This came as no surprise to me. In my 16 years experience as a dental nurse I saw many patients pass through the surgery suffering with TMJ.
Conventional treatments on offer had mixed success and included wearing splints at night, taking muscle relaxant drugs and painkillers, adjusting high fillings and replacing worn fillings. When these measures failed, patients would be referred to a specialist for extensive tests including panoramic x-rays and even MRI. Surgery was an option but was very rarely considered as a last resort.
So what is TMJ? Why is it so difficult to diagnose and treat? More importantly what can we as massage therapists do about it?

“TMJ” stands for TemporoMandibular Joint.

The TMJ is the hinge joint that connects the lower jaw (mandible) to the temporal bone of the skull. The joints move up and down and side to side and enable you to talk, chew, and yawn. Muscles attached to and surrounding the joint control it’s position and movement.
Because it combines a hinge action with sliding motions, the TMJ is one of the most complex joints in your body. The parts of the bones that interact in the joint are covered with cartilage and are separated by a small shock-absorbing disk, which keeps the movement smooth.
“TMJ” is also used to describe a number of diseases and disorders associated with the joint.

What are TMJ Diseases/Disorders?

TMJ diseases and disorders are a complex set of conditions that can cause pain in the area of the joint and associated muscles and/ or problems using the jaw. Both or just one of the joints may be affected. TMJ diseases and disorders can affect a person’s ability to speak, eat, chew, swallow, and even breathe.
TMJ diseases and disorders fall mainly into three categories. A person may have one or more of these conditions at the same time.

• Myofascial pain. This refers to discomfort or pain in the muscles that control jaw function and can also extend to the muscles in the neck and shoulders.
• Internal derangement of the joint. This involves displacement of the disc that acts as a cushion between the skull and lower jaw.
• Inflammatory joint disease, including arthritis, an inflammatory condition that affects a joint; and synovitis, an inflammatory condition of the synovial membrane. The synovial membrane lines the joint and produces a fluid that lubricates the joint.

Causes

Certain factors can make people more prone to TMJ disorder.
• Having one dominant chewing side
• Teeth Grinding (Bruxism): Many people grind their teeth when they sleep. Other people tend to clench their teeth during stressful situations. Both situations put unnecessary stress on the jaw.
• Whiplash Injury to the neck.
• Dentures: Having worn-down dentures or ones that do not fit properly can cause jaw imbalance.
• Repetitive Chewing: Consistent gum chewing or tendency to eat other chewy foods can weaken jaw muscles.
• Heavy Telephone Use: Using the phone for long periods of time, while cradling the phone between the chin and shoulder, can cause jaw pain.
• Dental Orthodontia

How do we know if a client has TMJ?

First and foremost, as massage therapists it is NOT our job to diagnose
Even for the dental surgeon diagnosing TMJ diseases and disorders can be difficult and confusing. Apart from the three main categories stated above, facial pain can be a symptom of many conditions, such as sinus or ear infections, decayed or abscessed teeth, various types of headache, and facial neuralgia (nerve-related facial pain).
Massage can bring about huge relief for TMJ sufferers where the soft tissues are involved. However there is always the possibility of another problem that needs intervention by a dental professional.

If a client is describing symptoms that make you suspect TMJ there is a simple palpation assessment you can perform to help determine if there is a problem with the joint and soft tissues. You should then refer your client to their dentist for a full assessment and diagnosis and then bring them back to you for treatment to complement the work their dentist is doing.
Signs and symptoms

Pain is the most common symptom. TMJ pain is often described as a dull aching pain in the jaw joint and nearby areas, including the ear. Some people, however, report no pain, but still have problems using their jaw. Other symptoms can include:

•Being unable to open the mouth comfortably
•Clicking, popping or grating sounds in the jaw joint
• Jaws that get “stuck” or “lock” in the open- or closed-mouth position (Trismus)
•Headaches
•A bite that feels uncomfortable or “off”
•Neck, shoulder and back pain
•Swelling on the side of the face

Additional symptoms may include: ringing in the ears, ear pain, decreased hearing, dizzness and vision problems, sensitivity to light, and headaches.

So what can WE do?

The good news is that appropriately trained massage therapists are in a unique position to help sufferers of this condition get out of pain. Disorders of the muscles of the TMJ are the most common complaints by TMJ patients.
The two major observations concerning the muscles are pain and dysfunction. Simple cases of this type of TMJ are caused by overuse of the muscles. Pain in the joint will often be coming from the soft tissues surrounding it. Even if there is a physical problem with the disc or the joint itself the muscles will often be involved and a significant reduction in pain and improved function can be achieved with trigger point work.
My own Journey with TMJ and trigger point therapy

It was shortly after qualifying as a massage therapist that my boss at the surgery mentioned trigger points to me as he had heard they could be indicated in TMJ.
This passing comment set me on a path of discovery which was to shape my whole massage career.
I discovered that trigger points in the trapezius, sub occipitals and SCM are often the main cause of pain in the TMJ. These can then set up satellite or secondary trigger points in the masticatory muscles (temporalis, masseter, lateral pterygoid, and medial pterygoid).
For example trigger points in the SCM can maintain secondary trigger points in the jaw muscles that are the cause of jaw pain and misalignment of the TMJ itself. When you treat the primary trigger points the secondary are often resolved also .
Over the next few months we began looking for volunteers amongst our TMJ patients to try massage for their condition. Everyone we asked was enthusiastic -after all what was the worst that could happen? They might just have a nice massage?
To all of our amazement the treatments began to make a real difference to people who had been through years of pain and restriction.

One such person was a young woman called Vicky. A student at Veterinary college, Vicky was under huge amounts of stress. When she first came to me she had a trismus. Her jaw was locked closed and at her first visit, she could only open her mouth the width of two fingers. She also suffered from severe headaches.
Vicky attended for massage and trigger point therapy weekly. In the beginning we could not treat the muscles of mastication due to the severely limited access, so treatment was focused around the neck and shoulders particularly the trapezius, sub occipitals and SCM.
After her third appointment Vicky was very pleased to report that she could now open her mouth the width of four fingers. I respectfully pointed out that for most people to be able to do that they would need a flip top head! We then continued to treat these muscles for another three weekly appointments after which Vicky reported that her jaw felt loose and comfortable and pain free and her headaches were gone. Vicky continues to have monthly maintenance treatments to help prevent the problem returning.
This story was just one in a series of success stories with this condition which set me off on my “Trigger Point Journey”.
This soon led me to Jing Advanced Massage and their fantastic Advanced Clinical Massage courses which teach proven trigger point protocols for the treatment of pain. My practical experience led to the one day TMJ course, which gives you great techniques to help make a real difference to sufferers of this debilitating condition.

About Tracey Kiernan and Jing Advanced Massage

Tracey Kiernan is a former dental nurse turned massage therapist who specializes in the treatment of pain from her clinic in Liverpool. She is also a head teacher for Jing Advanced Massage. Jing Advanced Massage and Training is an organisation dedicated to excellence in all aspects of postgraduate massage training. Based in Brighton, we offer courses around the country all of which aim to make you the best bodywork therapist you can possibly be. Please call or check our website for further information and course dates.
www.jingmassage.com
info@jingmassage.com
Tel: 01273 628942

Each treatment session with Jill is tailored to individual need and is designed to help clients out of pain within 1-6 sessions.

Jill has been training with Jing for 8 years and has a certificate in Advanced Massage. She is currently a student on the Jing BTEC (level 6) Advanced Diploma in Clinical and Sports Massage. She is also a licensed practitioner in the Niel-Asher technique for treatment of frozen shoulder.

Jill’s areas of expertise are in; myofascial release, trigger point therapy, soft tissue release, hot stone fusion, advanced stretching, positional release and pregnancy massage.

Some time ago, I replayed this snippet several times, struck by the power of the central concept of mindfulness and its application to bodywork. These words are so appropriate to our bodywork practice – good bodywork is creative bodywork and as the speaker so eloquently expresses – unless we are in the present moment we are ‘entirely unable’ to be creative. Yet how often are we actually really in the present moment? When we massage are we truly engaged in ‘what is happening’ – are we totally absorbed and fascinated by the feel of the tissues, sensing differences not just physically but emotionally and psychologically? Or, more likely, are we thinking about what we will do next from the ‘routine’ we have learned – or even worse, how long this is taking, how our back is hurting, when will the session be over, or what we are having for dinner?

The key concept of ‘exquisite and excellent’ bodywork lies in our ability to truly focus. Mindful bodywork enables us to pay attention to whether that trigger point technique is really releasing the tissues or producing no change – if so maybe we
need to change our pressure slightly, or our body mechanics or even choose a different technique. I find in my own practice that even the simple act of truly drawing my attention to my work enables a change to happen. As the visionary cranial
therapist Hugh Milne states; “Presence is more important than technique. Beginners want to learn more and more techniques. When you achieve mastery, one technique will do.” In the East, meditation and mindfulness are inseparable from most healing practices. However, their importance can often be overlooked in the West. Beautiful in their simplicity, applying the concepts of mindfulness and meditation to your bodywork can improve enjoyment of your work, enhance results, improve client relationships and enable you to
better manage your work–life balance. This may sound like a fanciful ‘quick fix’ but the truth is that although these concepts are easy to understand, mastery requires a great deal of practice. And the good news is that we can use our own massage practices to do this – any bodywork session is a wonderful opportunity to put meditation and mindfulness into action. If you let your work be your meditation you will never ‘work’ another day in your life – you will leave your massage sessions feeling refreshed energized and bursting with positivism!

What is meditation?
When you read books about meditation, there is often a great deal of emphasis placed on different techniques such as chanting, certain practices with the breath, visualization etc. However, the most important feature of meditation is not technique, but the way of being, the spirit, which is one of quiet focus – of being rather than doing. This can be a difficult concept as it is the opposite of the way we are accustomed to achieving in the West – through striving and effort and often-accompanying stress. In contrast, meditation is simply a question of being, of melting, like a piece of butter left in the sun. You just quietly sit, your body still, your speech silent, your mind at ease, and allow thoughts to come and go, without letting them play havoc on you. Most forms of meditation
practice all place central importance on being mindful of the breath. This is a very simple process – just be aware of the breath, how it feels in your body, noticing any small movements, sounds or rhythms to which you don’t usually pay attention. When you are breathing out, know that you are breathing out. When you breathe in, know that you are breathing in, without going into the usual kind of internal dialogue in which our minds endlessly engage if left to their own devices. This is so much harder than it sounds! Our ‘monkey minds’ are constantly aiming to stray, create noise and endless chatter. A regular practice of meditation enables us to gradually develop our ability to be truly mindful and in the moment. There is a famous Zen saying: “When I eat, I eat; when I sleep, I sleep”. Whatever you do, you are fully present in the act. Of course one can add, “When I massage, I massage!”

What is mindfulness?
Mindfulness is a central concept of the teachings of the Buddha and is felt to be a spiritual faculty that is of great importance in the path to enlightenment. Mindfulness is basically an attentive awareness of the reality of things (especially of the present moment). The Buddha advocated that one should establish mindfulness in one’s day-to-day life maintaining as much as possible, a calm awareness of one’s bodily functions, feelings, thoughts and perceptions, and consciousness itself. Over the last few decades, the importance of mindfulness in maintaining positive mental health and reducing stress has been recognised by modern psychology. Mindfulness practice, inherited from the Buddhist tradition, has been presented free from any religious connotations and is increasingly being employed to alleviate a variety of mental and physical conditions, including chronic pain, obsessive-compulsive disorder, anxiety, and in the prevention of relapse in depression and drug addiction. The psychologist, Dr. Jon Kabat-Zinn has been at the forefront of these developments and, in 1979, founded the Mindfulness-based Stress Reduction programme at the University of Massachusetts to treat the chronically ill. His MBSR programmes (an 8-week course) have proved hugely successful in dealing with a host of physical and mental health issues. Mindfulness, meditation and massage There are many ways that mindfulness and meditation can be employed to positive effect within your bodywork practice.

Here are a few ideas:
Starting your treatments The mindful 3-breath basics!

Take time at the start of each and every treatment to become truly aware of yourself and your client’s body. Once your client is on the
table, take a few seconds to notice how your own body is feeling before initiating contact. Notice where the weight is on your feet, how you are feeling and most importantly tune into your breath and follow it for at least 3 breaths, This only takes a second but will radically change your ‘entry’ into your session. Usually just truly becoming aware of your body enables you to relax your posture, to release any tension and to begin to clear your mind. I feel that to do a truly effective bodywork
session your body should feel like a ‘still pond’ – it is only from this starting point that you will be able to pick up changes and responses in your client. Then let your hands float slowly down and rest them lightly on your client’s body. Anywhere will do – I like to put one hand on the sacrum and one between the shoulder blades, other possibilities are holding the feet or the head. At this point you are not trying to ‘do’ anything you are simply ‘being’, allowing your client to start to come to his or her own place of stillness. Tune
into the movements of your client’s breathing with your hands and follow with your attention for at least 3 breaths. Be completely absorbed by what you are feeling, the texture of the drape, the quality and rhythm of the movements, the feeling of your hands against the body. Again just following for only 3 breaths will make a tremendous difference to your connection with your client. You may find that just through this simple exercise of paying attention, your client’s breathing starts to slow down and change.

Talking your client through a simple mindfulness exercise If you feel confident you can enhance the effects of the above by talking your client through a short and simple mindfulness exercise at the start of the session. This is a great way to quiet down those clients who like to talk endlessly throughout the treatment and gives both you and your client permission to focus on their body rather than the ‘monkey chatter’ of their mind. Say something like: “Now to begin the treatment, just allow yourself to tune into your body. Just gently notice the feeling of your body against the couch, noticing the feeling of the towel and the feeling of my hands. And now just gently draw your attention to the breath, noticing the in breath and the out breath. Allow yourself to tune into those small movements and sounds you don’t usually notice. As you pay awareness to the breath you may find it start to change. Just notice the changes, don’t judge or try to interpret. Allow yourself to just be.” This basic script is enough for the client to start to notice their own body and begin to release
tension, which already makes your job so much easier!

Mindfulness during the session
Setting the tone for the treatment in the above way, continue your practice with always striving to develop your skills of mindful bodywork during the session. Aim to continually draw your mind back to your hands and the feeling of your client’s body, noticing when your mind starts to wander and just gently drawing yourself back to the feeling of the present moment. Tuning into your own breath is key to bringing yourself back into your own body rather than your head. The simple act of drawing your attention to what is really going on can produce far more results than technique administered with no awareness. Mindfulness as self-help for clients after the session
Developing a meditation and mindfulness practice can be a wonderful self-help tool for clients who are experiencing chronic pain or stress-related problems. There are usually lots of different facilities locally offering meditation groups; also look for the MBSR programmes.

I leave you with the words of Thich Nhat Hanh
from his lovely yet simple book ‘Peace in Every
Breath’.

“Breathing in I see myself as
space. Breathing out I feel
free.” CHW

© Rachel Fairweather is co-founder and director of the Jing Institute of
Advanced Massage. The Jing Institute of Advanced Massage Training is an
organisation dedicated to excellence in all aspects of postgraduate massage
training. Based in Brighton, we offer courses around the country. Our courses
include longer qualifications in advanced massage including our revolutionary
BTEC Level 6 (degree level) in Advanced Clinical and Sports massage and 1-2
day CPD courses in Hot Stone Fusion, trigger point, myofascial release,
stretching, pregnancy, on site, living anatomy and many others. You can also
check out the approaches discussed in this article in our DVD in advanced
clinical massage techniques, downloadable from the website. Please call or
check our website for further information and course dates. Tel: 01273 628942
www.jingmassage.com info@jingmassage.com
Or follow us on Facebook or Twitter!

A great community of professional therapists and expert teachers who wanted to make a difference.

Background:

The Jing Institute is a revolutionary postgraduate training organisation providing master CPD courses and ground-breaking qualifications. The winner of this year’s CAM Expo Outstanding Achievement award, JING offers a new qualification to UK therapists, the BTEC level 6 in Advanced Clinical and Sports Massage accredited by Edexcel. By giving therapists the opportunity to train to degree level, JING has achieved great strides for the massage world. Founders, Rachel Fairweather and Meghan Mari have been therapists for over 20 years and began training master therapists in New York City in 1999. In 2003, they brought their pioneering courses to Brighton, centered on treating specific pain conditions such as frozen shoulder and sciatica. The feedback was phenomenal and JING trained therapist’s expanded their practices to an entire new height using proven JING protocols to get clients out of pain. JING became known as the place to train if you want to have a full-time practice and really make a difference in client’s lives. JING, now offers over 50 Master CPD courses, 3 Advanced Certificates, and the BTEC level 6. Therapists can train around the country with an expert team for just 2 days, or up to 3 years.

Current Mission Statement:

To see the profession and you, the professionals, gain the expertise and recognition that you deserve.

Future:

JING is going global! Meghan and Rachel and are sought after international guest lecturers in massage and anatomy at several UK and US massage and yoga schools, including the International Dermal Institute, Chichester College, McTimoney Chiropractic Association and the FHT. They have been nominated for the Tutor of the year Award at the FHT 50 year conference this July and will be offering 8 workshops. They will continue to write articles for several professional magazines, including Choice health and Well-being and now Massage World. JING annually offer a large workshop programme at CAM expo and are expanding to least four of the major trade shows. The biggest news is, as part of the BTEC level 6, The JING Institute is working with the University of York to develop a centre of clinical massage research unparallelled in the UK.

Why Should Massage World readers come to the JING Institute:

Join the revolution! You want to be the best and JING wants you to be the best! JING has created a revolution by offering the most comprehensive post graduate training in the UK open to therapists from all backgrounds. Courses include the Advanced Clinical Massage series to treat pain such as RSI, Whiplash, and knee pain, Trigger point Therapy, Advanced Certificate in Myofascial Release, Advanced certificate in Musculoskeletal anatomy, Pregnancy Massage, Eastern and Sports Techniques. As the creators of the BTEC level 6 in Advanced Clinical and Sports massage, accredited by Edexcel, JING is the only institution approved to offer this level of massage education in the UK. The work we teach is serious but we do it with a lot of laughter. We use innovative teaching methods that ensure that you leave courses with the material in your hands, head and hearts. All work is taught practically so that you can use it right away in your clinic.

All courses are recognized by the FHT, CtHA and all major professional bodies for CPD points. Contact details:

JING Institute of Advanced Massage Training
28/29 Bond Street
Brighton
BN1 1RD
Tel: 01273 628 942
info@jingmassage.com
www.jingmassage.com
Course Venues: Brighton, London,
Edinburgh, Kendal, Cornwall,
Liverpool

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Course Dates

The Level 2 course is for students who have successfully taken part in the Level 1 course. Building on the material previously learnt, students will be able to take their skills to the next level. The applications will be more complex and use a greater range of tape shapes. More enhanced techniques will be covered such as taping for internal problems, corrective taping, fascia techniques and lymphatic taping.
Level 2 provides all the knowledge and skills to master:
1. the principles behind pain relief, circulation improvement, swelling reduction and lymphatic support.
2. cutting techniques to create different shapes
3. the decision tree to choose the right shape for a particular treatment
4. 10-20 common taping techniques, muscle and ligament techniques, visceral techniques, fascia techniques

The taping techniques applied will be for the ankle, calf/Achilles tendon, knee, upper leg, hip, abdominal muscles, lower and upper back, neck, shoulder, upper arm, elbow, lower arm, wrist and fingers.
The course is very interactive and practical, supported by an instruction manual, a step-by-step guide and videos and is presented by a fun and knowledgeable expert: Olympic Physiotherapist and Director of the ActiTaping Academy Hans de Bruijn.

Course Dates

The taping techniques applied will be for the ankle, calf/Achilles tendon, knee, upper leg, hip, abdominal muscles, lower and upper back,neck, shoulder, upper arm, elbow, lower arm, wrist and fingers.
The course is very interactive and practical and is supported by an instruction manual, a step-by-step guide and videos.
Come along and learn some great techniques from a knowledgeable and fun presenter, Olympic Physiotherapist and Director of the ActiTaping Academy: Hans De Bruijn.

Course Dates

Clinics in Buckingham and East Claydon since 2007. Individual treatments with an emphasis on listening touch working with soft tissues to facilitate the body’s natural healing process. Effective treatments for all pathologies and injuries whether sports related, lifestyle injuries, chronic conditions and cancer etc.

These courses are suitable for any qualified bodyworkers. They are taught by Jo Crill, a Chartered Physiotherapist who has worked with these techniques for the last 9 years, studying with both the Upledger Institute and Jean-Pierre himself.

Course Dates

My passion for helping people out of pain motivated me to discover and hone my intuitive “listening” touch assisting me to identify and eliminate repetitive strains and injuries, head and neck pain, back, shoulder plus arm aches whilst also addressing sciatic, hip plus leg injuries or pains.

I aim to provide a non-judgmental and safe ambience to facilitate physiological and psychological recuperation.

My previous scientific background has enabled me to methodically search for Deeper understanding of the body and massage methods that have a goal orientated outcome i.e. “treatments that work”.

Appointments include a 15 min assessment on your first visit, a goal orientated treatment plan and aftercare advice for a pain-free future.

I am fully insured and have have completed the qualifications for:
Deep Tissue and Therapeutic remedial massage
Sports massage (Pain-free)
Myofascial release (MFR)
Structural fascial bodywork
Hot stone fusion
Amma Fusion
Advanced clinical massage:
- Carpal tunnel, wrist and arm pain
- Neck and shoulder, shoulder girdle pain
- Hip and pelvis, leg, knee and foot pain
- Spine and lower back pain
- Advanced sports stretching and soft tissue release
Lymphatic Drainage Massage

I believe that any therapy involving touch should be individual and must be tailored to resonate with the person receiving.