The temporomandibular joint (TMJ) is located between the cheek and the ear. Pain at the TMJ can be mild to severe, isolated to the joint or widespread to the neck and head. It can become so debilitating that you could struggle with chewing, eating or opening your mouth normally.
Physio can be used to assess and treat potential muscular contributors to this pain in ways other health practitioners may not be able to, or to refer patients to the necessary health practitioners.
The role of Physio in TMJ Disorders
Over 50% of TMD are of muscular (myofascial) origins while the rest are due to inflammation at the joint. To work out the difference in a physiotherapy assessment, we not only look at the jaw and ear (sometimes with a gloved hand, like a visit to the dentist) but also the neck and head movements and posture.
What a Physio can do to treat TMJ Disorders
Relief from pain comes from relaxing the TMJ muscles which are overworked and strengthening the muscles which are underperforming.
Treatment includes resolving muscle spasm at the neck and jaw with massage or dry-needling. We also mobilise stiff joints, prescribe shoulder, neck and jaw exercises. If appropriate, a referral to a dentist or GP will be provided.
Behaviour modification like decreasing clenching or grinding must also be addressed. I find that a huge part of managing TMD effectively is gently identifying the factors which trigger or contribute to the behavioural conditions. This is so we can gradually make realistic life-style changes and devise sustainable ways to manage the factors. If necessary we can co-manage with a counsellor to create an effective pathway to recovery long-term.
Evidence for the benefits of Physio
Conservatively managed TMJs can decrease pain, improve mouth opening and resolve TMD within 3 months.
Recent systematic reviews support treating the TMJ and neck in combination as it is more effective than treating the neck alone for TMD. Interestingly, outcomes are comparable between counselling + TMJ exercise or counselling + splinting therapy. So if you haven’t seen a dentist yet or had a splint made, it’s definitely worth trying physiotherapy.
TMJ Consultation FAQs
What are the symptoms of TMJ Disorders?
If you experience any of the following symptoms it is likely you are experiencing problems at your TMJ:
Waking with a stiff neck, jaw or headache
Painful popping, clicking or clunking with movement
Painful asymmetrical movement
Difficulties with yawning, laughing, singing and eating
Grinding or clenching during the day or night
70-86% of TMD patients have recurrent headache while 14-21% of those who have headache have TMD signs/symptoms.
Who is more likely to have TMJ Disorders?
10-15% of the population is affected by TMD (temporomandibular disorder) and it is more common in women between the ages of 20 and 44. There’s also a high correlation between headache and neck pain.
Habitual grinding and clenching of the teeth are strong factors, as well as high levels of stress and anxiety. Sudden injury or trauma can also cause TMJ pain as can braces or structural abnormalities but are less common. Stress and anxiety is a common factor which often triggers or greatly contributes to myofascial TMD symptoms.