Jaw Pain- the Temporomandibular Joint (TMJ)
This blog is aimed at providing a little more insight into the structure, functions and problems that occur at the TMJ for anyone who has had problems in the past or is currently suffering from jaw pain, clicking or tightness that leads to grinding and what an experienced Physiotherapists can do to help you.
Injury commonly presents with pain on opening your mouth, biting and chewing and the tightness and aching pain that disturbs sleep, cause headaches and often leads to dental issues.
What is TMD?
TMD refers to “TemporoMandibular Disorder” which is the collection of symptoms from the jaw (Temporomandibular Joint or TMJ) and the muscles involved in its movement.
** See picture below. Note: When I write TMD, Its a fancy way of referring to jaw pain and symptoms.
TMD is arguably just as common as back pain! Research suggests that 1:3 people will experience symptoms of TMJ pain at some point in their life. That is huge!
And why it this so important ?… Well symptoms can be so debilitating for patients! Think about it, we use our jaw in almost all social interactions, creating facial expressions, talking, eating etc, so any limitation or pain can really impact us constantly. It is also not an area of Physio that is taught in great depth during Physio school, which is utter MADNESS!
Physios should be the primary practitioners treating this condition, with help from dentists in screening, referring and splinting when necessary! TMD presentations are primarily a musculoskeletal condition (involving muscle and skeleton) which all Physios are equipped to assess, treat and manage! We have the skills in assessment of joint movements, have keen observational skills to measure range of movement, movement quality and posture, we have the hands on techniques to treat joints and muscles AND are experienced in providing patient education. More importantly, research suggests Physio is highly effective in treating patients with jaw pain and TMD symptoms! We also provide non-invasive and cost effective treatment when compared with splinting therapy and surgery, so why wouldn’t you head to a Physio first before considering these?
I feel it’s important to add here, that almost ALL patients will see improvement in their symptoms within 6 weeks, with the right advice and an experienced clinician, jaw pain begone!
Signs and symptoms of TMD?
Before I delve into a ‘typical’ TMD presentation, let me give you a brief overview of jaw ‘normal’. The jaw joint is involved in normal tasks of talking, eating, yawning; it should be pain free with these movements and at rest! Our jaws should open roughly 3 fingers wide and have a small degree of forward movement/ translation when open (you can feel this by softly placing a finger in front of the ears, as your jaw opens a space should open up under your fingertip). Movement should be uniform on both sides with controlled and straight opening and closing. I would even consider clicking and popping a degree of normal, so long as there are not any abnormal movement or pain issues coinciding (this stands for any musculoskeletal structure, think clicky knees!).
When the TMD becomes a problem, patients will present with a combination of 2 or more of these symptoms;
- in the muscles of the face, particularly around the mouth
- with jaw movement, ie. with chewing, singing, talking
- with subconscious jaw movement (known as parafunction) such as sleep
- bruxism, clenching with stress etc
- headaches near the temples
- ear ache (in the absence of a medical explanation)
- neck pain
ALTERED JAW MOVEMENT
- restricted mouth opening
- movement to one side with opening
- movement to one side followed by a corrective ‘S’ shaped movement
- excessive jaw opening +/- apprehension
A JAW THAT LOCKS
These symptoms are often temporary and DO NOT signal a serious problem.
Read: WILL get better with physio!
If you are sitting reading this blog and are recognising any of the symptoms above, you should consider a trip in to Woopi Physio or Sapphire Beach Physio and let us help you with your jaw pain!
How can we help to reduce jaw pain?
Well, the first step is to get you in to see a skilled Physio to ASSESS the jaw; We will talk about what makes your jaw feel worse and better, assess other possible structures, look at current jaw mechanics and its resting state and screen for contributing habits and causes.
One of the most important parts in the management of jaw pain and TMD is identifying any contributing factors, such as poor posture and bad habits or ‘parafunctional habits’.) Parafunctional habits involve jaw activity outside of normal function… pen chewing, nail biting, teeth clenching, gum chewing etc. These are the hardest to break, but there are lots of nifty little tricks we can put in place to help!
Once we have this information, we will have an idea of what hands-on TREATMENT is going to help the most! This will tailored to each patient.
Next comes the MANAGEMENT. I would consider jaw physio “20% my assistance, and 80% of what the patient can do’’ (mostly because we can’t live in everyone’s pocket!) Our team use the findings from the assessment and treatment to; prescribe specific home exercises and put habit breaking tactics into place.
Finally, we have to IDENTIFY THE PRIMARY DRIVER. The primary driver refers to the main cause of persisting symptoms and ongoing jaw pain and, in my opinion, is the MOST important step in managing your symptoms and creating long term change. By talking and screening with specific questionnaires, we can start putting the puzzle pieces together. Primary drivers can be as simple as poor posture or those bad habits, if we are lucky, as these are easy to work through!
Where it can get a little trickier from a physio perspective, is when the primary driver is not mechanical. It’s not from posture, or bad habits, rather linked to high levels of emotional stress. This is so common!! Although this is outside the remit of physio, we regularly screen for stress as a primary driver. This is absolutely vital so we can help direct you to the right healthcare professional… we can provide all the best treatment in the world, but if stress is the biggest driver, your jaw pain will be harder to shift without some help in that department too! SO, if you have jaw pain and are a total stress head/ in the middle of exams/ having an extended existential life crisis… come in, let us help alleviate the pain; it’s just important to understand that managing your stress is EQUALLY as important.
How to help long term jaw pain?
What happens if you’ve had years of jaw pain OR you’ve been given some sort of super scary diagnosis? Your disc sits in the wrong place, you have arthritis, you grind at night time? How can you possibly change that when you’re asleep?
Time for MYTH BUSTERS…
1 Discs can be out of place and NOT cause pain, physio will help!
2 Joint degeneration/ arthritis can be helped!
3 Night time grinding/ bruxism (you’ve got this now) can be helped!
The literature shows that ‘healthy’ people, without jaw pain, can have disc displacement; meaning you may not be able to get rid of that weird popping and clicking but there is NO REASON why a displaced disc should cause you jaw pain.
Likewise, people can grind at night and be pain free! Night time grinding/ bruxism, is considered NORMAL. When bruxism is creating jaw pain and symptoms however, there are things we can address… Bruxism can be caused by stress, anxiety, coffee, poor sleep, alcohol, recreational drug use, sleep apnoea, smoking etc – part of our management strategies will be to help you quit, reduce caffeine and alcohol, help you sleep, the list goes on.
Finally, you’re not a lost cause if you have joint degeneration. Likely you have some easily helped contributing factors to your pain, like the above mentioned poor posture, teeth clenching, gum chewing etc.
Some tips to help reduce jaw pain
1 See a skilled physio!
2 Try limit chewing gum and hard foods if you have pain
3 Set an alarm on your phone at regular intervals, to remind you not to clench
4 Aim for 8 hours of restful sleep – reducing caffeine, alcohol and blue light (phone and laptop) stimulus 3 hours before bed will help.
5 Try gentle self massage, a technique your physio will teach you– Three times a day for 2 minutes to help the muscles to relax…
I hope you’ve found this blog on jaw pain helpful and interesting.
We look forward to helping you to be pain free!
From Brittany Wawryk, Lead Physio specialising in Vocal and Performance Physio, Move Sports Medicine, – our Sister clinic in London.