WILLING TO TRY ANYTHING TO MAKE THE JAW PAIN STOP?
That is a good attitude!
However, before you go to the extreme….
Let us talk a moment about what might be the cause of the pain and how Neuromuscular (NMT) Therapy can help you, without going to the extreme.
You are not going to believe this at first, I know and hopefully after reading you will understand; how our posture, especially forward head posture, plays a vital role in the development of Temporomandibular Joint Disorder (TM Disorder), Myofascial Pain-Syndrome, TMJ Pain Dysfunction Syndrome or TM Dysfunction, Malocclusion, or Occlusal Disharmony.
A lot of names for this jaw pain, ‘this stems in part from the poor success experienced by researchers in achieving a consensus of definition, they are however virtually unanimous in agreement that its diagnosis is complex and controversial’ (Kalamir et al 2007).
That is right, our Forward Head Posture has the tendency to pull on our anterior neck muscles (Suprahyoids and Infrahyoids), which in turn pull on the mastication muscles (Masseter, Temporalis, Lateral Pterygoid, Medial Pterygoid and Digastric), which in turn pulls in a dysfunctional manner, on the incredibly unique, complex bilateral articulating, Temporomandibular Joint (TMJ).
The two, TM joints, one on each side of the jaw are actually composed of a two synovial joints, upper and lower joints which act unison. The upper sliding (athrodial) joint is between the disc-condyle complex and the mandibular fossa of the termporal bone, allowing the lower jaw bone (mandible) to slide along the cranium bone. The lower hinge (ginglimoid) joint is between the mandible and the articular disc, which comprises the disc-condyle complex, and allows the mandible to lower and open wide.
Ready? Ok, here we go.
Forward Head Posture is developed in many ways:
- the way we sleep at night
- lack of lumbar support in chairs including our vehicles
- where the computer monitor/TV is located
- holding our phones against our ears with our shoulders
- mouth breathing or upper chest breathing
- my favorite STRESS
Not only do humans have the tendency to clinch there teeth together during stressful moments, but we also want to protect our necks and chest; so we roll our shoulders inward and pull our chin downward, Kind-of like a standing fetal position.
Since your habits and your mind wants you to stay in this head forward position, your body starts making adjustments to keep your eyes and ears level to the horizon.
As your body starts tightening down on this muscle or that muscle; pulling your head into a dysfunctional, but functional alignment with the horizon, and just like a see-saw when one end goes up the other goes down.
Therefore, if one muscle is pulled short, the antagonist (opposing) muscle becomes stretched and lengthened and this change reaction will continue through out the body, see postural balance for more information.
Janda (1986) termed the chain reaction Upper and Lower Cross Syndrome, he also has hypothesized ‘that the muscular pattern associated with TMJ problems may be the considered as locally involving hyperactivity and tension in the termporal and masseter muscles while, because of this hypertonicity, reciprocal inhibition occurs in the suprahyoid, digastric and mylohyoid muscles. The external pterygoid in particular, often develops spasm.’ He also states a typical pattern of muscular dysfunction of an individual with TMJ problems involving ‘upper trapezius, levator scapulae, scalenii, and sternocleidomastoid.
Simmons et al (1999) ‘Anterior head positioning with reflex elevator muscle activity also causes increased intraarticular (inside) pressure in the Temporomandibular Joint (TMJ) and can precipitate mild internal derangements in joints with compromised discs.’ They also note ‘that mandibular positioning; such as occurs in forward head position, can activate the temporalis muscle and/or its trigger points.’
A muscle in a shortened state is at its weakest state.
When we ask, ok demand a shortened muscle/muscles to move quickly ex.. turning your head to look at something, bending and twisting to pick something off the floor and for the jaw, yep, hollering for your favorite team can cause a creation of a TrP within a muscle band, as the muscle try’s to protect itself from tearing.
What is a TrPs? Scientifically, “A cluster of electrically active loci, each of which is associated with contraction knot and a dysfunctional motor endplate in skeletal muscle.”
TrPs in Layman’s terms… An area of a muscle where the muscle fibers have matted together into a nodule, in a taunt band of muscle fibers, due to a chemical and electrical imbalance and blockage.
Once a TrP forms in a muscle, it has a tendency to cause the formation of more TrP’s within the same muscle and to other muscles. A TrP within a muscle will refer pain to different region or regions of the body.
Which could be the reason other approaches to your pain have not worked.
By others, not looking in the right places for the culprit or culprits of this most elusive, baffling and painful of condition.
Photograph of a miniature from a Byzantine manuscript "Photo courtesy of History of Medicine”
So where would a Murphy’s Law Neuromuscular Therapist look?
After evaluating of the whole-body posture, paying particular attention to the hips, shoulders and head position, the Hyoid bone, and TM joint function ability.
Because of postural influences through the base of support, elimination of TrP activity in the muscles of the neck, and even of the lumbosacral region and lower limbs, may be critical for complete lasting relief of myofascial pain and dysfunction due to TrPs in the masticatory muscles (Simmons & Travel).
A good NMT Therapist will release TrPs in the necessary muscles to affect symmetrical balance of hip, shoulders and head positioning. After that, a NMT Therapist is going hunting for the TrPs that are causing the referral pains from common symptoms of TM Joint Dysfunction.
Symptoms tend to be chronic, and treatment is aimed at eliminating the precipitating factors. Many symptoms may not appear related to the TM Joint Dysfunction itself.
The following are common symptoms of TM Joint Dysfunction.
Headache: Most individuals with a TM Joint Dysfunction complain of tension type headache, and some reported facial pain. Pain is often made worse while opening and closing the jaw. Exposure to cold weather or air-conditioned air may increase muscle contraction and facial pain.
Ear pain: Many individuals with a TM Joint Dysfunction notice a deep ear pain and do not have signs of ear infection. The ear pain is usually described as being in front of or below the ear.
Sounds during Opening and Closing of the Jaw: Grinding, crunching, or popping sounds, medically termed crepitus, are common for individuals with a TM Joint Dysfunction. In TM Disorders, this involves primarily displacement and distortion of the articular disc, as well as remodeling of the articular surfaces, and joint hypermobility (Solberg 1986). These sounds may or may not be accompanied by pain.
- Muscles affecting articular disc: Lateral Pterygoid
Dizziness: Some individuals with a TM Joint Dysfunction reported a vague sense of dizziness or imbalance.
- Muscles: Sternocleidomastoid (SCM)
Fullness of the ear: Some individuals with a TM Joint Dysfunction describe muffled, clogged, or full ears. They may notice ear fullness and pain during airplane takeoffs and landings. These symptoms are usually caused by eustachian-tube dysfunction, the structure responsible for the regulation of pressure in the middle ear. It hypothesized that individuals with TM Joint Dysfunctions have hyperactivity (TrPs) of the muscles affecting and responsible for regulating the opening and closing of the eustachian tube.
- Muscles: Medial Pterygoid, Tensor Veli Palatini (soft pallet of mouth)
Ringing in the ear (Tinnitus): Individuals may experience noise or ringing in the ears called, Tinnitus.
Tooth Pain: Individuals experiencing pain, with no signs of infection of other dental cause, in the
- Upper/Lower Molars: Muscle: Masseter
- Maxillary (Upper) Toothaches or Tooth sensitivity. Muscle: Temporalis
- Four Lower Incisor teeth. Muscles: Digastric
Difficulty Swallowing: Some Individuals with a TM Joint Dysfunction describe pain in the throat or difficulty swallowing.
Changes in Voice Range: Some Individuals with a TM Joint Dysfunction describe a scratchy voice or hoarseness, loss of tone or capability of hitting the notes.