Physiotherapy Treatment for TMJ Pain

Most people first hear of the temporomandibular joint (TMJ) when they find themselves suffering from jaw pain or stiffness. Normally very robust, when these joints become inflamed it can be difficult to give them adequate rest, and significant pain and functional issues can arise. Thankfully, physiotherapy treatment for TMJ pain and dysfunction can be very effective.

What is TMJ (Temporomandibular Joint) Dysfunction?

The temporomandibular joints (TMJs) are located at the connection point of the jaw bones and the temporal bone of the skull, at both sides of the face, just in front of the ears. In addition to these bones, the muscles we use to chew and open/close our mouths connect here, and there is also a small disc (the ‘articular disc’) located between the bones that provides cushioning for the joint (like the disc tissue found between the vertebrae of our spines).

What makes the TMJ disc unique is that it is the only disc in the body that has the ability to regenerate! This is due in part to exceptional blood perfusion (blood flow), which helps it to heal if it becomes injured or irritated/inflamed. Given the vital importance of these joints to eating and therefore survival, it’s perhaps not surprising that they are so robustly built and actively repaired by the body. Despite this, like with all other joints in the body, inflammation and dysfunction can arise in the TMJ.

TMJ dysfunction (known as ‘TMD’) is a condition involving pain in the jaw joints and/or surrounding muscles. This condition can result in significant loss of function whereby chewing, opening and yawning can be limited and/or painful. It can involve both sides, or one side only. Other symptoms associated with TMD include jaw noises such as clicking or crunching, intermittent locking while opening or closing the mouth, headaches (often experienced at the ‘temples’ or temporal areas at the sides of the head), and neck pain or stiffness. Symptoms of jaw pain and stiffness is often worse first thing in the morning and during/after eating.

Why do people get Temporomandibular Joint Dysfunction?

There are several habits that can irritate the TMJ and lead to the development of Temporomandibular Joint Dysfunction (TMD). Specific ‘oral behaviours’ that tend to be associated with this condition include:

• Sleeping “wrong”: Sleeping in a position that puts pressure on the jaw (side sleeping or stomach sleeping with the head rotated fully in one direction), or clenching / grinding the teeth while asleep.
• Prolonged teeth contact: Clenching or grinding the teeth or holding teeth together for prolonged periods.
• Prolonged jaw activation: Tensing or clenching jaw muscles without bringing teeth together, holding the jaw forward or to the side, pressing the tongue forcibly against the teeth for prolonged periods.
• Postural irritation: Leaning with a hand on the jaw, cupping or resting the chin in the hand, holding a phone between your head and shoulders for prolonged periods.
• Eating overuse: Chewing food on one side only, chewing gum or frequently eating food between meals which requires a lot of chewing.
• Lifestyle overuse: Playing a musical instrument involving the mouth or jaw (woodwind, brass, string instruments), sustained periods of singing, or sustained talking for long periods of time.
• Yawning with a wide opening.

Becoming aware of the particular movement or usage pattern of the mouth and jaw that is causing or exacerbating the dysfunction is essential for treating TMD.

Treatment of TMJ Pain and Dysfunction

Patients with jaw pain or clicking are occasionally referred by their dentist or physician to an oral surgeon. Many patients discover – only after a long wait to be seen by this specialist – that they are not a good candidate for surgery. Waiting to address TMJ dysfunction can be counter productive, prolonging symptoms and worsening the condition.

Thankfully, physiotherapy can be highly effective in treating TMJ pain and dysfunction. Numerous clinical studies have shown that manual physical therapy interventions and home exercise programming can significantly improve pain and jaw function (you can see these recent Systematic Reviews at ref 1,2).

Physiotherapy Management of Temporomandibular Joint Dysfunction

Finding a TMJ physiotherapist experienced in the treatment of TMD can help change the course of symptoms and alleviate the pain and joint restriction (restricted mouth opening) that is common with this condition. Equally important is learning how to prevent recurrence, a core tenant of the physiotherapist’s approach to treating TMJ dysfunction.

Physiotherapy treatment for TMJ pain and dysfunction typically includes:

• Hands-on manual therapy to restore pain-free range of motion at the TMJ, off-load the irritated TMJ disc, and enable proper gliding at the joint.
• Hands-on soft tissue massage and stretching of tight jaw and neck muscles.
• Training in jaw relaxation techniques to enable tight chewing muscles to release excessive tension.
• Dry needling or acupuncture to address any trigger points in jaw muscles and reduce pain.
• Strengthening exercises to address muscle imbalances of jaw muscles, and to correct faulty motor patterning of the jaw during opening and/or closing movements.
• Advice on sleeping positioning, chewing patterning and diet, temporarily modifying food size or texture to decrease stress to the jaw, allowing recovery.
• Postural strategies for decreasing strain on the jaw due to postural factors (addressing any positioning/ergonomic factors due to workstation set-up, forward head posture, etc).
• Treatment of the neck and back (and even the pelvis in some cases!).  Joint restrictions found in these areas can adversely impact the position of the jaw and movement patterns in some individuals.

You no longer need to just ‘grin and bear it’

TMD can be a very painful and frustrating condition. It can also present social and professional challenges by making talking and eating painful or difficult.

The good news is that you don’t have to live with it, and for most sufferers, surgery is neither warranted nor recommended. In our experience TMJ pain and dysfunction is effectively treatable with physiotherapy, and this is supported by the broader physiotherapy and clinical research communities.

Beyond providing manual therapy and exercise to address the immediate issues, TMJ physiotherapists can help their patients better understand their TMJ condition and what to do to take care of their jaw muscles and joints. This comprehensive approach to TMJ physiotherapy can result in long-term benefits for patients and reduce the risk of recurrence.

About the author

Paul Messner is an experienced physical therapist with training in TMJ rehabilitation.  He is well-known for his expertise in treating patients with various TMJ disorders and receives regular referrals from dentists and oral surgeons in Toronto.

References

1. Herrera-Valencia A., Ruiz-Munoz M., et al. Efficacy of Manual Therapy in Temporomandibular Joint Disorders and Its Medium-and Long-Term Effects on Pain and Maximum Mouth Opening: A Systemic Review and Meta-Analysis. J. Clin. Med. 2020, 9(11), 3404; https://doi.org/10.3390/jcm9113404
2. Martins W.R., Blasczyk J.C., et al. Efficacy of musculoskeletal manual approach in the treatment of temporomandibular joint disorder: A systematic review with meta-analysis. Manual Therapy. 2016, 21, p10-17.  http://dx.doi.org/10.1016/j.math.2015.06.009

For more information on TMJ pain and dysfunction and how it can be treated, please check out: International Network for Orofacial Pain and Related Disorders Methodology (http://www.rdc-tmdinternational.org).