The TMJ or temporomandibular joint is the formal anatomical name given to the jaw joint, where the mandible bone (which forms the lower jaw) meets the skull (at the temporal bone). There are a number of muscles which attach to and surround this joint and which are involved in mastication (i.e. chewing) as well as other facial movements involving the jaw. Excessive chronic tension in the muscles connected with and surrounding the TMJ can cause not only local pain perception in the area of the jaw itself, but can also set-up pain referral patterns (through trigger points) causing regular experiences of headaches, migraines, involuntary teeth grinding (bruxism), gum or tooth related pain and even tiniuts (ringing in the ears). Muscular tension or shortening in the muscle fibres resulting in restricted range of movement of the jaw joint can also cause pain and even a limited opening movement of the mouth itself (e.g. trismus). Differences in the tensioning of the muscles on opposite sides of the face / jaw can cause uneven bite or malocclusion scenarios.Physical trauma such as those caused by whiplash or other sudden violent impact to the skull or neck area can set-up chronic "holding" tension which then becomes "locked" into the muscles of the skull, jaw or neck as the body freezes itself up in that split second reaction of self defensive protection. This tensioned holding scenario in muscles and related soft tissues (in any area of the body) is seen so commonly after many traumatic or sudden impact related situations (including high exertion force tooth extractions as well as many other invasive dental procedures).
What is not always commonly understood is that an effective and permanent unlocking of this tension will still not be permitted by the body itself long (week, months or years) after the perceived danger event has passed until it is satisfactorily notified that the threat has passed, and so in clinical massage therapy it is the goal to gradually introduce this notification of safety to the body to begin the process of gently unlocking itself; the muscles and soft tissues affected will be engaged in this process through safe, gentle, specific and highly focused manipulation and release work.
Apart from the physical conditions described above, unrelenting stress and emotional upset experienced by a person is another way in which muscles of the TMJ can become dysfunctional or become locked into a chronic pain pattern. In fact, the emotional element is perhaps the most common underlying cause of TMJ dysfunction and pain, simply because there is an actual physical neurological connection between the sensory (as well as the motor) nerves within the TMJ itself which in turn interfaces with the brain and spinal chord via a branch of the Trigeminal nerve. The feedback loop within this neurological pathway means that emotional stress can cause the muscles of the TMJ to clench or tighten up (quite a lot of people will unconsciously clench or even grind their teeth as a response to coping with or being faced with stress); likewise tightening up or clenching of the muscles in this area causes an increased perceptual registering of emotional stress to be generated in (the primitive reptilian part of) the brain and nervous system. So, as you can see that one feeds back into the other causing a potentially vicious cycle, until something comes along which can interrupt this cycle! Physical exercises which help to stretch and relax the soft tissues of the TMJ are a vital consideration as well as whole body and mind relaxation practices or activities in order to lower emotional stress and decrease sympathetic nervous system tone (and therefore increase the parasympathetic nervous system response).
As well as the perception of stress levels in our daily lives, history of invasive dental work and the related impact of other physical or emotional trauma, the type of food which makes up our diet can also have an effect. The more prolonged and harder we have to chew our food, the higher the chances of the TMJ muscles becoming chronically tense. Of course, as with any other set of muscles in the body, there are many effective preventative self care exercises and things that one can do in order to look after our TMJs and ease pain, preferable before it becomes chronic.
This video shows examples of just some of the self care exercises you can do in order to reduce tension in the muscles of the TMJ:
Chronic TMJ dysfunction and pain can respond very favourably to specific and effective physical therapy approaches such as clinical massage which mixes and combines elements from trigger point therapy, neuromusclar massage, myofascial release, stretching, acupressure massage, craniosacral therapy, as well as sometimes work with hydrotherapy to bring in soothing sources of moist heat and cold as appropriate all into the same session to suit the needs of the individual client. Here is a very informative article from a massage therapy trade journal written by a dental nurse who subsequently devised a unique clinical massage protocol for alleviating TMJ (as well as other jaw, teeth and headache) related pain conditions after training in clinical massage techniques herself and pooling this together with her dental nurse training:
TMJ & Clinical Massage Article (Today's Therapist Magazine Dec/Jan 2009) - PDF File
Here is a very highly recommended website with lots of visual charts depicting the pain referral patterns that can be experienced and get set-up due to trigger point activity in muscles of the head and neck - have a look to see if the charts below match up with any pain patterns you might be experiencing:
A list of some the important muscles involved in jaw pain and movement restriction issues:
Digastric (plus others in the "suprahyoid" group)
These muscles are commonly indicated for frequently reoccurring headaches with pain radiating patterns which can be mapped out predictably by the person experiencing them:
Another informative site with TMJ related information and along with a helpful beginner's musculoskeletal tutorial summarizing which muscles are involved in performing what physical movements of the jaw have a look at http://abbottcenter.com/bostonpaintherapy/2009/10/01/jaw-pain-and-tmj-final-details/
If you are interested in wading even more into some technical depth, this particular article is somewhat heavy on technical anatomical description and details, but well worth reading if you have the relevant background and want to investigate how and why clinical massage (and myofascial release work in particular) can help address TMJ related chronic pain issues:
TMJ & MFR Article (Today's Therapist Magazine - Jul/Aug 2008) - PDF File
This entire article was prompted by some recent sessions I'd performed with a client to help them out with TMJ related pain including subconscious teeth grinding at night, regular headaches around the perimeter of the ears and down the side of the neck, malaligned bite and a very limited ability to open the mouth - so limited that opening the mouth to take a bit from a sandwich was virtually impossible such was the pain as well as just the physical restriction in range of movement of the jaw before we got to work. Conventional MRI scans had not been able to shed any light on what was going for this client, yet we managed to produce a significant shift in jaw movement with decrease in pain from session 1 as well as reduction in teeth grinding at night, all to a degree which had not been experienced with conventional other treatments elsewhere. Improvements continued in session 2 and session 3 will be next week (at the time of writing this article). Will aim to update with progress on this blog as we progress. The protocols and techniques I use aim to produce effective and permanent shifts on a 4 to 6 session basis when performed on a weekly session basis - provided that the client also diligently follows the additional selfcare advice at home as well as attending the weekly regular sessions.
It has been reported by one particular source that 90% of musculoskeletal issues have an element of TMJ involvement to it, yet TMJ dysfunction isn't necessarily the root cause (no pun intended). "As a above, so below" provides us with a useful perspective from which we could spring board off of in order to begin looking at the picture of the body in an alternative and more holistic relationship, so according the Lovett Brothers Principle each vertebrae bone in the spine has is intimately related to a matching counterpart at the opposite end, thus the bones of the jaw, skull and neck have counterparts which they are affected by (and visa-versa) in the lumbar (lower back) and sacral areas of the pelvis.
TMD or TMJD (temporomandibular joint dysfunction) as it is sometimes referred to as is certainly a very big topic, I hope I've managed to cover as many of the salient issues as possible here, but there is still so much more that I could say that hasn't been raised in this particular article, so I would very much welcome your feedback, comments, questions and suggestions for amendments, additions and further articles on this topic.
Article Author: Henry Tang (Clinical Massage Therapist) - Spaces of Possibilities Wellness Centre (Crows Nest, Sydney, Australia)
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