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  • Writer's pictureMurray Kovesy

Jaw Pain - Myotherapy for Temporomandibular Joint Dysfunction

Updated: Jan 9, 2020

Jaw pain is a common complaint which is sought for treatment. In most cases jaw pain presents chronically but can also be acute in nature. Myotherapy and Remedial Massage techniques for jaw specific symptoms can have a major positive influence in reducing pain and associated dysfunction. Myofascial trigger point pain has been reported as the most prevalent cause of painful symptoms in Temporomandibular Dysfunction (TMD).

Tempromandibular Dysfuction (TMD) is a term used to describe clinical problems involving the temporomandibular joint and/or the muscles. The temporomandibular joint is made up of two hinges connecting your jaw bone to your skull. These joints allow the movements needed for speaking, eating and facial expression. TMD can cause pain, abnormal jaw movements and joint noises.

Causes of Temporomandibular Joint Dysfuction?

TMD can be caused by a number of different factors individually or combined together. Symptoms can arise from problems with the muscles of your jaw or with the parts of the joint itself. Some causes of TMD include;

  • A past injury to the jaw. Most likely from whiplash or heavy blow incident affecting the joint or the muscles of your head and neck.

  • Constant grinding or clenching of the teeth causing trigger points which puts pressure on the joint.

  • Stress is a major factor. Stress can cause you to tighten facial and jaw muscles or clench the teeth without knowing.

  • Osteoarthritis of the joint which is associated with wear and tear overtime.

  • Movement of the disc between the ball and socket of the joint causing alignment issues.

  • Dental issues like new fillings or dentures causing an uneven bite.

Temporomandibular Joint Symptoms

TMD often causes severe pain and discomfort. It can be temporary but will often last many years. It might affect one or both sides of your face. More women than men have it and is most common among people between the ages of 20 and 40 years.

Common symptoms include:

  • Myofascial pain or tenderness of the face, jaw, ear, and or neck.

  • Limited or deviating jaw opening and closing.

  • Pain made worst with chewing, speaking or opening the mouth wide.

  • Temporary locking in the open or closed mouth position.

  • Clicking or grinding noises of the jaw joint when you opening the mouth or chewing. This may or may not be painful.

  • Ringing in the ears (tinnitus).

  • Tension headaches referring from muscular trigger points.

  • An uncomfortable or uneven bite.

  • Shoulder and neck pain and tenderness.

Diagnosis of Temporomandibular Joint

First a proper history and physical assessment is needed by a therapist to understand the underlying cause of symptoms and dysfunction. Assessing the jaw joints includes looking at movements of opening and closing the mouth, whether this causes pain or tenderness and any associated clicking, popping or grating noises.

In a recent study Myofascial pain due to TrPs was the primary diagnosis of TMD, almost 3 times the incidence of primary joint pain. Considering this data, it is important to make a distinction between true temporomandibular joint pain and myofascial pain due to TrPs.

Ruling out other conditions that causes similar symptoms may be performed by a dentist as well which include things like tooth decay, sinus problems, arthritis or gum disease. If needed a full face X-ray may be used to view your jaw, temporomandibular joints and teeth to rule out other internal problems.

A physical therapist will feel the outside of the jaw joints by applying pressure to both joints near the ear. Firm palpation may be uncomfortable but is only painful if the joint capsule is inflamed. Tenderness to joint palpation is relatively mild compared to that typically seen with the acute inflammatory conditions. In more chronic cases there will be muscular trigger points in the muscles like the masseter, pterygoid or sternocleidomastoid causing referred pain to the joint. Because TrPs appear to play an important role in migraine and tension-type headaches, all headache patients should be evaluated for their presence as well.

Treatment for Temporomandibular Joint

Often palpation of the masseter muscle, particularly the deep fibers, reproduces the patient's symptoms. Myofascial TrPs in this part of the masseter muscle have been reported to cause unilateral tinnitus and accounted for the high pitched sound the patient complains of with clenching. Having the masseter massaged and release is of high importance.

Physical therapy, Remedial Massage and Myotherapy for jaw pain and dysfunction has shown to be effective to restore and relieve symptoms. Massage and trigger point therapy of the muscles of the jaw including the masseter, buccinator and pterigoids. Home care advise may include stretches of the jaw, self massage and using heat and cold packs for blood flow and inflammation of muscles. Apply an ice pack to the side of your face and temple area for about 10 minutes. Do a few simple jaw stretches. When you’re done, hold a warm towel or washcloth to the side of your face for about 5 minutes.

Dry Needling of the jaw is an effective way to restore muscle tension and improve symptoms. This is where needles are directed into muscular trigger points to give relief. Dry Needling has been shown to be effective in reducing or eliminating both the referred symptoms and local tenderness from myofascial trigger points. As a massetter muscle is one of the strongest in the human body it is often stubborn to release. Transcutaneous electrical nerve stimulation (TENS) is a low-level electrical currents to provide pain relief by relaxing your jaw joint and facial muscles.

Stress is a major trigger for jaw related pain. Myofascial TrP activity increases dramatically in response to psychological stress and diminishes with relaxation. Tension-type headaches also worsen with stress and improve with relaxation. Managing stress level and learning relaxation techniques both help to loosen up your jaw. Physical therapy and massage is a great way to reduce stress levels whilst receiving physical symptoms.

If grinding of teeth at night (bruxism) is happening a splint or night guard is recommended. These plastic mouthpieces fit over your upper and lower teeth to help protect the surfaces. They lessen the effects of clenching or grinding and correct your bite by putting your teeth in a more correct position.

Correcting and practising good posture helps to reduce neck and facial pain symptoms. Don't rest your chin on your hand. Don’t hold the phone between your shoulder and ear. Be aware of when your clenching your jaw during times of stress. This will relieve pressure on your jaw. Nonsteroidal anti-inflammatory drugs (NSAIDs) is acute stages, like naproxen or ibuprofen, can relieve muscle pain and swelling. If other treatments can't help surgery is an option but one not taken lightly. A second or third opinion is needed as once surgery is done it can't be undone.

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