Jaw Pain? Consider a Visit to Your Physical Therapist!

Temporomandibular disorder (TMD) is a disruption of the normal movement of the jaw and includes a variety of conditions associated with pain and dysfunction of the temporomandibular joint (TMJ), more commonly know as the jaw and its muscles. It is estimated that 20% of the population is affected by TMD, and only 10–20% of those affected seek treatment.1

Pain in the TMJ can be caused by overuse, tension, decreased blood flow, and other complications in various joints and muscles in the head, neck, and oral cavity.

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TMD may present with numerous symptoms, such as headaches, tinnitus (ringing in the ear), altered jaw movement, jaw popping or clicking, limited jaw opening, difficulty swallowing, toothache, dizziness, neck pain, and vertigo.2

TMD affects people of all ages. The disorder is often influenced by poor posture, poor oral habits (e.g., teeth grinding or clenching, gum chewing, and fingernail biting), and high stress levels. Stress can be defined as either conscious or subconscious stress. A conscious stress response may be due to a specific event and can result in elevated heart rate, anxiety, and inability to sleep. A subconscious stressor would be the absence of those symptoms during waking hours and is created over a period of time. It can present itself when sleeping and result in teeth grinding. Subconscious stressors are usually an internal struggle that is overlooked or suppressed.3

Those with TMD often present with poor posture and a greater forward head position than individuals without TMD (see the image below). Increased tension in the muscles at the base of the head (suboccipitals) caused by a forward posture can lead to muscle imbalance, pain, and decreased jaw motion and displacement, which directly affect the TMJ.4

Other causes of TMD include teeth grinding and/or clenching, which are involuntary behaviors. Teeth grinding is primarily a nocturnal behavior, while clenching may occur during the day or at night. In severe cases, disc displacement of the jaw and arthritis may occur and may require further medical intervention.5Sports-pt-1-28-2

TMD is also caused by microtraumas and macrotraumas. Microtraumas include repetitive insult to the jaw, as seen with karate, boxing, or wrestling injuries. Macrotraumas include more forceful and direct insults to the jaw; these are often linked to jaw dislocations, which are most commonly seen in motor vehicle accidents.

Noninvasive, conservative treatments generally provide improvement or relief of TMD symptoms and are recommended in the initial management of the disorder. Physical therapists are frequently involved in the management of TMD, often in collaboration with dental professionals. In a survey of members of the American Dental Association, physical therapy was listed as an additional treatment among 10–17% of patients. A wide variety of physical therapy techniques – including specific joint movement and manual therapy to the jaw and neck, postural exercises to increase strength around the shoulder blade region, soft tissue massage, electrotherapy, biofeedback, relaxation techniques, and flexibility exercises for the jaw and neck – can be effective in managing this disorder. 6,7

If you or someone you know is experiencing TMD or symptoms related to TMD, consider talking to your dentist and reaching out to a physical therapist to see what options are available to you. For more information, contact us at info@sptny.com.

References:

1. Pedroni CR, De Oliveira AS, Guaratini MI. “Prevalence Study of Signs and Symptoms of Temporomandibular Disorders in University Students.” Journal of Oral Rehabilitation, 30 no. 3 (2003): 283–289.

2. Dworkin SF, Huggins K, Wilson L, et al. “A Randomized Clinical Trial Using Research Diagnostic Criteria for Temporomandibular Disorders: Axis I to Target Clinic Cases for a Tailored Self-Care TMD Program.” Journal of Orofacial Pain 6 (2002): 48–63.

3. http://www.subconscious-mindpower.com/brain/the-effects-of-stress-on-the-brain

4. Di Fabio RP. “Physical Therapy for Patient with TMD: A Descriptive Study of Treatment, Disability, and Health Status.” Journal of Orofacial Pain 12 (1998): 124 –135.

5. Sturdivant J, Friction JR. “Physical Therapy for Temporomandibular Disorders and Orofacial Pain.” Current Opinion Dentistry 4 (1991): 4885–4896.

6. Feine JS, Lund JP. “An Assessment of the Efficacy of Physical Therapy and Physical Modalities for the Control of Chronic Musculoskeletal Pain.” Pain 71 (1997): 5–23.

7. Minagi S, Nozaki S, Sato T, Tsuru H. “A Manipulation Technique for Treatment of Anterior Disk Displacement with Reduction.” Journal of Prosthetic Dentistry 65 (1991): 686–691.

Other References:

8. Linde C, Isacsson G, Jonsson B. “Outcome of 6-Week Treatment with Transcutaneous Electric Nerve Stimulation Compared with Splint on Symptomatic TMJ Disc Displacement without Reduction.” Acta Odontologica Scandinavica 53 (1995): 92–98.

9. Conti PCR. “Low Level Laser Therapy in the Treatment of Temporo-mandibular Disorders (TMD): A Double-Blind Pilot Study.” Cranio 15, no. 2 (1997): 144–149.

10. Wright EF, Domenech MA, Fischer JR Jr. “Usefulness of Posture Training for Patients with Temporomandibular Disorders.” Journal of the American Dental Association 131 (2000): 202–210.

11. Nicolakis P, Erdogmus CB, Kopf A, et al. “Exercise Therapy for Craniomandibular Disorders.” Archives of Physical Medicine and Rehabilitation 81 (2000): 1137–1142.

12. Nicolakis P, Erdogmus CB, Kollmitzer J, et al. “An Investigation of the Effectiveness of Exercise and Manual Therapy in Treating Symptoms of TMJ Osteoarthritis. Cranio 19, no. 1 (2001): 26 –32.

13. Michelotti A, Steenks MH, Farella M, et al. “The Additional Value of a Home Physical Therapy Regimen versus Patient Education Only for the Short-Term Treatment of Myofascial Pain of the Jaw Muscles: Short-Term Results of a Randomized Clinical Trial.” Journal of Orofacial Pain 18, no. 2 (2004): 114 –125.