Temporomandibular Joint Dysfunction (TMJ)

Manual therapy is a fundamental component of any successful TMJ protocol. All TMJ patients will experience an enhanced outcome with the inclusion of manual therapy in a comprehensive program of TMJ care.

What is TMJ?

In TMJ dysfunction, repeated clenching or grinding of the jaw causes a shortening and inflammation in the muscles of the jaw and anterior neck. This tension causes pain or neurological symptoms throughout the head and neck, which are often worse in the morning. Prolonged symptoms lead to permanent damage in the articular disc and neurologically ingrained pain patterns.

Secondary Problems Resulting from TMJ

This tension also leads to a domino-like chain effect of biomechanical problems. First, the jaw is pulled sideways or into an underbite. To correct the resulting weight imbalance, the shoulder or hip will shift contralaterally, causing a sheer on neighboring joints. Second, facilitated jaw muscles pull the head forward. With every inch the head moves forward, the weight of the head on the neck is increased by ten pounds. This dramatically increases the load on the joints and muscles of the neck and entire back. It can be attributed to pain as far away as the feet. Conversely, rotations in the pelvis can keep the neck locked into a forward position. A few clients will require work on the lower back and abdominal muscles in order to experience lasting relief from TMJ.

Treating TMJ

It has been my observation that TMJ responds best to myofascial release. The profoundly gentle nature of this work affects both the stress-related and structural components of TMJ.

The treatment begins by softening and lengthening the muscles of the throat, jaw, and upper chest. On the whole, this treatment is profoundly relaxing. Next, trigger points in numerous muscles of the posterior neck and upper back are released. Finally, work inside the mouth is performed, with the client’s consent and within his or her tolerance.

TMJ Exercises and Follow-up

After substantial symptom relief has been achieved, the client is provided with a simple exercise and stretch routine for long-term success. Periodic massage therapy is usually recommended unless the external stressor that is causing the grinding can be removed. The client is encouraged to schedule regular care as a preventative measure, rather than wait for the inevitable painful flareup. With adherence to an exercise program and lifestyle changes, some clients will experience permanent relief without the need for further therapy. Magnesium supplementation is also known to be helpful.

TMJ Treatment Protocol

— Full postural assessment to measure head position, jaw position, spinal curves, and presence of Morton’s Foot
— Jaw and neck range of motion tests
— Myofascial release to jaw, neck, and head
— Therapeutic stretch and exercise program

Referral to a neuromuscular dentist, behavioral therapist, or nutritionist may be indicated.

Symptoms of TMJ can include:

— Pain in the jaw muscles
— Pain in the neck and shoulders
— Chronic headache
— Jaw muscle stiffness
— Limited movement or locking of the jaw
— Ear pain and/or pressure
— Painful clicking, popping, or grating in the jaw joint when opening or closing the mouth
— A bite that feels “off”