Maximizing Your Mobility: If you have jaw pain, chew on this
Jaw pain, often known as TMJ (temporomandibular joint) dysfunction, is tenderness of the temporomandibular joint, located on the side of one’s face, just in front of the ear. Often described as a “popping” or “locking” while eating or talking, TMJ pain can be the result of trauma, muscle imbalance, postural imbalance, malocclusion or all of the above.
How you open and close your mouth is the result of the action of the joints on either side of your jaw, the muscles of the jaw and tongue, and the relationship of your teeth as they meet. These all work together. A change in one part will cause a change in the function of the other parts. In addition, the position of your neck, or cervical spine, heavily influences alignment of the TMJ and subsequently the amount of stress put on it.
Functionally, the inability to obtain full functional opening of the mouth may be related specifically to the TM joint or involve the shortened muscles used in chewing. In addition, ‘clicking’ of the TMJ can indicate a rough joint surface, a hypermobile joint or disc, and/or muscle in-coordination or imbalance. Commonly, concurrent conditions of a stiff and painful neck as well as headaches located at the base of the skull or along the side of the head accompany TMJ pain.
Possible causes of TMJ dysfunction:
Parafunction
Anything that causes a loss of the physiological state of rest at the TM joint is known as parafunction. Examples of this include smoking, nail biting, chewing on gum/lip/pencil, clenching or grinding of the teeth, or resting the jaw on your hand. These activities may lead to a change in the bite alignment, the muscle tone of the jaw / neck muscles, or the relationship between the head/neck/jaw. In addition, these activities increase compressive forces at the TM joint and lead to a loss of articular cartilage and osteoarthrosis.
Posture
A forward head postural (FHP) position causes compression of the articular disc, increasing strain on the TM joint. In addition, a FHP stretches the ligaments that hold the disc in place and places increased tension on the muscles we use to chew food and to talk with.
Disc subluxations
Between the temporal bone and the mandibular bone is a tissue known as the articular disc, which is held in place by both ligaments and muscles which attach to it. Its role is to assist in proper joint movement and provide cushioning between these two bones. Often, the disc gets pulled out of alignment resulting in deviation of jaw movement as well as an inability to open the mouth. Often the jaw gets locked/stuck with opening or closing. Clicking with opening or closing is often common with disc subluxations. This often results in our inability to chew or bite or may cause us to utilize only one side of our jaw.
Management of TMJ dysfunction
Management of TMJ dysfunction is best addressed by a team approach consisting of your dentist and a physical therapist. Dentists are experts at assessing the alignment of your bite and may utilize/fabricate splints to address issues related to alignment of the teeth and occlusion or closing of the mouth. As a physical therapist, we address TMJ dysfunction by assessing the TMJ mechanics as well as the evaluating other underlying causes. We employ exercises to address postural alignment and disc function in the TM joint, TMJ re-education, and manual therapy to reduce muscle tone and improve joint space and function. The result is a jaw that functions more normally, allowing you to talk and to chew without pain.
Quick tips for self-management:
Create a resting position for your jaw
To improve the resting position of your TM joint, start by resting your tongue on the roof of your mouth with your teeth slightly apart. Breathe through your nose. This relaxes the muscles of mastication (eating) surrounding the jaw and unloads the TM joint space.
Postural correction
A simple postural correction exercise is to stand against a wall and gently tuck your chin as you bring your shoulder blades together. This will help you create awareness of a more neutral spinal position and reduce the impact of a forward head posture on your jaw pain.
Diet and activity modification
If your jaw is sore, stick with softer foods to avoid further joint aggravation. Also, take a look at your habits/positions (parafunction) which may be contributing to your jaw pain.
Get help
Talk to your dentist and/or consult with your physical therapist about what can be done. Most people with TMJ dysfunction suffer for months or years before doing anything about it. A little bit of professional advice now can give you something painless to chew on for years to come!
Jeff Smith is a physical therapist with Northern Michigan Sports Medicine Center. Email him at jsmith@northernmichigansportsmed.com. This information is not to be considered medical advice and is not intended to replace consultation with a qualified medical professional.
