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How to solve pain in the jaw - TMJ Dysfunction
Problems with the jaw and surrounding soft tissues can create a multitude of uncomfortable, and sometimes debilitating symptoms for one in four of us. The umbrella term to describe these symptoms is TMJ or TMD, Temporomandibular Joint Dysfunction. This busy joint is an essential part of daily life; the complex and small sliding hinge joint connects our jawbone to our skull, making it possible for us to talk, chew and laugh with which I think we can all agree are basic but vital components to living a happy life!
In this article I would like to detail the many symptoms of TMJ as well as look at how massage techniques can alleviate the inconvenient and painful effects, and importantly the causes, of the dysfunction.
Signs of TMD range from mild and almost unnoticeable sensations, to acute or chronic pains that severely impact the quality of day to day living.
Pain in the muscles of mastication and/or in the joint itself
Radiating pain in the face, neck, behind the eye or around the sinuses
Clicking or grinding noises when open and closing the mouth
Reduced range of movement in the joint
Headaches or migraines
Bruxism (grinding of the teeth)
Tight neck and/or shoulders
Tinnitus or undiagnosed ear pain
Malocclusion i.e misalignment of the teeth when closing.
Not only is the reality of being in regular discomfort irritating, but the pain consequently affects quality of sleep, mood and productivity, which in turn exasperates the symptoms. Untreated pain symptoms may then go on to “provoke a demand for postural adaptation” as the body adjusts to cope with the pain and any imbalances, creating knock on reactions elsewhere in the body. Therefore, it is important to address these symptoms as early as possible.
NHS advice suggests eating soft foods, taking pain killers and holding ice packs or heat packs on the joint. Further more, extreme suggestions from independent health care providers range from botox to provide partial paralysis of the mastication muscles, Cerezen—a device fitted into the ear canal—and surgery. Dentists can offer bite guards and bite adjustments to relieve the grinding habit, as well as splints to provide short or long term relief that focuses on creating an optimal bite position.
All of these treatments can offer some relief, but mainly from the symptoms and not the causes.
So what are the causes of TMD? As noted in the Journal of Oral Rehabilitation, “The causes of TMD include structural (e.g., skeletal, neural, muscular), functional (e.g., posture, lifestyle), and psychological (e.g., stress) factors, or any combination of these factors .
In my experience of treating TMD these listed factors never act in solitude. Predominantly, those who I have seen presenting with TMD symptoms have been the protagonist in a story combining all three components. For example, the functional demands of an eight-hour-desk-day in a fast paced office can induce overworked neck muscles as the eyes strain towards the screen. Over time structural changes occur, such as a forward head posture—an anterior positioning of the cervical spine where the head dips forward. An accumulation of muscle fatigue in the cervical spine then activates local trigger points. (Trigger points are defined by Janet G. Travell as, “..a hyper-irritable spot in skeletal muscle…The spot is tender when pressed and can give rise to characteristic referred pain..”). The trigger point prompts local tenderness in the neck, referred pain, and as a result, a clenched jaw. The pain results in a lack of concentration in the office and stress accumulates, adding the final causal factor to the equation, as stress stimulates further clenching.
The above scenario is just one example where the functional use of the body is illustrated as the first step, but the plot could easily run the other way round too. For example, a stressful emotion such as fear or grief can lead to a change in posture, poor functionality then occurs and inappropriate joint motion patterns induce dysfunction within the structure of the muscular system.
HOW MASSAGE CAN TREAT THE SYMPTOMS AND THE CAUSES
The intention of massage treatment is to release the soft tissues—in this case, muscles, tendons and fasciae—but also to understand the bigger picture; whether an increase in jaw tension correlates with a particularly stressful period, whether a recent change of activities are putting pressure on the body in new and different ways, or whether an old injury, which may be seemingly unrelated, is revealing its ‘fascial creep’. (Fascial creep is described by Ruth Duncan, an Advanced Myofascial Specialist, as fascial strains that “..slowly tighten creating a loss of adaptive capacity”. Imagine pulling on the corner of your t-shirt and observing the changes to the rest of the shirt’s shape).
Taking in the whole picture is an important step in successfully treating TMD—and a characteristic approach for massage therapy. As part of the massage treatment the following protocols, carried out by an experienced therapist, will help increase the effectiveness of the soft tissue work:
A Consultation: An opportunity for the therapist to determine which potential causal components are present, referring to the aforementioned structural, functional and psychological factors.
Postural Assessment: The therapist will view the body as a whole to pinpoint any possible muscle imbalances around the immediate jaw area, and as far away as the hips and feet.
Assessment of the TMJ: Performing an intra-oral examination (inside the mouth with the use of examination gloves) and an examination from inside the ear, enables the therapist to gain clarity on joint deviation, problems with the articular disc of the joint and the muscles of mastication.
By going through these steps both therapist and client together can begin to understand the entirety of potential contributing factors. With this information positive action can be taken to address the causes.
Massage therapy offers a far less invasive solution to many of the widely offered suggestions for dealing with TMD issues. In my own experience clients have felt great improvement after a series of three to four treatments, with some people enjoying a level of pain relief after just one session.
As therapists we can address these issues with hands on work in a safe and relaxing environment. We can also provide after-care exercises and stretches that empower each individual to take control of caring for their own body with confidence, while also serving to make progress between treatments. When we have a deeper understanding and connection to the workings of our own unique beings, the journey to a pain-free life is much speedier!
Written by Amy Moffat, May 2018
 Manfredini D, Castroflorio T, Perinetti G, Guarda-Nardini L. “Dental occlusion, body posture and temporomandibular disorders: where we are now and where we are heading for”. Journal of Oral Rehabilitation, 2012.
 Lundeen TF, Sturdevant JR, George JM. “Stress as a factor in muscle and temporomandibular joint pain. Journal of Oral Rehabilitation, 1987.
 Janet G. Travell & David G. Simons, Myofascial Pain and Dysfunction: The Trigger Point Manual, 1983.
 Ruth Duncan speaking at COPA 2018 in London, ‘Fascia & Pain’.
Illustration of the temporalis muscle and the TMJ
Common Trigger Point referral patterns in the head, neck and jaw.
My next article, out in June 2018, will examine the need for physical therapists to utilise the 'Biopsychosocial' model when treating clients.
Until relatively recently the traditional approach towards health has been medical and/or biological. We are now understanding the links between biological factors, psychological factors and social factors in both the decline and improvement of disease and pain. By broadening our approach and understanding as therapists we can educate those in need to better understand their circumstances, while also using the model to provide better treatments.
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