Physical Therapy Can Help Chronic Jaw Pain

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. Overuse, tension, decreased blood flow, and other complications in various joints and muscles in the head, neck, and oral cavity can cause pain in the TMJ.

TMD affects individuals of all ages. In fact, it is estimated that 20% of the population is affected, but only 10-20% of those affected seek treatment.1

Symptoms

TMD sufferers may experience headaches, tinnitus (ringing in ear), altered jaw movement, jaw popping or clicking, limited jaw opening, difficulty swallowing, toothache, dizziness, neck pain, and/or vertigo.2

Causes

Pain in the TMJ can be caused by a wide variety of factors related to overuse, tension, decreased blood flow, and other complications in various joints and muscles in the head, neck, and oral cavity.

The most common causes include:

Poor posture: Individuals with TMD present frequently display poor posture and a more forward head position than individuals without TMD. Increased tension in the muscles at the base of the head (suboccipiatals) caused by a forward posture can lead to muscle imbalance, pain, decreased jaw motion, and displacement which directly affects the TMJ.3

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 result in elevated heart rate, anxiety, and/or inability to sleep. A subconscious stressor is created over a period of time and can often present itself when sleeping and result in the grinding of teeth. Subconscious stressors usually stem from an internal struggle that is overlooked or suppressed. 13

Teeth grinding and/or clenching: Teeth grinding is primarily an involuntary nocturnal behavior. Clenching can 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.4

Micro- 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 and are often linked to jaw dislocations, most commonly seen in motor vehicle accidents.

Treatment

Noninvasive, conservative treatments generally provide improvement or relief of symptoms and are recommended in the initial management of TMD. Physical therapists are frequently involved in the management of TMD, often in collaboration with dental professionals. A wide variety of PT 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 the management of this disorder. 5-12

Patients suffering from chronic jaw pain should consult a physical therapist to determine what type of treatment plan is right for them.

References:
1 Pedroni CR, De Oliveira AS, Guaratini MI. Prevalence study of signs and symptoms of temporomandibular disorders in university students. J Oral Rehabil. 2003;30:283–289.

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. J Orofac Pain. 2002;6:48–63.

3 Di Fabio RP. Physical therapy for patient with TMD: a descriptive study of treatment, disability, and health status. J Orofac Pain. 1998;12: 124 –135.

4 Sturdivant J, Friction JR. Physical therapy for temporomandibular disorders and  orofacial pain. Curr Opin Dent. 1991;4:4885–4896.

5 Feine JS, Lund JP. An assessment of the efficacy of physical therapy and physical modalities for the control of chronic musculoskeletal pain. Pain. 1997;71:5–23.

6 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 Odontal Scand. 1995;53:92–98.

7 Conti PCR. Low-level laser therapy in the treatment of temporo-mandibular disorders (TMD): a double blind pilot study. Cranio. 1997;15(2):144 –149.

8 Wright EF, Domenech MA, Fischer JR Jr. Usefulness of posture training for patients with temporomandibular disorders. J Am Dent Assoc. 2000;131:202–210.

9 Nicolakis P, Erdogmus CB, Kopf A, et al. Exercise therapy for craniomandibular disorders. Arch Phys Med Rehabil. 2000;81:1137–1142

10 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. 2001;19(1):26 –32.

11 Minagi S, Nozaki S, Sato T, Tsuru H. A manipulation technique for treatment of anterior disk displacement with reduction. J Prosthet Dent. 1991;65:686 – 691.

12 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. J Orofac Pain. 2004;18(2): 114 –125.

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