The temporomandibular joints (TMJs) are located at the connection point of the jawbones and the temporal bone of the skull, at both sides of the face, just in front of the ears. In addition to these bones, the muscles we use to chew and open/close our mouths connect here, and there is also a small disc (the ‘articular disc’) located between the bones that provides cushioning for the joint (like the disc tissue found between the vertebrae of our spines).
What makes the TMJ disc unique is that it is the only disc in the body that has the ability to regenerate! This is due in part to exceptional blood perfusion(blood flow), which helps it to heal if it becomes injured or irritated/inflamed. Given the vital importance of these joints to eating and therefore survival, it’s perhaps not surprising that they are so robustly built and actively repaired by the body. Despite this, like with all other joints in the body, inflammation and dysfunction can arise in the TMJ.
TMJ dysfunction (known as ‘TMD’) is a condition involving pain in the jaw joints and/or surrounding muscles. This condition can result in significant loss of function whereby chewing, opening and yawning can be limited and/or painful. It can involve both sides, or one side only. Other symptoms associated with TMD include jaw noises such as clicking or crunching, intermittent locking while opening or closing the mouth, headaches (often experienced at the ‘temples’ or temporal areas at the sides of the head), and neck pain or stiffness. Symptoms of jaw pain and stiffness are often worse first thing in the morning and during/after eating.
WHY DO PEOPLE GET TEMPOROMANDIBULAR JOINT DYSFUNCTION?
There are several habits that can irritate the TMJ and lead to the development of Temporomandibular Joint Dysfunction (TMD). Specific ‘oral behaviours’ that tend to be associated with this condition include:
- Sleeping “wrong”: Sleeping in a position that puts pressure on the jaw or clenching / grinding the teeth while asleep.
- Prolonged teeth contact: Clenching or grinding the teeth or holding teeth together for prolonged periods.
- Prolonged jaw activation: Tensing or clenching jaw muscles without bringing teeth together, holding the jaw forward or to the side, pressing the tongue forcibly against the teeth for prolonged periods.
- Postural irritation: Leaning with a hand on the jaw, cupping or resting the chin in the hand, holding a phone between your head and shoulders for prolonged periods.
- Eating overuse: Chewing food on one side only, chewing gum or frequently eating food between meals which requires a lot of chewing.
- Lifestyle overuse: Playing a musical instrument involving the mouth or jaw (woodwind, brass, string instruments), sustained periods of singing, or sustained talking for long periods of time.
- Yawning with a wide opening.
PHYSIOTHERAPY TREATMENT FORTMJ PAIN AND DYSFUNCTION TYPICALLY INCLUDES:
- Hands-on manual therapy to restore pain-free range of motion at the TMJ, off-load the irritated TMJ disc, and enable proper gliding at the joint.
- Hands-on soft tissue massage and stretching of tight jaw and neck muscles.
- Training in jaw relaxation techniques to enable tight chewing muscles to release excessive tension.
- Dry needling or acupuncture to address any trigger points in jaw muscles and reduce pain.
- Strengthening exercises to address muscle imbalances of jaw muscles, and to correct faulty motor patterning of the jaw during opening and/or closing movements.
- Advice on sleeping positioning, chewing patterning and diet, temporarily modifying food size or texture to decrease stress to the jaw, allowing recovery.
- Postural strategies for decreasing strain on the jaw due to postural factors (addressing any positioning/ergonomic factors due to workstation set-up, forward head posture, etc).
- Treatment of the neck and back (and even the pelvis in some cases!). Joint restrictions found in these areas can adversely impact the position of the jaw and movement patterns in some individuals.
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