Figures from the British Dental Health Foundation estimate that 1 in 4 people suffer from TMJ (temporo-manibular joint disorder) – a debilitating condition that can cause intense pain in the face and jaw and completely affect the quality of a person’s life.
While teaching a course in massage for the treatment of TMJ I asked students how many thought they had TMJ. In a room of 30 people, 5 people raised their hand. By the end of the morning, after a palpation assessment exercise and discussion around signs and symptoms I asked the question again and this time over half the class raised their hand.
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.
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)
•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.
This article was written by Jing teacher Tracey Kiernan
Tel: 01273 628942