Jaw pain is one of the symptoms of temporomandibular joint disorder (TMD). Considering over 10 million individuals in the United States experiences TMD it can be considered fairly common. But what exactly is TMD?
WHAT IS TEMPEROMANDIBULAR JOINT DISORDER (TMD)?
Jaw movement is guided by the temperomandibular joint (TMJ). Here are some common causes that lead to TMD:
- Bad posture–Face it…many of us sit a lot–commuting to/from work, sitting at a desk in front of a computer, cradling the telephone against the same shoulder for extended periods of time…as well as standing activities such as always carrying your child on the same hip–all of these activities can place the head in an awkward position and cause jaw problems. Consistently being in this forward head position puts undue stress on muscles, ligaments, as well as discs in the neck and jaw. This forces the jaw to “rest” in an opened position, causing our chewing muscles to become overused.
- Malocclusion (problems with teeth alignment)–Greater stress is placed on your TMJ if your teeth come together in an unusual way.
- Bruxism (chronic jaw clenching and grinding teeth at night)–Many individuals unknowingly clench their jaws at night while they sleep, usually due to stress. This puts constant stress on the TMJ because of the constant strain on the joint and surrounding muscles.
- Trismus (lockjaw)–This condition is caused by spasming jaw muscles which prevents the jaw from being able to be fully opened. Causes may include tetanus, trauma to the jaw, and radiation therapy to the neck and face.
- Fracture–Trauma to the face or head could result in a fracture to the lower jaw. Even when the fracture is completely healed, lingering TMJ pain and/or stiffness may remain.
- Surgery–There may be a loss in mobility and function of the TMJ following facial or jaw surgery.
WHAT DOES TMD FEEL LIKE?
Symptoms of TMD may include:
- Jaw pain
- Difficulty opening your mouth to eat or talk
- Jaw fatigue
- Ringing in your ears
- Neck pain
- Locking jaw
HOW IS TMD DIAGNOSED?
A comprehensive exam by your Physical Therapist is critical in diagnosing the cause of your TMD symptoms. This exam should include:
- A comprehensive medical history, including questioning any prior surgeries, fractures, or other trauma to your head, neck, or jaw.
- A comprehensive physical examination to assess mobility of your head, neck, and jaw; postural assessment to look for signs of a forward head posture; TMJ exam to look for abnormalities in jaw movement, including opening/closing (which should include an intraoral exam where the Physical Therapist places his/her hands inside your mouth). Note: If after the physical examination your Physical Therapist feels that your jaw symptoms are the result of malocclusion (alignment of the teeth), he/she should refer you to your dentist for further evaluation.
HOW CAN PHYSICAL THERAPY HELP WITH TMD?
The goal of Physical Therapy is to decrease your pain and to restore the natural movement of your jaw. Assuming that your diagnosis of TMD is not due to malocclusion (teeth alignment), the following treatments would most likely be utilized by your Physical Therapist:
- Improve jaw mobility, relieve head/neck/jaw pain–Your Physical Therapist should utilize manual therapy techniques such as myofascial release, intraoral mobilization, soft tissue massage, and manual cervical traction/suboccipital release to help restore normal neck and jaw muscle and joint mobility and flexibility, as well as to address any adhesions within the soft tissue that may be contributing to restrictions in motion and causing discomfort.
- Postural Education–Your Physical Therapist will evaluate your sitting and standing posture to reduce forward head position. If you are one of the many individuals who display this type of posture you will be placing a larger stress on the muscles beneath your chin, leading to cause the lower jaw to pull back and the mouth to be in an open position even when resting, thus causing increased strain on your TMJ. It is also possible that you could be overworking the jaw muscles to force the jaw to close so your mouth does not remain open all the time. Your Physical Therapist will be able to show you exercises to minimize strain placed on the neck and jaw muscles.
- Special considerations–If it is determined that your TMD is caused by malocclusion (teeth alignment), your dentist should be able to fabricate a special appliance called a bite guard that should help to relieve pain and improve jaw function by creating a natural resting position of the jaw to relieve stress on the TMJ.
CAN TMD BE PREVENTED?
The key to preventing TMJ problems is to maintain good posture, as discussed above, as well as minimizing stress.. As mentioned previously, your Physical Therapist can show you how to maintain good posture in sitting and standing to prevent future episodes of TMD. Here are some general tips for helping to prevent the onset of TMD:
- Avoid smoking
- Avoid sleeping on your stomach, which forces the head/neck to rotate to one side in order to maintain an open airway, thus increasing stress on the TMJ
- Avoid eating hard or chewy foods, including chewing ice
- Avoid receptive chewing, such as gum chewing
- Avoid opening the jaw too wide, as in yawning
- Maintain good oral hygiene
Some tips at work:
- Make sure your computer monitor is aligned directly in front of you and not off to one side where you are forced to look in one direction for extended periods of time.
- If you use a phone a lot throughout the day, using a hands-free headset will allow the neck and jaw to remain in a neutral (restful) position.
PLEASE NOTE–JAW PAIN IS ONE OF THE SYMPTOMS OF TMD. IT IS EXTREMELY IMPORTANT TO NOTE THAT JAW PAIN CAN ALSO BE A SYMPTOM OF A HEART ATTACK. SEEK MEDICAL ATTENTION IMMEDIATELY IF YOUR JAW PAIN IS ACCOMPANIED BY:
- Chest pain
- Shortness of breath
- Pain or numbness in your left arm
If you or someone you know is experiencing head/neck/jaw pain, don’t wait to take action. Call my office at once at (302)691-9055 or visit my website at www.wildermanpt.com to schedule your FREE 30 minute consultation to see how Physical Therapy can help you. Don’t delay–schedule now!