Our physical therapists focus on reducing the pain and discomfort of temporomandibular joint dysfunction (TMJD) by relaxing the tension associated with the temporomandibular joint (TMJ) through exercise and habit modification. We use Hanna Somatic Movment, gentle exercises that are designed to relax muscles to restore proper alignment. We do not do painful stretching or trigger point massage that can exacerbate the discomfort. Before we talk about TMJD and what physical therapy can do to help orofacial and jaw pain, you should understand what the TMJ is, what causes TMJD, and then what options for treatment are available for you.
TMJ stands for the temporomandibular joint (temporal like the temple bone of your skull and mandible meaning your jaw bone). The TMJ is one of the most complicated joints of your body. Movement of this joint is finely coordinated allowing us to open our mouths wide and move our jaws from side to side so we can talk, chew, yawn, swallow and sneeze.
When the TMJ becomes tight and painful, the condition is called TMJD or temporomandibular joint dysfunction syndrome. There are many causes of TMJD including direct trauma to the jaw like might happen in a car accident or fall, tooth aches or misaligned teeth, traumatic or poorly done dental work, jaw clenching, grinding teeth, neurological problems, poor posture, and even stress which could lead to stiffening of the muscles of the jaw or head for extended periods, which could also produce strain on the joints and muscles in this area.
When the TMJ undergoes one of above mentioned traumas, the muscles around the joint reflexively tighten up to protect the joint. At the same time, that protective vice limits the jaw's ability to move which causes the pain in facial muscles as we try to fight them whenever we try to speak or eat. This fight between us and our body's response to trauma is one of the major causes of the discomfort associated with TMJD.
Symptoms and Diagnosis of TMJD
The pain associated with TMJD can be treated in a variety of ways, depending on the cause and the severity of the symptoms. Some of the symptoms of TMJD include:
- Jaw clenching during the day or at night
- Jaw pain and tightness
- Grinding teeth at night (bruxism)
- Discomfort or pain of the mouth, face, cheek, or chin
- Inability to open or close the jaw smoothly, evenly, or completely
- Jaw deviates to one side when opening
- Clicking or popping jaw joints
- Migraines or headaches
- Difficulty chewing
- Hissing, buzzing, ringing, or roaring sounds in the ears
- Ear pain wihtout infection
- Neck pain or stiffness
- Tired, sore neck problems
- Shoulder aches
Treatment techniques can be broken into those which are conservative (i.e. not requiring surgery or direct intervention) including medications, jaw braces, and exercises. Other invasive interventions are usually reserved for the most severe cases after conservative treatments have failed and include injections and surgery.
Non-Invasive Treatments Include:
Manual Therapy: Refers to a physical treatment done by the therapist to the patient and can include includes soft tissue and joint mobilization as well as gentle joint manipulation.
Therapeutic Exercises: These are the physical therapist's area of specialization. An experienced physical therapist can teach you exercises that help you lengthen and relax the muscles surrounding the joint reducing tension and pain. Therapists have at their disposal a variety of exercises with and without assistive devices that can focus on restoring and maintaining strength of muscle, endurance, flexibility, stability and balance of the jaw and neck.
Neuro-Reeducation: Precise, micromovement exercise is combined with electrical stimulation from electrodes to improve muscle recruitment and coordination. The overall result is smoother, and reduced tension during motion.
Modalities: Tools and procedures like thermotherapy, electrostimulation, iontophoresis, ultrasound, and LASER therapy which are applied to the patient and can enhance tissue healing and reduce pain.
Postural Training: One of the causes of TMD is bad posture, especially if you head sticks forward of your body which causes great stress on the neck. Try improving your posture especially while sitting.
Habit Modification: Avoid the activity that is causing the stress including nail biting, gum chewing, and ice biting.
Diet Modification: Avoid foods that are difficult to chew. Increase the amount of soft foods in your diet like soup and yogurt or cut your food into small pieces.
Medication: Some anti-inflammatory drugs can help with the pain and discomfort but rarely address the cause of the TMD. You should consult with your physician before using any drugs.
Compresses: Apply hot packs or cloths soaked in warm water over the area of pain. This may help reduce the muscle spasms. Alternatively, cold compresses or ice packs can reduce swelling. Try both at different times and see which helps you more. Again, compresses may help with symptom management, but rarely address the underlying cause.
Dental appliances: There are some devises such as splits or nightguards that can be prescribed by physicians, physical therapist, and dentists after you have received the diagnosis of TMJD.
Some invasive or irreversible treatments for TMJD include:
- Orthodontics to change the bite
- Crown and Bridge work to balance the bite
- Grinding down the teeth to bring the bite into balance (called occlusal adjustment)
- Repositioning splints also called orthotics which permanently alter the bite
- Surgery including TMJ replacement or implants. Be sure that you are working with an experienced provider and that you get independent opinions if you are considering this option.
What is physical therapy At FVPT Like for TMJD?
Your first physical therapy visit will be an evaluation where a physical therapist will work with you one-on-one to understand you symptoms and how your orofacial pain has been effecting you. The second half of your first visit may include manual therapy, where the physical therapist gently moves and manipulates the TMJ and the muscles surrounding the TMJ to get them to relax. This may include the therapist pressing on the muscles surround the TMJ from inside your mouth with a gloved hand.
When the muscles around of the TMJ have relaxed, the therapist will then help you relearn how to coordinate the movement of the TMJ using a series of exercises and give you a home exercise program. It may take several sessions to get to the point where your TMJD symptoms dissipate completely, though most patients report a drastic improvement in symptoms after one or two visits.
How can I learn more?
if you are interested in learning more about how physical therapy and Somatic Neuroeducation exercises can help you and your case of TMJD, please call us at (860) 673-0223 to request a consultation or to speak with a physical therapist over the phone. For more information about the TMJ and TMJD, see the National Institutes for Health Pamphlet on TMJ Disorders.