The treatment of the temporomandibular joint (TMJ) involves a combination of skilled manual therapy techniques and therapeutic exercises that all focus on taking stress off the muscles and joints that are involved in mastication (chewing). Most patients that are living with some type of pain in their jaw with chewing or talking need to be educated on better ways to improve their sitting and standing posture, proper foods to eat/avoid and also be taught detailed exercises that can help improve the proper joint mechanics needed to have normal and non-painful mouth opening and closing. Additional skilled manual therapy techniques can address dysfunctions of the cervical and thoracic spine that also assist in the improvement of posture.
To be more specific with the anatomy of the TMJ, it is important to understand the joint anatomy first. The mandible is the bone that makes up the entire lower jaw and meets the maxilla, which is the bottom surface of the skull. Essentially, 2 ball and socket joints meet on each side of the jaw, at the temporal region of the maxilla, mirroring each other. The normal joint mechanics at the TMJ involve an initial spinning motion during the initiation of mouth opening followed by a forward glide. When people have pain at the TMJ, these normal joint mechanics are usually impaired on one side or the other, which can lead to pain with chewing and talking. Physical therapists trained in manual therapy can help restore normal joint mechanics at the TMJ with joint mobilization techniques.
In addition to the joint anatomy and mechanics, the muscles involved in chewing consist of the temporalis located at the temporal lobe region on both sides and the masseter, which is located on both sides of the lower jaw attaching between the maxilla and mandible. These are the primary muscles involved with chewing. There are also deeper muscles involved with chewing and talking called the pterygoids, which are important to know when treating TMJ, because they can develop muscle trigger points along with the temporalis and masseter and treating these muscles with soft tissue mobilization can help reduce pain by more than 50% before a PT even performs joint mobilization.
The manual therapy and therapeutic exercises involved with the neck and upper back can consist of restoring normal upper or lower cervical alignment/ joint mobility/ soft tissue mobilization and at the thoracic spine to help assist the patient to improve their posture with less pain and improved awareness. As I mentioned earlier, posture should be the first thing that patients are educated on because sitting in a slumped/ slouched position and with a forward/ leaning head posture can increase stress on joints in the upper back, leading to stress in joints of the neck and especially joints of the TMJ that can lead to pain over a period of time affecting a person's ability to chew and talk.
People that are living with pain in the TMJ need to know that it is very treatable and the conservative interventions that a skilled physical therapist has to offer can be very cost effective. Education on simple home exercise techniques that can be done daily can have a profound effect on relieving pain. A lot of times, the initial treatment can involve splints, sometimes surgery and in some cases patients are told that nothing can be done.
If you are living with TMJ issues, do not hesitate to consult with your primary care physician in getting a referral for PT.
Andrew Squire, PT, DPT, CIMT
Promotion Physical Therapy at the Westover Hills office
Doctor of Physical Therapy
Certified Integrated Manual Therapist