OCTOBER!!! National Physical Therapy month here in the US. The goal of celebrating this month is to create awareness and highlight the transformative role physical therapy can play in improving one’s quality of life. So I thought of writing about something that not many people are aware of. As always, my patients have the answers. I recently had few patients with jaw pain who had no idea why they were referred to physical therapy. Very few people are aware of role of Physical Therapy in managing jaw pain. Also, good time to know which candy to avoid this Halloween if you have any jaw pain.
So, have you ever experienced pain while opening your mouth? May be clicking sound right in front of the ear while opening or chewing, or a feeling that the jaw won’t close or open? It’s terrifying, painful. If you did, blame it on your Temporo-mandibular joint (TMJ). I saw my dentist last week who took care of much needed dental work. I must say, I am quite impressed with the change in schedule, new equipment and sanitizing routine in place in light of COVID precautions. I felt safe enough to embark on this much needed dentist trip that was delayed by COVID. 15 minutes into the appointment, I had this pit in my stomach that my jaw will lock, I will not be able to close my mouth, it’s going to hurt or click when I attempt to close my mouth. I delayed asking for a break to rest my jaw as much as possible, but eventually had to raise my hand and sign for a break. Oh that sweet relief of slowing closing my mouth and relieving the tension in the jaw muscles.
TMJ is a joint located right in front of your ears on each side of your head. It connects your jaw bone (mandible) to the skull bone (temporals).
It is one of the most heavily utilized joint in our body, that isn’t much in limelight. It is the TMJ that mechanically allows you to open and close your mouth, and to some extent, move your jaw side to side. It facilitates eating, talking and all those facial expressions. Structurally, TMJ is a complex joint that involves a cartilage between the mandible and temporal bone. The coordinated action of various muscles involved and the smooth mechanics of the uniquely shaped cartilage allows for the powerful action of chewing, as well as finer actions of speech and expressions.
The spotlight shines on this joint only when something goes wrong. Common symptoms of TMJ dysfunction are:
- locking of jaw
- Clicking or popping sound while opening or closing mouth
- jaw pain that increases with wide mouth opening(yawn), or eating something hard
- reduced ability to open or close mouth completely
- ear pain/ hearing loss/ tinnitus (ringing in the ear)
- headache/ migraine
- neck and upper back pain
It is important to understand that not all symptoms are experienced by everyone. And it is always recommended to consult an expert for a correct diagnosis.
What causes TMJ dysfunction (TMD)? As with many other conditions in our body, this one has several possible reasons too.
- It is common for someone to feel some jaw pain, tightness after dental work, especially if they were required to have mouth open for a prolonged procedure. This usually resolves in a day or two.
- Grinding of teeth, known as Bruxism. Some people are unaware of their clenching habit. It’s common to see grinding of teeth at night time. Dentists work with patients to provide a well fitted mouth guard to prevent grinding/clenching.
- Asymmetrical Bite– Normally our upper and lower teeth fit together when we close our mouth, bite into something. When the bite is bad, or shifts away from its normal position, it affects the mechanics of TMJ which in turn causes the muscles of neck, jaw and face to tighten and not function effectively.
- Myofascial pain– involving jaw muscles
- Posture– Prolonged sustained abnormal postures can cause muscles of neck, upper back to tighten. These muscles are attached to jaw bone that can trigger series of dysfunctions, TMJ dysfunction being one of them.
- Cervical/thoracic Spine- Similar to postural issue, neck, upper/midback injuries can cause TMJ pain.
- Arthritis– affecting TMJ
- Trauma– blow to the jaw, fall hitting side of the face
PTs and Dentist are a team in this fight against TMJ dysfunction!
When assessing a patient referred for headache or neck pain, I will most certainly screen their TMJ for any possible referral. The muscles in jaw and neck work in a very coordinated fashion. Tightness in one area affects symptoms in other. I have seen great results with intra-oral muscle release that resolved neck or TMJ pain in few sessions. Manual therapy should be followed by an appropriate exercise program.
Studies have shown that combination of education and home physical therapy exercise regimen is clinically effective in treatment of TMD.1
Let’s take a look at some basic TMJ exercises. These are combination of postural exercises and focused exercises for TMJ and masticatory muscles (chewing muscles).
Resting position: Sit upright. Place the front 1/3rd of your tongue on the roof of your mouth, just behind the upper two front teeth with mild pressure. Your mouth should be closed, but teeth should be slightly apart. From this position, take few deep breaths. Focus on breathing from your belly and avoid chest expansion.
Isometrics in Resting Position:
Upper cervical distractions: Sit upright with neck relaxed and jaw in resting position. Lace your fingers behind your head for stabilization. Gently nod your head “yes” and feel the stretch in the back of your neck. Hold for 6 seconds, repeat 6- 10 times.
Shoulder Blade squeezes:
It is important to make some lifestyle changes to manage jaw pain. Here’s a list of what not to do- Avoid chewing gum, avoid eating hard foods, avoid chewing on only one side, avoid resting your chin on your hand, Avoid slouching and avoid clenching your teeth.
If you have TMJ pain, it is wise to also avoid some Halloween candy this season. Pass on the caramel and the hard candy. The chewy goodness of caramel can irritate an inflamed TMJ. Same goes with any Hard or crunchy candy. They put your TMJ in an unnatural position. Say No No to those Tootsie rolls, Caramel apple pops, swedish fish, Twizzlers, Candy Corn, Smarties. Pick out the good ones from your kid’s Halloween basket- Dove minis, Resee’s peanut butter cups…
In some cases, TMJ pain resolves on its own. If you have mild pain, exercises can help relieve the pain to some extent. It is always recommended to seek out a professional consult if pain persists. We always have something to help you in our bag of tricks! On that note, Happy Halloween!
- Michelotti A, Steenks MH, Farella M, Parisini F, Cimino R, Martina R. The additional value of a home physical therapy regimen versus patient education only for the treatment of myofascial pain of the jaw muscles: short-term results of a randomized clinical trial [published correction appears in J Orofac Pain. 2006 Spring;20(2):106]. J Orofac Pain. 2004;18(2):114-125.