Raleigh Premier Manual Physical Therapy
Raleigh Premier Manual Physical Therapy

TMJ Care

TMJ Care

Just like any joint in the body there can be dysfunctions in the TMJ leading to pain/TMD or Temporomandibular Dysfunction. There are sometimes issues with the joint capsule itself which can be tightness of the joint capsule/hypomobile, causing compression of the joint and limits the mobility of the mandible and the disc. There can also be too much mobility/hypermobile. This is when the capsule is too loose and doesn’t provide proper stability to the joint. A lot of times you will have a hypomobile joint on one side and as a compensation there is a hypermobile joint on the other. In our professional experience pain is most commonly present in the hypermobile joint.

When there is a dysfunction in the joint capsule and there becomes an instability in the joint, the disc can be the source of pain, clicking and or locking. In a normal joint the disc rests between the mandible and the base of the temporalis bone. It provides a cushion to prevent bone on bone rubbing which leads to arthritis. But when there is a chronic dysfunction in the joint or the above issue, a joint hypermobility, the disc will sometimes be out of place. Most of the time it rests anterior or forward to the joint. The disc can also get displaced more medial or lateral to the joint. A medial disc dysfunction is more associated with joint pain, a lateral dysfunction is less painful. When the disc is resting too far forward and one opens their mouth, the jaw will glide forward and the disc can relocate back into place. That is the common popping sound a lot of our patients get. A lot of times after the “pop”the pressure or pain in the jaw will decrease or it could also restore opening. The longer the disc is out of place and the surrounding tissue adapts to this dysfunction the more difficult it is to recapture the disc.

A normal Functioning TMJ: https://youtu.be/Nmg3xl13TY0

A dysfunctional TMJ: http://youtu.be/upbs7Hm9tRQ

Can this be treated? Yes, this is a multi disciplinary approach to make sure we address the joint from two angles. First as Physical Therapists we look at the TMJ and what the neck is doing. Second, your dentist or oral specialist will look at the TMJ and your bite or teeth.

From a PT perspective, your TMJ position and function is highly influenced by the way your head rests on your spine. The majority of our TMJ patients also experience headaches, neck stiffness, upper trap tightness and mid back pain. Please see the link below to see how your jaw and bite are affected by your head position: http://youtu.be/fC_51yNOqao

The most significant contributing segments to TMJ pain are the sub occipital joints. They are made up of the occiput/base of your skull and the first two vertebrae, C1 and C2. When the head is in a forward head position, or a slouched posture, the OA/occiput & C1 are stuck or tight in an extension position/chin forward. When your head is in extension it causes your jaw to rest in a back and up position. This position causes decreased space for your disc to rest and leads to joint dysfunction and your disc resting too far forward as described above.

If you feel like you get a lot of popping with eating try to sit up tall and tuck your chin and see if that changes your symptoms.

Obviously each patient is different and some people present with all these dysfunctions, some patients have only a couple of issues. An individual specialized evaluation will lead to a specific treatment plan for each patient. What is explained above are just the common findings.

Some less common symptoms that can be treated in Physical Therapy, seen in TMJ patients, are fullness or ringing in the ears, difficulty swallowing, vertigo and nasal congestion.

Specialized treatment includes: manual therapy mobilization of the sub occipital region, cervical and thoracic spine, mobilization of the TMJ and soft tissue work, both internally and externally. We also perform dry needling of the neck and jaw. There are some muscles that play an important role in the TMJ function that can only be reached with needles, they cannot be palpated with our hands which makes needling very effective in TMJ care. Also cupping will be used on occasion to alleviate fascial tension in the neck and TMJ. These modalities work great in conjunction with the manual work and the exercises given during therapy.

In addition to PT in the clinic, certain stressors need to be addressed as well. Stress, anxiety, sleeping positions as well as overall health all play a role in TMJ care. In our PT sessions we will discuss stress management, sleeping postures and ways to allow your TMJ to heal and restore proper function.

As stated earlier your dentist will also play an important role in your TMJ care. As therapists we look at the TMJ and spine. Your dentist looks at your TMJ and your teeth or bite. Again in order to resolve your issues permanently you need to address all areas affecting the TMJ. We recommend consulting with a dental TMJ specialist as well. One might need a mouth guard to help protect your teeth, prevent bruxism and allow your jaw to rest in a more neutral position.

If you have any questions, want to schedule an appointment or have a free 20 minute consultation please fill out your information in our contact section and we will have someone reach out to you.