped to effectively treat your TMJ and provide you with the support and guidance you need throughout the treatment process.
Can chiropractors effectively treat TMJ?
Yes, chiropractors can effectively treat TMJ. They use chiropractic adjustments and other complementary therapies to relieve symptoms and improve jaw function.
What types of chiropractic treatments are commonly used for TMJ?
Chiropractors commonly use chiropractic adjustments, soft tissue therapy, and exercises to treat TMJ. They may also recommend lifestyle changes and stress management techniques.
How long does it take for chiropractic treatment to show results for TMJ?
The duration of chiropractic treatment for TMJ can vary depending on the severity of the condition and individual response to treatment. Some patients may experience improvement in symptoms within a few sessions, while others may require ongoing treatment over several weeks or months.
Are chiropractic treatments for TMJ covered by insurance?
Insurance coverage for chiropractic treatments for TMJ can vary. It is recommended to contact your insurance provider to determine the extent of your coverage and any potential out-of-pocket expenses.
What are the benefits of seeing a chiropractor for TMJ instead of a dentist or other healthcare provider?
Chiropractors are trained to assess and treat the musculoskeletal system, including the jaw. They can provide non-invasive and drug-free treatment options for TMJ, focusing on the underlying causes of the condition rather than just symptom management. Chiropractic care may also be more cost-effective compared to other healthcare providers.
Can chiropractors help with TMJ pain?
Yes, chiropractors can help with TMJ pain. Chiropractic adjustments can be beneficial in relieving tension and improving alignment in the jaw, which can reduce TMJ symptoms.
What is TMJ?
TMJ stands for temporomandibular joint disorder. It is a condition that affects the jaw joint and can cause pain, stiffness, and difficulty in jaw movement.
How do chiropractors treat TMJ?
Chiropractors treat TMJ by using techniques such as manual adjustments, soft tissue therapy, and exercises to improve jaw alignment and reduce muscle tension.
Can chiropractic treatment completely cure TMJ?
Chiropractic treatment can help to alleviate TMJ symptoms, but it may not completely cure the condition. The effectiveness of treatment depends on the individual and the severity of their TMJ disorder.
What are some exercises that can help with TMJ pain?
Some exercises that can help with TMJ pain include jaw stretches, tongue exercises, and gentle massage of the jaw muscles. These exercises can help to improve jaw mobility and reduce muscle tension.