Jaw pain and TMJ: Treatment details, Part a

Ear pain, Jaw pain, Muscle information, TMJ pain / Tuesday, September 1st, 2009

This is a series on jaw pain and TMJ. If you missed the beginning, go back to part 1. You’ll find a case study, initial treatment notes, muscle information and a Neuromuscular Therapist’s thoughts.

Rodney had started Neuromuscular Therapy treatments in our Metro West clinic for jaw pain when chewing. After an initial evaluation and treatment (see previous Initial Treatment) he had 4 Massage Therapy treatments, two of which included the jaw, before he came back for more NMT.  He reported that currently the left side hurt in the joint (TMJ) and behind his ear. It was painful to eat but was OK at rest. Biting down and opening wide hurt the most. The other thing he noted was that his jaw seemed out of alignment.

For the first session to treat his jaw and TMJ pain I had treated just the side that hurt, gently checking the masticatory muscles that most commonly cause pain.

This second session I worked deeper in the muscles and found pain and twitching at the back edge of the masseter. Aha! A Trigger Point! Just what we Neuromuscular Therapists love to find. I was also more specific, looking for reasons for each complaint. The masseter muscle refers to the TM joint but also to the area behind the ear, two of Rodney’s complaints. Sustained pressure was applied where it was twitching and painful. I had to go back to the same spot three times before it calmed down.

The lateral pterygoid under his cheekbone was tender, but the medial pterygoid inside the angle of the jaw was very painful. He found that treatment of the medial pterygoid helped improve his sensation of jaw alignment.

The temporalis muscle doesn’t refer to the TM joint, but works on the team that closes the jaw when chewing. Rodney’s muscle was tender at the temple and along the side of his skull and very painful at the attachment to the jaw, accessed when his mouth was wide open. Obviously this was a cause of both the pain when biting down and when opening wide.

The three little muscles that go together from the styloid process deep in the space behind your ear lobe and branch out to the tongue, pharynx and hyoid bone were also tender. These muscles seem to crowd the jaw and increase pressure there, but also affect swallowing.

Since the suboccipitals are always involved mechanically when there is jaw pain, I treated them toward the end of the session. You can feel them work if you tuck your fingers in under the base of your skull and open your mouth wide.

The digastric and longissimus capitis attach to the mastoid process, the bony bump behind your ear lobe. They both refer pain behind the ear, so they were treated with the suboccipitals.

The SCM that attaches to the mastoid process and can cause ear and jaw pain was also checked. It was unremarkable.

He reported the next day at his Massage Therapy session that his jaw hurt from the NMT work, but he felt better overall.