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Body in Common

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Temporomandibular Disorder

(Jaw Pain)

This article is one of our series on common Physiotherapy conditions, and the best places to start to find relief.

​​What is TMD?

TMD is actually a term for many conditions that can happen, causing pain in your jaw, sinuses, ear, nose, throat, and even eyes.  It is a very common condition, and up to 10% of the population may suffer from TMD at some point of their lives.

The Temporomandibular Joint (TMJ) and its surrounding muscle structures is one of the most complex areas of human anatomy.  As a result, this area is very easy to misdiagnose: some people may only report headaches, while other people will report sharp pain when chewing.  Others may interpret the symptoms as a sinus problem.  This might include:

  • Jaw Pain

  • Jaw Popping or Clicking

  • Jaw Dislocation

  • Sinus Aches

  • Ear Aches

  • Stiffness in the muscles of jaw and head.

  • An inability to move your jaw through its full range.

  • Eye Pain

The good news is that Physiotherapy, combined with Stress-management and occasionally Dental guards can usually give you significant relief.

If TMD is so complex, what are some of the most common ways that it presents?

#1 - Muscles

When pain is of a muscular origin, it is called a Myalgia. The two most common muscles involved are the Masseter and Temporalis muscle. Both of these are elevators of the lower jaw (chewing/clenching muscle). Pain from a myalgia is located in the jaw, temple, in the ear or in front of the ear and is affected by movement of the jaw.

These muscles are very complex, as they 'hang' from the bones, but also performing sliding and circular movements.  This puts them under significantly more stress than many other muscles in the body.

Clients who have a muscular presentation may find that they grind their teeth during the night; chew asymmetrically; have a pre-existing injury; or a host of other underlying causes.

#2 - Joint

When pain is of a joint origin, it is called an Arthralgia. Similar to myalgia, pain from an arthralgia is located in the jaw, temple, in the ear or in front of the ear and is affected by movement of the jaw.

Clients often experience a grinding feeling, joint stiffness, or other similar joint-based conditions.  The causes may be the same as for muscular, or there may be other underlying reasons that the joint is not coping well.

#3 - Articular Disc

This is a bio-mechanical disorder that happens within the temporomandibular joint capsule, involving the condyle-disc complex (jaw bone and articular disc).  This area experience

forces from both the jaw bone and the skull, and is sensitive to inflammation if everything isn't in proper alignment.  The presentation may be very similar to joint pain, discussed above.

#4 - Wear and Tear

The disorder is caused by abnormal wear and tear of the joint with bony changes in the joint.  Degeneration is an unfortunate part of life, and catching it early results in the best outcomes for everyone.  Often behavioral changes can reduce the degeneration, and then more complex methods need to be considered.

Arthritis is also another common contributor that may be causing wear and tear.

 

#5 - Subluxation

 

Subluxation is the name for an incomplete dislocation of a joint.  In this case, the joint is hyper-mobile (too mobile). The disc-condyle complex is positioned forward and unable to return to a normal closed mouth position without being manually aided back to position.

In this case, to overcome the problem, the joint must be returned to its proper position, and therapy can assist in strengthening the surrounding areas to support the joint and prevent further subluxation.

 

How can we Treat Something so Complex?

As you can see, TMD is something that is best left to the professionals.  The variety of symptoms is very wide, and misdiagnosis is a real possibility.

An Australian-trained physiotherapist is a specialist in understanding muscle and bone structures of the body, and is the best place to start in achieving permanent relief.

First, the condition must be thoroughly assessed, and the underlying causes need to be found.  The causes vary from patient to patient - is it stress grinding, joint degeneration, pre-existing injury, muscle asymmetry?  There are many causes.

Once the cause is found, some immediate relief can usually be had by manually re-setting the joint position and performing muscular-releases on any muscle and tendon areas that have tightened up.  This provides the client some relief in the short term while the real cause is dealt with.

In the longer term, some behavioral modifications may help.  This may include:

  • Changing how you eat

  • Changing what you eat

  • Reducing stress to reduce clenching

  • Not resting you face on your hands

  • and many others.  Each person is unique.

Following on from this, clients can benefit from several sessions to re-train their jaw muscles to protect the TMJ, with the aim of removing the cause altogether.

If this sounds like you, you're not alone.  Please get in touch and book a Physiotherapy Initial Consultation to start the process back to being pain-free.

 

Natalie Tan

Head Physio at Body in Common Bangsar (Malaysia)

Bachelor of Physiotherapy - University of Melbourne

APPI-Certified Pilates Instructor - Matwork

APPI-Certified Pilates Instructor - Machine

Dry-Needling Training