Conditions

TMJ Pain

Our temporomandibular joint (TMJ for short) can present with a variety of issues related to sudden trauma, repetitive use, or postural strain to the joint itself and the muscles surrounding it. Issues in this area are sometimes referred to as TMD, or temporomandibular disorder. TMD is highest between the ages of 20-40, and is estimated to be present in around 6-12% of people.

As a group, TMD includes issues such as pain in the muscles or joints, limited range of motion, muscle weakness, jaw clicking, and other functional jaw limitations. TMJ issues can also contribute to neck pain and headaches due to the mechanical and neurological overlap in these areas. Conversely, it is also common to have TMJ issues after whiplash and concussion injuries.

Mechanically the TMJ is influenced by a variety of factors around the jaw. This includes biomechanical factors like how we breathe, our jaw and neck posture, our jaw and neck strength and muscle control, as well as habits like the foods we eat or how much tension we hold in our jaw throughout the day. Since the health of our teeth and bite also effects our TMJ, making sure there are no pre-existing or lingering dental issues is also helpful when dealing with TMD. Seeing your dentist should be the first step if TMD arises, but once dental issues are ruled out Chiropractors can be very helpful in assessment and treatment of biomechanical TMJ issues.

Causes of TMJ Disorder (TMD)

The muscles around the jaw can be strained with sudden, repetitive, and postural trauma. Often this will cause pain that is achy and worse with certain muscle actions. Depending on the severity of the strain and the muscle involved, this can cause issues with chewing, opening the mouth, as well as talking and singing.
Assessment involves testing the strength, mobility, control, and tightness of muscles and identifying the source of the symptoms. Chiropractic treatment involves soft tissue therapy to reduce muscle tension and reduce spasm, as well as exercise therapies to address issues found in the assessment.
Whiplash and related neck issues can significantly contribute to existing TMJ issues, and in some cases even directly cause symptoms felt in the TMJ and jaw area.
Neck issues change how our neck as well as our jaw functions. Neck posture, muscle control, and strength changes can influence the amount of tension our jaw muscles hold, and the presence of neck pain and headaches can often make us tighten or clench our jaw in response. Structures in the neck and head can also refer pain to jaw, usually to the lower jaw but sometimes around the TMJ.
It is important to consider the neck as a contributor to jaw issues whenever TMJ issues are persisting, especially if TMJ-focused dental or Chiropractic treatment has not resolved the issue.
Like whiplash injuries and neck issues, concussions cause a multitude of changes to how our neck, vision, and vestibular systems function. These changes can go on to impact the jaw by changing the local muscle activity, or by causing referred pain to the area of the jaw.
If there are ongoing TMJ issues present and you have a history of concussions, then it may be helpful to consider lingering concussive symptoms as contributing to TMD.
This category represents accumulated changes in our jaw’s posture and muscle control. One example is that jaw muscles can become hypoactive (under active), or hyperactive (overactive) over time. This can happen to our jaw-closing muscles, leading to things like clenching and grinding. It can also happen to the muscles that help to open the initial jaw movement or deviate the jaw from side to side, leading to jaw clicking or popping and sometimes pain.
These changes are multifactorial and not usually from any one cause, but a Chiropractor is able to assess jaw functions such as posture and muscle control, and relate dysfunction here to ongoing symptoms that may be present. Treatment often includes soft tissue therapy to relevant muscles, followed by exercises such as mobility, strengthening, posture, or muscle control exercises.

Issues to the temporomandibular joint itself can also exist. This includes inflammatory and non-inflammatory arthritis. These conditions are best managed by a dentist, with Chiropractic care is often playing a supportive role only. Treatment will vary by the nature and severity of the condition.
The TMJ has a disc located inside the joint. This disc can get irritated or injured and lead to an issue known as TMJ internal derangement. This is a more complex issue that is best co-managed with a Dentist, who can properly evaluate the stage of injury as well as analyze how your bite and tooth structure may contribute. Often Chiropractic care can play a supportive role and help with soft tissue therapy and exercise therapies.
Sprain to the ligaments around the TMJ is possible, but usually only following trauma. This type of injury can be managed by a Chiropractor depending on its severity. Mild-moderate sprains can find relief with soft tissue therapy and exercises to support the sprained ligaments as they heal. More severe sprains may need dental or medical management as more structural consequences may be present from the injury.

TMJ / TMD Treatments

Excessive tightness or strain is a common cause of TMJ issues. Soft tissue therapy helps by reducing tension and improving blood flow in overly tight or strained TMJ muscles. This helps to reduce TMJ related pain and discomfort, improve jaw flexibility / mobility, and restore normal jaw function.
Because the TMJ is such a sensitive area, soft tissue therapy usually involves working key areas for a short duration. A common phrase in TMJ treatment is “less is more”.
Key muscles that benefit from soft tissue therapy include the clenching muscles, the muscles of chewing, and muscles we use to open our jaw and move it side to side.
Joint mobilization is an effective treatment tool for TMJ that reduces pressure and pain coming from the joint capsule. It involves very gentle back and forth motion of the joint by a practitioner in a controlled range of movement. The goal is to restore normal movement and mobility to the joint, which helps to reduce pain and restore normal function in TMJ issues.
Because the TMJ is such a sensitive joint, Dr. van de Wall does not perform joint manipulations (popping-type adjustments) on the TMJ, and instead aims for more gentle joint mobilization.
This treatment is very helpful with anyone with reduced opening / “lock jaw”, TMJ disc issues, and TMJ arthritis issues.
TMJ therapeutic exercise is important to help maintain the benefits of hands-on treatments. What exercise approach is best depends on the person, and is guided by an examination where we try to find what is contributing to the TMJ issue.
Common exercise therapies include:
- TMJ strengthening exercises for any weak muscle(s)
- TMJ stretching and range of motion exercises to reduce muscle tension and improve range of motion
- TMJ related muscle control exercises such as jaw relaxation techniques, tongue relaxation techniques, and diaphragmatic breathing techniques. Believe it or not, our tongue habits and position and breathing habits effect our TMJ!