Got Jaw Pain?

Do you have discomfort with chewing, talking, or yawning? Have you had jaw pain and headaches that just won’t get better? Have you tried mouth guards but the jaw pain is still keeping you up at night? If so, it is possible you are experiencing symptoms of temporomandibular joint syndrome (TMJ). Approximately 33% of individuals will suffer with TMJ syndrome at some point in their life.1  Although it is often managed by Dentists or specialty physicians, many are not aware of the physical therapist’s role in examination and treatment.

Potential Causes:
TEETH GRINDING or CLENCHING: People are often given mouth guards to reduce the impact of the repetitive stress to the TMJ joint. If mouth guards have failed to reduce your symptoms, physical therapy treatment may be beneficial to you!
TRAUMA: Macrotrauma to the jaw occurs from major events such as a car accident or dislocation to the jaw. Other causes of jaw pain can be from microtraumas, including repetitive nail/pen/gum chewing. All of these stressors can result in misalignment of the joint, weakness or tightness of the muscles, and joint/disc changes.
POSTURE: Believe it or not, posture can be a leading cause to both headaches and jaw pain. TMJ is often noted in individuals who work at a desk throughout the week or individuals who carry stress in their neck. Poor posture can result in a forward head, rounded shoulders, and jaw tightness.
DEGENERATION: As we age, our joints’ space diminishes. If you think about it, we use our jaw A LOT to speak and chew every day. Though it is a small joint, degeneration can occur (especially if you are predisposed to trauma, teeth grinding, etc).

Anatomy:
The temporomandibular joint can be located by placing your fingers just in front of your ear on the side of your face. If you open and close your mouth, you can feel your TMJ moving. Appropriate mechanics of this joint allow us to open and close the mouth for chewing, talking, yawning, etc.
Inside the joint there is an articular disc that provides cushioning to the capsule. If displaced or worn down, it can often lead to pain, clicking, popping, or locking / limited motion of the jaw. In addition to the disc, there are several ligaments and muscles that attach to the TMJ, which can become weak, tight, and tender with jaw dysfunction.

How a Physical Therapist can help you:
EXAMINATION: After receiving a script from your MD or Dentist, a therapist will begin with assessing your jaw range of motion, strength, and joint mobility. Often times, the neck and upper back will be examined for motion and strength impairments. Examination can also include an internal assessment with gloves to find muscle tightness, tenderness and joint restrictions.

TREATMENT:
- MANUAL THERAPY: Therapists may include both internal and external soft tissue massage. Self massage techniques are often recommended for home maintenance.

- STRENGTHENING Exercises will be designed to address your impairments though may include neck & shoulder strengthening to address your posture. To target the jaw musculature, the therapist may instruct you in contract/relax exercises by simply pushing your jaw against your finger.
- RANGE OF MOTION & FLEXIBILITY: A therapist may work on the neck and jaw to restore your normal mechanics. This may involve both hands on passive range of motion techniques as well as active stretches for home.
- ERGONOMICS/POSTURAL AWARENESS: Your therapist may work with you to address changes to your work station setup or daily postural issues. Changing the way your sit and stand throughout the day may reduce tension on the TMJ.
- DRY NEEDLING: This technique to reduce jaw pain is similar to the acupuncture approach. Research shows that dry needling can reduce pain within the TMJ by triggering an inflammatory response in the joint or surrounding muscles.

Where to seek treatment: Please note, not all physical therapist feel comfortable treating TMJ. Once you receive a referral for treatment, call your clinic to confirm that your designated physical therapist will treat your condition. A simple google search can also do the trick!

Reference:
Wright, Edward F, and Sarah L North. “Management and Treatment of Temporomandibular Disorders: a Clinical Perspective.” The Journal of Manual & Manipulative Therapy, Journal of Manual & Manipulative Therapy, Inc., 2009, www.ncbi.nlm.nih.gov/pmc/articles/PMC2813497/.