Do you ever find it difficult to chew or yawn due to pain, clicking or locking in your jaws? Do you suffer from headaches, neck pain, ringing or stuffiness in the ears? A common source of many of these symptoms is from the temporo-mandibular joint, better known as TMJ or TMD (temporo-mandibular disorder). TMJ issues and are often undiagnosed or not treated, which leads to severe pain and significantly limited function with eating, talking, and other common functions.
The TMJ is located just in front of the ears on each side of your face, where the jaw meets the skull. The joint is supported by a number of muscles, cartilage, ligaments and an intra-joint disk that allows the joint to move and adapt to a variety of motions.
Jaw pain and clicking can come from any one of these structures, but most commonly the pain comes from the muscles around the joint or abnormal stress or degenerative changes to the small disk in the joint during opening and closing. Posture, neck mobility and muscle balance around the jaw and neck play an important role in proper function of the joint.
This disorder is called TMD by physicians, or Temporomandibular Joint Disorder.
There are many proposed causes for TMD. One of the most common of these is any history of trauma, fracture or blow to the chin or jaw.
It is proposed that these type of injuries are the start of many jaw problems that surface later in life. These injuries commonly occur in children with normal play and sports and are often not painful in the jaw at the time of injury.
Repetitive grinding of the teeth, also known as bruxism, and clenching of the jaw during sleep are also a common cause of TMD. Patients who do this are often not aware of these habits unless discovered by a dentist due to abnormal wear patterns on the teeth or by a family member who hears it.
Habitual gum chewing and nail biting are often causes of jaw pain due to the repetitive stress.
Many dental problems associated with mal-occlusion or misalignment of their teeth can cause abnormal wear and tear to the joint. It is also very common for patients with high levels of stress and anxiety to suffer from TMD due to frequent grinding or clenching of their teeth
Very often, patients diagnosed with TMD are told they must resign themselves to “living with” their condition, or having extremely risky and expensive jaw surgery. But knowledge of the causes of TMD are helping qualified physical therapists discover how muscle and joint remobilization techniques can dramatically decrease the symptoms related to TMD, and in some cases eliminate most of the headaches related to the disorder.
Manual physical therapy includes hands on techniques to improve joint motion and reduce muscle stiffness, trigger points around the jaw to alleviate stress on the disk and joint. These mobilizations are used to help the disk move in a normal way, decrease pain, and increase motion.
Specific manual therapy procedures are designed to help reduce a “lock”; of the jaw due to a displaced disk. Specific exercises are then prescribed to control and restore motion at the jaw and help re-educate the muscles surrounding the joint.
Soft tissue mobilization techniques are hands on techniques that are focused at the muscles around the jaw to reduce the trigger points and tenderness. Eventually, over time, the joints around your jaw will re-learn its proper motion, and the pain and discomfort associated with TMD will dramatically decrease or completely disappear.
If bruxism (night time clenching of the jaw and/or grinding of teeth) is a part of your problem, a Results therapist may also recommend a consult with a qualified dental therapist. They may determine that your recovery would be more complete if you used a custom-fitted mouthguard at night. A mouth guard, or splint, will ensure that when you clench your teeth at night, your teeth don’t touch and the pressure you are enacting won’t translate to your temporomandibular joint.
Trigger Point Dry Needling therapy is another treatment offered by physical therapists that has been shown to be effective in treating these trigger points. TDN can target very specific muscles in your jaw that are contracting and causing your jaw to misalign — and often cause headaches. If effective, TDN will release the muscle spasm and your jaw will immediately return to a relaxed state.
A thorough examination of your posture, upper neck and shoulder girdle is imperative to proper treatment of the TMJ due to the significant influence these areas have on the joint.
A recent study found that 44% of patients with cervicogenic headache had TMD. This study also showed that manual therapy techniques directed at the jaw showed significantly decreased headache intensities and increased neck function after the treatment.
The upper neck is very commonly found to be involved in patients with many of these symptoms. Sometimes the upper neck is found to be the primary source of the ear, jaw or headache pain.
Muscle stiffness in the neck and shoulders now quite common with those who work at a computer all day can refer pain and tension to the muscles in your face. This causes headaches common with TMD, but also can unknowingly force the jaw muscles to contract both during the day and at night. Constant muscle contraction will eventually force the jawbone and joints out of proper alignment, which is what causes the clicking, “catch,” or even locked jaw commonly associated with TMD.
We will be happy to work in conjunction with your dentist or physician for the most comprehensive treatment possible. If necessary we can also refer you to a dentist who commonly treats TMD. Most health insurances now allow individuals to self-refer to physical therapy without a referral from a physician or dentist.