Physical Therapy for TMJ Disorder

Caitlin Hard
Caitlin Hard Executive Assistant at AHS

As of May 1, dentists in Virginia have begun reopening their doors for preventative and non-emergency visits. Among the dental patients whose regular dental visits may have been postponed due to covid-19 restrictions are patients who suffer from Temporomandibular Joint Disorder (TMD). What you may not know, is that in addition to regular dental visits and evaluations, physical therapy is one of the most effective means of treating TMD.

What is the TMJ & What Causes TMD?

The temporomandibular joint (TMJ) is a hinge joint located on each side of your face, where the jaw meets the skull. The TMJ is important for jaw functions such as opening and closing your mouth, talking, and chewing. To perform functions such as biting and chewing, this facial joint produces forces as great as 134 pounds for women, and 190 pounds for men.1 Importantly, this joint is used more frequently than any other joint in the body- on average, 3500 times per day!1 Like all joints, the TMJ is surrounded by several muscles, ligaments, and cartilage to support and allow movement.

Injuries to the chin or jaw, history of trauma, bad posture, jaw clenching, poor teeth alignment are common causes of TMJ, and can result in symptoms such as:

– jaw pain

– clicking or locking of the jaw

– difficulty opening and closing the mouth

 – limited neck mobility and neck pain

– ear ringing

– headaches

– dizziness

Often, these symptoms are a side effect of a prior injury or trauma, and the pain and symptoms surface later in life.3 Some individuals who suffer from stress and anxiety can develop TMJ due to frequent grinding and clenching of their teeth, known as bruxism.3 The pain associated with TMD most commonly comes from irritated or strained muscles around the temporomandibular joint, or degenerative changes to the small disk within the joint.2

The Role of Physical Therapy in TMD Treatment

Physical therapists are experts in treating conditions related to joints and muscles. Using joint remobilization techniques, PTs can help patients with TMD ease pain, regain normal jaw movement, and in some cases, eliminate painful headaches associated with TMD.

During an initial evaluation, PTs review your medical history related to the head, neck, and jaw and observe movement patterns in the neck and TMJ. Due to the nature of the jaw bone, it is impossible to treat one side of the face without addressing the other side1; thus, PTs use a whole-body treatment approach to create an individualized plan of care to address TMD-related pain.

Physical therapists use several manual therapy techniques, including soft tissue mobilization, and intraoral massage and trigger point release, to reduce muscle stiffness, restore movement, and re-educate the muscles surrounding the TMJ. Physical therapists also will address any postural issues that may contribute to TMD symptoms; PTs teach patients how to change the resting positions of the jaw, head, neck, and shoulders to reduce unnecessary stress on the TMJ.2

Alternative treatment techniques such as Trigger Point Dry Needling (TDN) can be effective for loosening muscles surrounding the TMJ. In a previous blog post, here, AHS Physical Therapist and experienced TMD treatment specialist, Madhura Gurjar, discusses the benefits of TDN. For TMD, the use of intramuscular stimulation can help target trigger points in very small muscles in the face and jaw, and often can provide immediate muscle relaxation and pain relief.

Physical therapists work in conjunction with many healthcare providers and specialists, including Dentists and Oral Surgeons, to manage and treat patients with TMD. In Virginia, no referral from a physician or dentist is required for the first 30 days of physical therapy treatment. Temporomandibular joint disorder is a unique condition that is caused by biological, environmental, behavioral, social, emotional and cognitive factors, and PTs can refer patients to other specialists for more comprehensive treatment, if needed. 

References
1. Hoban, Patrick. Manual Therapy Treatment of the Temporomandibular Joint. Manual Therapy Treatment of the Temporomandibular Joint, Great Lakes Seminars.

2. “Physical Therapy Guide to Temporomandibular Joint Disorder.” American Physical Therapy Association, 22 Dec. 2019, www.choosept.com/symptomsconditionsdetail/physical-therapy-guide-to-temporomandibular-joint-disorder.

3. “TMJ Disorder.” Results Physiotherapy, www.resultspt.com/tmj.

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