No More Clicking or Popping! What You Can Do To Relieve Your Jaw Pain!

Now that you know the anatomy of the TMJ and what dysfunctions can occur. Let’s dive into the treatment options available. There are multiple approaches to treating TMJ dysfunction. You guessed it, physical therapy is one of them.

Physical Therapy

Evaluation Your physical therapist will start the evaluation with taking a thorough history.

• Evaluate your cervical spine and posture.

• Examine your TMJ to find out how well it functions and whether there are any abnormalities in your jaw motion.

• Measure your jaw opening, closing, side to side movements, protrusion, and retrusion. This allows them to get a baseline of your overall jaw movement.

• Determine if your teeth and alignment are playing a role in your discomfort. Grinding your teeth or clenching your teeth especially at night can be a cause for your pain and dysfunction. If that is the case, your physical therapist should refer you to a dentist that specializes in TMD, who can advise you on corrections for your alignment, such as a bite guard that creates a natural resting position to relax your TMJ, relieve pain, and improve jaw function.

Return Visit/Treatment

The goal for treatment is to restore natural movement of your jaw and decrease your pain. There are different aspects to treatment that will help both.

Posture Education

Many of us sit with our head in a forward head posture. By doing so, you are placing greater strain on the muscles beneath your chin, causing the lower jaw to pull back and the mouth to be in an open position even when resting, thus increasing stress on the TMJ. At the same time, you may be overworking the jaw muscles to force the jaw closed so your mouth isn’t open all the time. Your physical therapist will teach you how to be aware of your posture and give you corrections to improve the position of your jaw, head, neck, and shoulders while sitting, standing, and walking.

Improving Jaw Movement

Your physical therapist will use skilled hands-on techniques (manual therapy) to gently increase movement and relieve pain in the surrounding tissues and joints. Manual therapy can be used to stretch the jaw in order to restore normal joint and muscle flexibility. Adhesions (scar tissue) can form due to an injury. Manual therapy will help break the adhesions allowing for better motion.

Manual therapy can consist of soft tissue mobilization (massage) and joint mobilizations. Typically, soft tissue mobilization is performed first to help take the tension off the joint then the joint mobilizations are performed. Soft tissue mobilization can take place in the shoulder, neck, and facial musculature. Intraoral soft tissue mobilization is beneficially as well. The therapist uses their hands inside your mouth to loosen the muscles of mastication along your cheek. Joint mobilizations will be performed as well to the cervical spine, thoracic spine, and jaw. Dry needling is also a technique that can help decrease trigger points in the musculature. TMJ joint mobilizations are done with the physical therapists’ hand inside your mouth. The joint mobilizations are small movements, but help tremendously to improve movement.

Your therapist can also use ultrasound externally on your TMJ to help calm down the joint, capsule, and surrounding musculature. Electrical stimulation can also be applied to help decrease pain along the TMJ.

Exercises

Once the muscles are in a relaxed state and the joint has been mobilized, then the strengthening exercises can occur. These exercises are low-load so they don’t exert a lot of pressure on the TMJ, but can strengthen the muscles of the jaw and restore a more natural, pain-free motion.

Mouth Opening Perform 10 every two hours

Sit with your shoulders and face relaxed. Place the tip of your tongue on the roof of your mouth, slowly open your mouth while keeping your tongue on the roof of your mouth. Only open as wide as your tongue allows you. This should be a pain free motion.

Isometric Jaw Movements Perform 3 in each direction, holding for 10 seconds

Sit with your shoulders and jaw relaxed. Place two fingers at your chin, draw your chin forward, gently resist with your fingers. This should be a pain free motion. You will do the same for side to side motion. Place two fingers on your lower jaw on the side near your chin. Move your lower jaw towards your fingers, gently resist that movement. You will repeat on the opposite side as well.

Patient Education

• Place computer monitor at eye level so you don’t have to look up, down, or to the side throughout the day

• Keep all work directly in front of you and not off to the side

• If you are on the phone at work for long periods of time, use a headset that allows the neck and jaw to remain in a restful position.

• Avoid repetitive chewing, such a gum

• Avoid opening the jaw too wide

• Avoid eating hard or chewy foods

  • Bagels

  • Apples

  • Carrots

  • Corn on the cob

  • Nuts

  • Pretzels

  • Popcorn

  • Chips

  • Caramel

  • Gummy candies

  • Hard breads

• Maintain good oral hygiene and tooth health

• Avoid sleeping on your stomach, which forces the neck to rotate to one direction in order to maintain an open airway, increasing stress on the TMJ

• Choose soft foods

  • Scrambled eggs

  • Oatmeal

  • Yogurt

  • Quiche

  • Tofu

  • Soup

  • Smoothies

  • Pasta

  • Fish

  • Mashed potatoes

  • Milkshakes

  • Bananas

  • Applesauce

  • Gelatin

  • Ice cream

• Place ice pack on jaw for severe pain, leave on for 10 to 20 minutes

• Use moist heat on tight muscles of the neck, shoulders, and jaw for muscle soreness or pain

• During routine dental visits, take breaks when needed. Don’t keep mouth open for the entirety of the visit

Surgery

In some cases, arthroscopic surgery can be an effective treatment for various types of TMJ disorders as open-joint surgery.

Arthrocentesis

• Minimally invasive procedure that involves the insertion of small needles into the joint so that fluid can be irrigated through the joint to remove debris and inflammatory byproducts

Injections

• Corticosteroid injections into the joint may be helpful. Infrequently, injecting botulinum toxin type A (botox) into the jaw muscles used for chewing may relieve pain associated with TMJ disorders

TMJ Arthroscopy

• A small thin tube is placed into the joint space, an arthroscope is then inserted and small surgical instruments are used for surgery. TMJ arthroscopy has fewer risks and complications than open-joint surgery does, but it has some limitations.

Modified Condylotomy

• This addresses the TMJ indirectly, with surgery on the mandible, but not in the joint itself. It may be helpful for treatment of pain and if locking is experienced.

Open-Joint Surgery

• If your jaw pain does not resolve with more conservative treatments and it appears it be caused by a structural problem in the joint, your doctor or dentist may suggest open-joint surgery to repair or replace the joint. However, open-joint surgery involves more risks than other procedures and should be considered very carefully, after discussing the pros and cons.

Personally, I would recommend doing everything you can before having surgery on your jaw. There are conservative methods that have positive outcomes for patients with TMJ dysfunction. If you or someone you know suffers from jaw pain, please don’t live with it any longer, find a physical therapist that treats TMJ. You won’t regret your decision. It is unnecessary pain that you don’t have to live with.

Disclaimer: I am in no way diagnosing anyone, if you have persistent pain you need to call your local physical therapist and schedule an appointment.