TMJ- How Can Physical Therapy Help?

TMJ vs. TMD

Patients are often told that they have TMJ when complaining of pain in the jaw region however this is misleading because the TMJ is actually the acronym for the Temporomandibular Joint- the joint between the mandible bone (jaw bone) and the temporal bone (skull bone). When one presents with pain in this region, a better term would be temporomandibular dysfunction (TMD).

Symptoms of TMD

  • Pain in the face, ear, TMJ, Facial muscles and neck can be symptoms of TMD.
  • Pain may be acute-occurring suddenly, or chronic pain that may have been present for years.
  • Pain may be constant where the person always feels some pain at any given time or may come and go.
  • Trismus, the restriction of normal mouth opening, may also be present and can be caused by joint restrictions or muscle tension.
  • Patients may also notice a deviation of the jaw to one side with opening and closing
  • Headaches are a common symptom of TMD.

 

TMJ Anatomy


The Temporomandibular joint is the connection between the convex slope of the articular eminence of the temporal bone (skull) and the convex condyle of the mandible (jaw bone). Because a convex on convex joint surface is unstable, a biconcave disc sits between the articular eminence and the condyle. This disc acts as a stabilizer of the joint and a shock absorber. The joint is further stabilized by ligaments and joint capsule.

TMJ Mechanics


Two joint movement occur with mouth opening. First the condyle will rotate on the disc and then the condyle (with the disc) will translate forward on the articular eminence of temporal bone. With closing, movement occurs inreverse order. Problems can occur when not enough of the rotation occurs and there is excessive translation.

Muscles of Mastication


The masseter (deep and superficial heads), temporalis and the lateral pterygoid muscles are responsible for chewing and mouth closure. These muscles can become hyperactive due to poor postural habits, bad oral habits such as nail biting, pen chewing etc and with bite problems. If these muscles are hyperactive than compression of the TMJ can occur as well as pain from muscle trigger points.

Bruxism or Clenching


Bruxism is overactivity of the muscles of mastication. This can result from stress, bad oral habits (nail biting, penchewing, lip/cheek biting, clenching and grinding), and can lead to headaches, face pain, and jaw pain.

Trauma


TMD could result from trauma such as a blow to the face, a fall on the chin, or whiplash resulting in muscle overactivity and possible joint disturbances- eventually leading to arthritic changes.

TMJ Hypermobility


The term hypermobility is used when a joint is too “loose” and patients that are hypermobile throughout the body may often develop pain due to over stretching or excessive motion of the TMJs. The ligaments and tissue supporting the jaw become too loose leading to poor stability of the jaw possibly contributing to dislocation or subluxation of the TMJ. If a patient has hypermobility throughout the body, then it is important to learn proper head and spinal posture to maintain a neutral position of the TMJ to allow for better stability and learn the limits of mouth opening to prevent over stretching the TMJs and reduce the risk of disc displacement.

TMD Management


TMD can involve many factors and management of the problem is more realistic than a quick fix. In order to manage the problem, the patient with TMD must understand why symptoms are occurring and how to minimize the cause.Management may include postural exercises, simple daily exercises to reduce tension in the neck and face, suspension of bad oral habits, breathing exercises/meditation to reduce stress, and limiting the amount of hard food eaten to reduce compression forces on the TMJ. Additionally, mouth guards and/or dental work may be necessary to correct bite problems/bruxism.

TMJ Evaluation

During your evaluation, the TMJ specialists at Spectrum Physical Therapy will take your history and ask about the causes of pain and other symptoms as well as questions about dental work history.

Posture from head to toe is evaluated to have a better understanding of the base in which your jaw sits and facial bone symmetry is assessed. Joint mobility testing of the neck, upper back and TMJs is performed for an understanding of your mechanics and identification of any joint dysfunction. Soft tissues in the head, neck, shoulders and upper back are assessed to determine activity and tenderness/trigger points of muscle tissue.

Following your evaluation, you will be given a physical therapy diagnosis and a comprehensive explanation of your therapist’s findings and discuss your plan of care for treatment, including a home exercise program.

Treatment for TMD, Headaches and Neck Pain

 

  • Joint mobilization techniques to restore proper joint mechanics of the TMJ/neck/back and ROM.
  • Dry needling of trigger points within the facial, neck and shoulder muscles to reduce acute and chronic myofascial pain and restore normal jaw and muscle function.
  • Soft tissue mobilization to improve soft tissue tension and ROM. Self treatment techniques taught so you can manage your symptoms.
  • Education about proper posture and oral habits, as well as self treatment techniques and exercises for self management.
  • Facial exercises to decrease the tension in your facial muscles
  • Postural exercises to promote proper head and spinal alignment
  • Breathing exercises to restore diaphragmatic breathing and help with relaxation.

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