Have you or someone you know ever dealt with jaw pain, popping/clicking of the jaw or difficulty fully opening or closing the mouth? There is potential that there is involvement of the Temporomandibular Complex (TMC) and it is not commonly known that physical therapy can help to address these symptoms, deficits or functional limitations. The TMC is made of the Temporomandibular Joint (TMJ) and the surrounding structures and muscles. It is responsible for allowing the opening and closing of your mouth, talking, chewing and yawning. Symptoms that can be associated with Temporomandibular Dysfunction or Disease (TMD) are jaw pain, popping/clicking, neck pain, headaches, difficulty opening or closing, ringing or fullness sensation of the ear and dizziness.
Physical Therapy Approaches
Deficits in the neck, specifically the upper cervical spine, are often found and associated with these symptoms or dysfunctions of the TMJ. There is a relationship between the upper cervical spine and the muscles of mastication, indicating that the cervical spine must be addressed in many cases. Physical therapy aims to address these deficits with several approaches, consisting of manual therapy (joint mobilizations to the neck and/or TMJ), soft-tissue mobilization of the muscles of mastication and/or neck, patient education regarding how posture/positions impact the TMJ and the associated muscles, as well as targeted exercises and stretches.
Although the best posture is a moving posture (any prolonged position/posture is typically not a good position/posture), a forward-head posture specifically has been shown to cause an increase in muscle activation and tone of the muscles that are meant to chew and close the mouth. This can lead to increased compression of the TMJ and teeth grinding, and potentially lead to pain, headaches or joint dysfunction. Dentists will work to help with teeth alignment, as this approach can help teeth fit together better and therefore reduce surrounding muscle tone. Approaching TMD from a teeth alignment standpoint is called an “occlusive approach.” When necessary, physical therapy will work closely with your dental clinician to ensure both approaches (joint specific and occlusive) are appropriate and being addressed correctly.
The most common activities related to work that tend to exacerbate TMD and its associated symptoms are typically related to causing increased compression at the TMJ.
- Forward-head posture
- Resting your chin on your hand
- Cradling the phone in between your shoulder and ear
- Prolonged positions of any kind (specifically with head tilted or rotated to one side, e.g., two monitors)
This is just a small list of commonly seen positions/activities that can influence the TMJ. As always, it depends on the person. Just as mentioned before, there is no perfect posture (“the best posture is a moving posture”) and not all of the activities listed above will be problematic for everybody. This is where having a physical therapist who specializes in TMJ treatment can help guide a person through the process, in addition to manual therapy, targeted exercises and coordinating care with other providers to ensure the most effective care is provided.
If you have any questions or would like to be evaluated by a skilled physical therapist, please contact us!