TMJ conditions and Jaw pain

Jaw pain is more common than we think and it presents itself in many different ways that you may not even know! The jaw is a special joint because there is no other joint complex in the body that moves the same way. As a result, there are many ways that the jaw can have challenges that lead to pain including headaches and locking of the jaw.

The Basics 

The temporomandibular joints (TMJ) or the jaw is something that most people do not think about unless there are issues surrounding it. We use these joints a lot with chewing, talking and swallowing which are inevitable things we do every day.

The TMJ connects the jawbone to the skull and the TMJ disorder occurs when something goes wrong with the jaw muscles or joints.

 

The TMJ is made up of four major muscles, three major external ligaments, multiple smaller ligaments between the ear bones and the TMJ disc and a very special joint that contains a disc, a capsule around it and has two movements that need to be synchronized on both sides for it function normally. For such a small area, it is a really complex movement pattern that can have a lot of challenges.

 

 

 

 

 

There are a variety of movements that the TMJ can do but simply put the jaw’s major function is to open and close to allow for talking and chewing. However, even to do this function the two joints have to work together and start by rotating to open the jaw and then shift forward (protrusion) in order to open wide enough to chew. On closing, the jaw must shift backwards (retrusion) and the rotate back to close. Any changes in this synchonized movement will cause the jaw to shift from side to side, possibly click, possibly get locked and possibly lead to pain.

Here’s a video that captures this really well from Functional Anatomy TMJ.

https://www.youtube.com/watch?time_continue=1&v=SCS4MiHJ5Xw&feature=emb_logo

Causes of Jaw Pain

Jaw pain has many sources and it often times comes with ongoing stress on the joint over time. Most cases are repetitive stress based although some can be due to traumatic reasons as well. Here is a list of causes that are not everything that can lead to jaw pain

• Sinus Problems
• Cavity and Sensitivity in the teeth
• Long-term maintaining of an open mouth state (ie: dental surgery or procedures)
• Chronic grinding and clenching teeth
• Traumatic Injury (sport-specific, car accident, falls, contact sports, etc)
• Arthritis in the joint
• Heart attack (often accompanied with other symptoms)
• Inflammatory conditions (Rheumatoid Arthritis, autoimmune disease, etc)

Every person’s cause may be different but the most common cases from a Chiropractic office looks to be after dental procedures, chronic stress and teeth grinding or trauma related. By no means, does this article suggest that dental procedures should not be done. Dental procedures are critical for the maintenance of health, however, the ability to hold your mouth open for hours on end will strain and put stress on most of the muscles and ligaments in the mouth and it is advisable to be assessed for TMJ issues when it is safe to do so.

 

Treatment towards Jaw Pain

In clinic, the treatment is short as the tissues of the jaw are very tender but the approach is broken into three phases. Muscle work to loosen tight tissues and activate inactive muscles, get the joint moving properly and lastly reteaching light exercises to reprogram proper jaw motion patterns.

Muscle work is done on all four of the muscles both on the outside of the jaw (when applicable) and on the inside of the jaw (with gloves of course). The jaw muscles can be extremely tight due to tension and often times clients may tear due to nature of the sensitive tissue. Both sides of the jaw muscles are worked on as there is a balance between both sides so while one side is tight the other is likely to be inactive.

For joint mobility of the jaw, it is very delicate. There are adjustments a chiropractor can make but personally, I find them too jarring and forceful so often times gentle mobility to guide the proper motion is used or the use of an adjusting tool is used to provide force into the joint where movement is needed.

The exercises will be provided below to help those with some of these challenges!

Headaches and Jaw Pain

A lot of jaw tension does not necessarily show up as jaw pain. Often times it can present with clicking, locking or most commonly headaches. A lot of tension in the jaw is muscular based and these muscles all have referral patterns or “knots” that can create pain to present elsewhere. We’ll break down each muscle here and all of the images found here are brought to you by www.triggerpoints.net and these images are used for education purposes.

 

 

 

 

 

Temporalis Muscle

This muscle that is found on the side of the head, above the ears is responsible for biting or closing the jaw. Looking at these referral diagrams it shows that specific trigger points (X’s) can create pain both in the head and into the teeth.

 

 

 

 

 

 

Medial Pterygoid Muscle

This muscle is found on the inside of the mouth underneath the cheekbone and it is responsible for aiding with biting, moving the jaw forward and side to side to help with chewing while eating. Looking at these referral diagrams it shows that specific trigger points (Xs) can create pain all around the jaw, the ear and into the neck as well.

Lateral Pterygoid Muscle

This muscle is found on the inside of the mouth also underneath the cheekbone area and it assists with opening the mouth, moving the jaw forward and moving the jaw side to side as well! It is the partner to the medial pterygoid muscle listed above where it is a give and take to control motion in the jaw. Looking at these referral diagrams below that show the trigger points (Xs) can create pain on the TMJ but also create some sinus location pains as well!

 

Masseter Muscle

The masseter muscle is a large muscle that is more external and attaches to the cheekbone. It is one of the stronger muscles of the jaw and it helps with closing the jaw and you can feel it pulsing outwards as you chew! Looking at the referral diagrom below, the trigger points (Xs) show that the masseter muscle can create pain in the jaw and ear but also it can give a headache into the front of the head as well!

 

Who should I see for my jaw challenges?

TMJ conditions are challenging in nature to diagnose, treat and maintain. Often times, the first choice is to see your dentist for an assessment especially if it is affecting your bite or teeth are painful. Since many cases are due to dental issues it is a great place to start. Some solutions may be fillings for cavities, some removal of teeth, a bite guard to prevent extra pressure or much more options. However, for the physical aspect of muscular pains and joint motion challenges there are chiropractors that know how to work with the jaw if they are trained in this treatment as well as some massage therapists, naturopaths and physiotherapists. TMJ work does require some extra training and experience as it is a tender and delicate joint and the most extreme cases may need specialist assessments as well. A starting point is to see your dentist and for further information a knowledgeable chiropractor, physiotherapist, massage therapist or naturopath would likely be your second stop!

 

Exercises:

Controlled yawning

Self massage of the jaw

Open in a straight line in the mirror (Goldfish exercises partial)

 

 

Resisted opening of the mouth

Resisted closing of the mouth

 

As always, if you have any questions about your conditions and would like to schedule an appointment with us at Baseline Health and Wellness you can give us a call at 6046744027 or schedule online at www.baselinewellness.ca

Provided by Dr. Kody Au, Vancouver Chiropractor

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