TMD: Diagnosis and Treatment
Temporomandibular Dysfunction (TMD) is a common condition affecting the temporomandibular joint (TMJ) and impairing functions such as opening and closing of the jaw, chewing, and talking. The TMJ, located in front of the ear, is a sliding hinge joint, with attachments from the chewing muscles as well as neck muscles. TMD is considered a musculoskeletal disorder much like knee or shoulder pain, but is also impacted by the alignment of the teeth and the spine. The function of the TMJ can be compromised by a number of factors.
What are the causes of jaw pain and temporomandibular dysfunction?
Factors impacting TMD:
- Postural dysfunction
- Upper cervical spine dysfunction
- Bruxism (jaw clenching or grinding)
- Malocclusion (poor alignment of the teeth)
- Arthritis of the TMJ
- Jaw trauma
- Intra-articular Disc Displacement
How can I help my own jaw pain?
Temporomandiblar dysfunction is impacted by a number of different factors. Some of which you can address fairly easily on you own. More skilled interventions such as jaw mobilizations are best left to a physical therapist. Here are few areas that you can make changes that will likely impact your symptoms positively:
Posture Correction – Forward head posture places increased force on the back of the jaw joint which is a common culprit in the generation of jaw pain. You can demonstrate this concept to yourself with a quick, easy exercise. Sit tall with your head stacked as depicted in the picture on the left, then push your jaw forward to make an under bite. You will notice that this moves with relative ease. Now exaggerate a slumped position like the picture on the right, then try to push your jaw forward again. You will likely notice a bit more tension and difficulty with efforts to push your jaw forward. This fascial pull present with forward head posture will generate more baseline compression of the TMJ along with increased pain. Whenever you find yourself in a slumped position for driving or computer work, the inherent tension of the neck muscles will pull and compress your jaw adversely.
Small changes in daily positioning habits can be helpful as well. Sleeping on the stomach will tend to push the jaw to the side creating asymmetric forces. The jaw muscles will usually try to correct this by tightening. For TMJ pain, it is best to sleep with a supportive pillow in sidelying or on your back. If you tend to be a stomach sleeper and wake frequently with jaw pain, then addressing this position is a good idea. If you have a hard time not rolling onto your stomach while sleeping you can try wearing a t-shirt with a breast pocket and placing a tennis ball in the pocket. Resting your chin on your first for reading or computer work will also produce extra compression on the jaw joints. Efforts to reduce the time you spend in these positions will pay dividends.
Reducing Jaw Clenching – Clenching during the day is one of the main causes of extra compression on the TMJ and extra tension on the chewing muscles such as the temporalis and the masseter. At rest your tongue should rest lightly on the top of the mouth. Clenching is considered to be any time your teeth are touching at rest and your tongue is lying on the bottom of the mouth. This will add compression to the TMJ and tension to the jaw muscles contributing to both facets of TMD. Another sure sign of jaw clenching is the appearance of a scalloped tongue in the morning or during the day. It is difficult to down train jaw clenching tendencies, but can be done with some formal exercise and consistent attention. See the following handouts for a good start. (LINK for jaw floating protocol)
Reducing Jaw muscle tightness – Addressing jaw clenching is a good first step, but the chewing muscle of the jaw are often riddled with trigger points and muscle knots. Addressing this yourself can help with pain and will also help to reduce overall facial tension and jaw clenching proclivities. The most common two culprits for facial pain are the masseter and temporalis muscles. You can stretch and release these yourself with a few simple techniques. (LINK for facial stretches)
Where the previous few techniques and efforts can be helpful in improving symptoms and jaw function, there is often underlying stiffness and mobility deficits of the jaw joint and the closely related cervical spine. Addressing these issues is most effectively and safely performed by a physical therapist with training in jaw treatment.
How can PT help with TMJ pain?
Improving Neck Movement– Upper cervical mobility can impact the motion and positioning of the jaw. There is a high association between TMD and neck pain. Dysfunction of the upper cervical spine can produce pain in the face and jaw similar to the symptoms commonly associated with TMD. Treatment involves manual therapy to restore motion to these joints and exercises to reinforce improved movement patterns.
Improving Jaw Movement – Mobility restrictions in the jaw muscles, tendons, and ligaments can produce deviations with opening that cause repetitive stress injury to these tissues. Interventions to address this include mobilization of the TMJ as well as soft tissue mobilization of the facial and intra-oral muscles. To ensure a thorough diagnosis and for additional information, schedule an appointment at our Seattle-based physical therapy office
Dustin Steffan, DPT is a physical therapist in Seattle who specializes in orthopedic and sports rehabilitation with a focus on temporomandilbar dysfunction.