Many of us, at some point in our lives have or will experience TMJ dysfunction. Perhaps you have discovered that you clench or grind your teeth at night, or maybe your jaw is an on-going source of entertainment at birthday parties and work functions. Everyone likes a good “weird body” trick once in a while, but when it starts to hurt or hinder your everyday life, it’s time to call in a pro. We all know to seek a dentist or other oral doctor when trouble in our mouths comes up, but did you know your massage therapist (me!) can also be of great assistance in dealing with the painful symptoms of TMJ dysfunction?
The temporomandibular joint (TMJ) is a hinge joint between the mandible (jaw) and the temporal bone of the skull. The jaw fits with the temporal bone via the mandibular condyle which sits in the mandibular fossa of the temporal bone, just beneath the bony shelf of the skull. The joint is supported by a joint capsule and three additional ligaments that aid in holding the mandibular condyle in the fossa.
The mandible is moved by 4 paired muscles; temporalis, masseter, medial pterygoid and the 2-headed lateral pterygoid. All of these muscles, with the exception of the lateral pterygoid, close the jaw. The lateral pterygoid is the lone jaw opener. Working together, these muscles perform the action of mastication, the grinding and chewing up of our food, as well as assisting in speech and playing wind instruments. Together with the ligaments, the soft tissues form a sling or hammock in which the jaw is suspended. It is these soft tissues alone that move and support the jaw and, typically, it is in these soft tissues where the first signs of jaw trouble spring up.
Possibly the most common issue that is associated with jaw pain is clenching and grinding (bruxism) at night. Many people are unaware of grinding their teeth at night and it is often a partner who informs them of the noise coming from their mouths. This will (hopefully) prompt the grinder to visit the dentist and inquire about a mouth guard at night. This is important for protecting the teeth from being worn out. Left unattended to, the teeth can degrade over time and even begin to fracture and crack.
If it is not a partner or dentist that informs the grinder, then typically the first thing that is noticed is stiffness and perhaps a dull ache along the sides of the jaw in the masseter or a temporal headache where temporalis attaches. These two muscles are the big power muscles of the jaw, exerting the majority of force when the jaw is closing and clenching. Since clenching and teeth grinding at night are possibly the most common source of jaw pain, it is no mystery that these two muscles will be the first canaries in the mine shaft to suffer. With time and zero intervention, the other muscles of mastication become involved and the pain and stiffness may increase in duration, frequency and intensity. As the over employment of these muscles drags on we may start to encounter jaw noise, feelings of the jaw getting stuck part way, inner ear pain or pain that persists even when the muscles are not being consciously employed.
There are many ways jaw pain from clenching and grinding can start; injuries to the jaw, head or neck are probably the most obvious and can result in spasm in the muscles of the jaw, preventing normal jaw function. Immobilization of the jaw due to fracture can result in jaw stiffness and pain due to compression, post intervention. Extensive dental work or oral surgeries that involve prolonged jaw opening can create temporary jaw pain or worsen a current jaw pain syndrome. Postural dysfunctions such as scoliosis or exaggerated head-forward posture can affect the jaw by changing the way the head is positioned over the neck and shoulders. Malocclusion of the teeth can also disrupt jaw mechanics as the jaw works to perform mastication with teeth that do not line up correctly; interstingly, treatment of malocclusion through braces can also generate pain. As the braces move the teeth around, the jaw relearns how to move in order to use the teeth in their new, corrected position. While this is all a good thing, body adaptation can be uncomfortable. The muscles are learning to move in new patterns and thus are being used in different ways which can result in muscles feeling tired, inflamed and achy. And of course, general muscle tension and stress are likely the most common causes for clenching and grinding which can result in jaw pain and associated headaches.
While your dentist is the first person you should see when you are experiencing jaw pain to rule out the presence of infection or other concerns, a well trained RMT can be a great addition to the treatment plan. The primary focus in most massage treatment plans is to reduce the muscular hypertonicity and restore balance across the joints and ligaments to improve freedom of movement. As stated above, the mandible rests in a soft tissue sling made up of the muscles of the jaw so treating TMJ pain, from the perspective of an RMT, is all about restoring that sling to appropriate levels of tension so the mandible can move freely and rest in a relaxed position (lips closed, teeth parted). By reducing tonicity in the muscles of the jaw as well as the surrounding regions, it can be possible to not only reduce the pain symptoms associated with jaw dysfunction or braces, but also restore the mobility and function for more severe cases.
The benefits of seeing an RMT for jaw pain and stiffness go beyond the pain and stiffness. By reducing the pain and increasing the mobility, the jaw is freed up to perform the tasks required of it. Like eating great big burgers from the BBQ, fresh picked corn on the cob in late August, biting in to a crisp juicy apple, singing your favourite songs at full volume and yawning like a lion without the fear of getting stuck half open or dealing with spasms of pain that ruin your summer BBQ plans
If you are dealing with jaw pain, stiffness and dysfunction, do yourself a favour and consider massage therapy a useful tool to getting you back on track.