What exactly is TMJ?

The temporomandibular joints (TMJs) are very complex and are made up of muscles, tendons, a disc and bones. You have a temporomandibular joint on each side of your jaw (right and left side). Each part contributes to the smooth movement of the temporomandibular joint. When the muscles are relaxed and in balance and both jaw joints open and close comfortably, we are able to talk, chew, or yawn without discomfort or pain.

What causes this condition?

TMJ disorders can be caused by arthritis, trauma, clenching, grinding, poorly performed dental work. One concept to teach is "spin then slide." Generally when we speak or open the mouth small amounts the TMJ should spin on the disc like turning a doorknob. When we open the mouth larger amounts like during yawning or eating food the joint first spins (turning the doorknob) then slides forward (open the door). Most problems are caused by the joint sliding forward before it spins completely (you can't open the door without turning the doorknob all the way). This causes the TMJ disc to be displaced over time and the joint to degenerate. Normal jaws open in a straight line like a train on a track. Dysfunctional jaws "fall off the track" and deviate from midline while opening. Poor posture, stress, tight muscles and upper neck issues can also cause TMJ pain.

What are the symptoms?

The symptoms include facial/jaw pain, stiffness, headaches, ear pain, tinnitus (ringing in the ear), clicking in the jaw and locking of the jaw.

How does a Manual Physical Therapist treat/prevent this condition?

There are many approaches to treating temporomandibular joint (TMJ) pain. Generally a multifactorial approach works best. Working on proper sequencing such as "spin the slide" is one approach. Other concepts include postural education and the relationship of the upper neck to the TMJ. Exercises such as axial elongation (lengthening the neck) and scapular retraction (setting the shoulder blades) help with proper alignment and strengthening of the postural muscles. Relaxation techniques, proper resting position of the jaw and tongue as well as diaphragmatic breathing are also included in a well-rounded home exercise program. TMJ exercises help to normalize the resting position of the jaw, regain proper tracking and restore proper sequence and timing of movement. Manual treatments can make joints, nerves and muscles move better, reduce pain and improve strength. Through proper exercise and manual treatment most TMJ problems can be controlled. Your dentist may also use a night guard or oral appliances to help normalize the joints.