The Temporomandibular Joint (TMJ), or jaw joint, connects the lower jaw bone to the temporal bone of the skull in front of the ear allowing us to open and close our mouths to talk, chew, yawn, and move our mouth side to side.
What is TMD?
Temporomandibular Dysfunction (TMD) is really a group of disorders of the TMJ that results in jaw joint pain and dysfunction in the natural movements of the jaw. More than 25% of the general population is effected by some type of TMD. TMD affects more women than men and is most often diagnosed in individuals aged 20 to 40 years old. Its causes range from poor posture, stress leading to chronic jaw clenching/teeth grinding, poor teeth alignment, trauma/fractures, dental procedures that require your jaw to be opened for long periods of time, or conditions such as” lockjaw”, where the muscles around the jaw spasm and reduce the opening of the mouth. The most common TMD conditions are myofascial pain that causes pain in the muscles that control jaw movement, derangement of the joint such as dislocated jaw or displaced disc, and arthritis of the temporomandibular joint. Common symptoms of TMD are jaw pain, facial pain, clicking, popping, or locking of the jaw when moving it, limited mouth opening, difficulty chewing, ear pain, ringing in the ears, chronic headaches, migraines, and neck pain.
How Can Physical Therapy Help?
A doctor or dentist will commonly prescribe Physical Therapy for patients with TMD both as a conservative treatment and after TMJ surgery. Physical therapy is a non-invasive treatment that helps to ease pain, relax muscle, regain normal jaw movement, and lessen daily stress on the jaw joint. Common treatments used by a physical therapist include:
Education in proper posture to avoid having your head in a forward position which places strain on the TMJ and causes your jaw muscles to work overtime trying to keep your mouth in a closed position. You will learn exercises to help you achieve and maintain proper alignment to get your jaw into a good resting position.
Manual hands on techniques to relax and stretch muscles that are in spasm as well as improve the mobility of the TMJ.
Gentle low load exercises to stretch and strengthen the muscles of the jaw and neck to help with posture and restore more normal functional mobility of the jaw.
Modalities for pain control such as ultrasound that uses sound waves to create a heat energy in the muscles to help them relax and heal and electrical stimulation that uses light electrical current to help the pain pathway shut off.
Anti-inflammatory modalities such as iontophoresis which is a noninvasive way to deliver a steroid medication through the skin to the jaw region and ice to help decrease pain inflammation and muscle spasm.
Top 10 Prevention Tips
- Keep your teeth apart and lips together at rest. Practice resting tongue on roof of mouth. No clenching.
- Avoid excessive biting habits such as fingernails, chewing tops of pens, chewing gum etc.
- When yawning, keep your tongue on the roof of your mouth to keep from opening too far
- Stop sleeping on your stomach. Sleeping on your back is ideal but when sleeping on sides make sure to alternate sides. Use an orthopedic pillow to support your natural neck curve. The smaller bump on pillow is for sleeping on your back and the larger bump is for sleeping on your side. When on your side make sure that the pressure is on your cheek and not your jaw.
5. Address grinding of teeth with use of a mouth guard at night.
6. Stop resting your head with your hand under your chin.
7. Use a head set instead of holding phone between your ear and shoulder
8. When reading or using your cell phone make sure to prop up what you are reading so that you can keep your head and neck aligned properly.
9. When working at a desk or using a laptop make sure to position your work station to keep your head and neck aligned properly and take frequent stretch breaks to give your muscles time to relax. Use a document holder to keep you from needing to turn your head to the side when typing into the computer.
10. When eating, avoid anything chewy, painful, ortiring.
Foods to Avoid: Chewing gum or ice, Hard and chewy candy, Tougher meats like steak, Crunchy raw vegetables like raw carrots, corn on cob, Salads, Bagels or other hard chewy breads, Crunchy foods such as nuts or peanut brittle, Caffeine which can increase muscle tension and disturb sleep, Mixed consistency foods such as ice cream with nuts or yogurt with granola as unexpectedly chewing a harder piece can aggravate TMJ problems
Foods that are OK: Fish, chicken, smoothies, yogurt, soft cooked vegetables, eggs, pasta, mashed potato. Peel apples and other skinned foods. Cut all food into small pieces.
Chew food with both sides of back teeth at the same time and avoid biting into big food like burgers.
By Mary Coe, PT