The two hinge joints that connect the jaw to the skull in front of the ears are known as the temporomandibular joints (TMJ). When working properly, they allow your jaw to open, close, move to the left and right, and glide forward and back via muscle activation and joint movements. This allows you to perform activities such as opening our mouth, speaking, yawning, sneezing, chewing, and eating. When there is a problem with these joint and/or the surrounding tissues, then the jaw and face become painful and normal movement may be effected.
- Bruxism, or clenching the jaw, puts a strain on the jaw and facial muscles and may cause them to spasm.
- Malocclusion, or teeth malalignment, places stress and wear and tear on the jaw joints.
- Poor posture, such as holding your head in a forward position, puts a strain on the muscles in the jaw, neck, and upper back, and on the discs in the jaw joint.
- Arthritis in one or both TMJs.
- Surgery of the face and jaw, causing loss of mobility, strength, and function of the jaw and surrounding muscles.
- Displacement of the disc between the two jaw bones, which may cause jaw clicking, popping, and pain.
- Fractures of the jaw, which results in stiffness and loss of strength in the jaw.
- Trismus (“lockjaw”) from spasm of surrounding muscles, which causes a restriction in the ability to open the mouth.
Symptoms of TMD may include one or more of the following:
- Face, eye, ear, neck, and jaw pain.
- Headaches.
- Ringing in the ears.
- Dizziness.
- Jaw clicking, popping and / or locking.
- Teeth grinding.
- Neck stiffness.
- Malocclusion of the teeth.
- Deviation of the jaw with mouth opening.
- Fatigue with speaking.
What is the role of physical therapy (PT) in the treatment of Temporomandibular Disorder?
Physical therapists, along with dentists, orthodontists, and oral surgeons, are vital members of the healthcare team working with those with TMD. A comprehensive physical therapy assessment is performed on the initial visit, which includes reviewing your history and current complaints and conducting a physical exam of your head, face, jaw, neck, chest, and upper back. The therapist’s exam findings are shared with you and a treatment plan is described. Expectations regarding treatment are reviewed. In some cases, you may be referred to your dentist for further examination or fabrication of a bite guard for those who grind their teeth.
Physical therapy treatment for TMD is multi-factorial and is based on the examination findings. Often, treatment will include one or more of the following procedures:
- Posture education and exercises to decrease pain-related stress in the jaw, head, neck, and upper back and neck.
- Manual therapy (hands on therapy) to the muscles, ligaments, and joints to help improve mobility and decrease pain. This can include soft tissue mobilization, joint mobilization, and neuromuscular techniques to the muscles, ligaments, and joints in the face, jaws, and neck, as well as manual stretching.
- Modalities, such as heat, ice, or ultrasound, to decrease pain and muscle tension and spasm.
- Low load therapeutic exercises to help with mobility and strength of the jaw, face, and neck muscles.
- Motor control and movement retraining to optimize jaw and neck movement patterns.
- Relaxation and Stress Management techniques and education.
- Instruction in diet modification to help rest the jaw.
My personal story with TMD:
Having undergone two jaw surgeries six years apart that required my jaw to be wired shut for three and two months, respectively, I have personal experience treating my own bilateral TMD, not once but twice! When the wires were removed each time, I had bilateral jaw and face pain and very limited jaw mobility due to stiff muscles and jaw joints, which significantly limited my ability to open my mouth and eat. Speaking and prolonged talking, something that a physical therapist does all day, was difficult and very tiring. However, with my own self-treatment and home exercise program, my jaw mobility and function returned to normal within four to six weeks after each surgery. I have to admit, being a physical therapist and knowing what to do and when to do it was very helpful in my rapid recovery both times!
