Monday Medical: Understanding TMJ dysfunction
January 18, 2015
Have you ever bitten into an apple or bagel and felt a "popping" in your jaw? Do you often end your workday with a dull ache at your temples or cheeks? Has your jaw ever "locked" or felt off center?
If you answered "yes" to any or all of these questions, you may be suffering from a condition commonly referred to as temporomandibular joint dysfunction. Symptoms of TMJ include popping and clicking of the jaw, face pain and sometimes debilitating headaches.
The TMJ is located just in front of the ears on either side of your face. It is the connection between the skull and the lower jaw called the mandible. As with many joints in the body, the TMJ has a disc associated with it. As you open and close your mouth, the upper portion of the mandible rolls forward and back, with the disc sliding beneath it.
Unfortunately, for many, this process is not so simple. The disc may fail to slide and rotate as it should, producing a click. The disc also can get stuck in a forward or backward position, causing the jaw to stick or lock.
Many powerful muscles are associated with the TMJ. The main muscles associated with the TMJ are the masseters (in the cheeks), medial and lateral pterygoids (deep in the face) and temporali (over the temples). Imbalances or trigger points in these muscles can cause the headaches and facial pain.
In some cases, imbalances are the result of injury or trauma, however, in many cases lifestyle habits are pointed to as the cause. If you think that you may have TMJ dysfunction, consider making the following changes to your daily routine or health care habits:
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• Sleeping. The best sleeping position to prevent bruxism (grinding of the teeth) is lying on your back with a pillow that optimally supports the curve in your neck. A mouth splint, made by your dentist and worn while sleeping, can be extremely helpful.
• Posture. Notice that when you push your head forward, your jaw is encouraged to fall open. To keep the mouth closed, you must rely on facial muscles to pull it closed, producing unwanted tension. Many people who have jaw and headache pain have what is known as "forward head posture." This posture can often be changed significantly through stretching and strengthening exercises.
• Diet modification. Many foods can trigger headaches. It often is difficult to determine which foods are the culprits because headaches can often occur hours after eating the offending food. A safe bet is to eliminate exceptionally crunchy or chewy foods until painful symptoms settle down.
• Neuromuscular re-education. This is a fancy phrase used to describe retraining the body to move in the appropriate manner without conscious control. Exercises aimed at relaxing the muscles surrounding the jaw and improving alignment of the TMJ are primary treatment components.
• Massage. As mentioned, the muscles around the jaw can develop excessive tension and trigger points. Massage therapists or physical therapists trained in intra-oral massage can help with this problem.
• Stress reduction. Many patients experience an increase in symptoms during stressful times. People often will walk around or sleep with a clenched jaw without even realizing it. Consider yoga, Pilates, meditation, physical activity or lifestyle changes that can reduce stress.
This article has illustrated some of the remedies for TMJ dysfunction. Many people suffer needlessly simply because they do not realize that conservative treatment options exist. Consider consulting your physical therapist and/or dental professional for an individualized treatment program.
Jennifer Kerr, DPT, is a physical therapist at SportsMed who has experience in treating TMJ dysfunction.