Jaw pain and TMJ: A Neuromuscular Therapy point of view

Jaw pain, Neuromuscular therapy, Tips for therapists, TMJ pain / Saturday, August 29th, 2009

This series on jaw pain and TMJ is based on the case study of Rodney D. If you missed the beginning, go back to Part 1.

So what do I think about when someone comes into my Neuromuscular Therapy office near Boston saying that they have TMJ pain or jaw pain?

The lateral pterygoid! Sounds like a dinosaur. This muscle must always be treated with these complaints for two basic reasons. One, the muscle attaches to the temperomandibular joint and the disc that protects it from wearing. Two, it has a Trigger Point that refers right into the joint. Voila, a combination of local and referred pain plus mechanical ramifications. The whole package. Of course there are several muscles involved, but this one is key.

The next thing I think about is why has the joint become tight? Usually it’s from clenching the jaw or grinding the teeth. Stress and anxiety are the most common reasons for these actions. Finding coping mechanisms for managing stress is crucial.

Usually I ask if the patient has seen a doctor or TMJ specialist to check for medical and mechanical issues, or has been fitted for a night guard to prevent tension and damage from clenching and grinding. These issues are for the medical professionals.

Structural asymmetries are common among TMJ sufferers. A difference in leg length tilts the pelvis which tilts the shoulder girdle which tilts the jaw. When the jaw tilts, the muscles that hold it back in place get overworked and tense trying to maintain symmetry. Correcting for a lower limb length inequality  (LLLI) with a heel lift or a difference in the size of the hip bones (hemipelvic asymmetry) with a butt lift can be a simple answer to correcting jaw pain.

Postural considerations such as the common head-forward posture need to be corrected for the same reasons as structural asymmetries. If the head is forward, the muscles that hold the jaw back from falling forward get overworked and tense. This applies to leaning over any work space as well as to poor posture. Think of what happens when you lean over a kitchen counter when preparing food.

As a Neuromuscular Therapist, I’m always considering Trigger Points. The most common muscles to target for treatment besides the lateral pterygoid are the masseter, medial pterygoid and temporalis. The muscles of the neck always get involved, especially the SCM and upper trapezius, although the suboccipitals, longissimus capitis and posterior cervical group need to be checked. A thorough therapist would also check the muscles in the front of the neck, those attaching to the styloid process, and the muscles of the throat as well as those that are involved in swallowing.

So let’s go back to Rodney D. and see how these thoughts apply to his symptoms and look at what was done for treatment.