TMJ Issues - Jaw Pain

TMJ stands for the temporomandibular joint, which connects the lower jaw ​(mandible) to the temporal bones of the skull.
 
The TM joint is one of the most used joints in the body, as we use it at least 2000 times a day when we speak, chew, swallow, yawn, kiss or snore and it has a biting power of 70 kg. A variety of cranial nerves synchronises all of the above activities and it is because of its physiology that this complex structure acts differently than other joints in the body. The TM joint and the powerful muscles attached to it are directly linked to the central nervous system and the whole craniosacral system.
 
For a long time TMJ was considered to be a dental problem but it is now widely regarded as a multifactorial condition. Wearing a splint can provide relief for TMJ symptoms like headaches and protect the teeth but it does not address any underlying causes. In addressing TMJ issues, clenching, grinding, whiplash, slips and falls, braces, stress, trauma, emotional factors, structural imbalances and integration of all structures – upper jaw, lower jaw, surrounding muscles, temporal bones and cranium needs to be taken into account, including whole body strains.
 
A few specialists have now upgraded the name from TMJ to the Cranio Mandibular joint and some are working with cranially trained osteopaths and craniosacral therapist to achieve whole body integration. (Dr. Wojciech Tarnowski).
 
TMJ Syndrome or TMJD - Temporomandibular joint Disorder – can range from mildly annoying to a highly debilitating condition which can manifest itself not only in the classic symptoms of jaw and facial pain, but also in:

• Chronic headaches; Migraines
• Shoulder and neck pain, stiff neck
• Ear pain: hissing or buzzing sound in ear, dizziness
• Pain and pressure behind the eyes
• Throat – swallowing difficulties, sore throat
• Teeth Grinding and Clenching during sleep;
• Jaw stiffness and lack of movement in the jaw joint affecting ability to speak or chew:
• Clicking/Popping jaw when you open or close your mouth
• And many more

 
Causes
TMJ dysfunction can be caused by a derangement of the actual disk or arthritis but what is often not addressed effectively, is that many persistent issues and jaw problems arise as a result of stress, manifesting for example as teeth grinding, muscle spasm or as a variety of other forms of TMJ Syndrome. TMJ syndrome is usually a symptom not a cause. 90% of cases are not primary temporomandibular joint disturbances ((Upledger, 1987, Beyond the Dura). They are usually a result of craniosacral system dysfunction: temporal bone, hard palate, intra-oral imbalances, fascial restrictions and/or due to stress factors like poor posture or emotional tension.  
 
How Does Craniosacral Treat TMJ?
Cranio addresses the whole person not just a body part, i.e. Cranio looks at the interconnected of the systems in the body. The TMJ’s have many interrelationships with the whole body, so treating TMJ issues may involve work on other parts of the body as well. Practically this means that Cranio releases and integrates all surrounding structures: upper and lower jaw, the jaw (masseter) muscle, temporal bones, upper cervical (neck) vertebrae and the whole cranium. Cranio looks at postural imbalances like hip problems or forward head posture but also addresses craniosacral imbalances in other areas that may have ricochet up to the TMJ’s. Stress and emotional states do play a big role in TMJ issues and here Cranio addresses the emotional states first as it causes a deregulation in the nervous system and no amount of mechanical treatment will otherwise completely resolve the problem.
 
Five easy things you can do at home to start alleviating TMJ issues:
Depending on the cause of your TMJ disorder, different self-care strategies work really well.

• If you are like me and the word “exercise” makes you gaze into the distance–this one actually works extremely well as it works on the cross sections between the jaw and other areas, improving posture and alignment for hips, shoulders and neck. My clients report feeling a difference straight away. Sitting pillow squeeze exercise: sit on a chair hold your knees and hips at 90 degrees, Place a yoga block or firm pillow between your knees and clasp your hands behind your back, putting your shoulder blades together.  Squeeze the block or pillow between your knees whilst drawing your belly button to your spine but keeping the stomach relaxed and then release. Keep breathing and do 50 times or more.
• Hot potato  - practice opening and closing the mouth as if you have a hot potato in your mouth. Best not to open your mouth to the extremes but to a range where it feels comfortable, small and controlled and feel how this exercise influences the neck by putting your fingertips at the back of your head releasing both muscles at same time.
• When sitting behind computers or phones, we tend to move our head forward. This will cause the muscles attached to the TMJ, neck and shoulders to work in overdrive. Ensure your head sits directly on top of your shoulders –i.e. the ear lobes sit directly on top of the shoulder joint. A good way of practicing this is to do Chin Tucks: slightly tuck your chin to your chest as if you are holding an orange between your chin and chest, creating a double chin and therefore stretching your cervical vertebrae.
• The upper and lower teeth should never touch except when eating. Take a few minutes several times a day to bring some conscious awareness to the habit of clenching, so you can learn to release the lower jaw mindfully. This is a very important practice.
• Your tongue should rest on the soft part of the roof of your mouth - and the tip of your tongue behind your 2 front teeth.
  

 
Some random facts that might just make you win that Trivia Quiz one day:

• The lower jaw is called the mandible and has 16 muscles group attachments.
• The upper jaw is called the maxillae and connects with 45% of the cranial bones, a misaligned upper jaw can cause havoc with the facial bones.
• The fulcrum of movement of the jaw i.e. opening and closing the mouth is between the first and second Cervical Vertebrae  -also knows as Guzay’s Theorem. Jaw tension often equates upper neck tension as they directly influence each another.
• The motor component of the trigeminal nerve (the fifth cranial nerve) controls the movement of our muscles of mastication (eating) and is influenced by the Reticular Activating System (RAS) in the brainstem - strongly connected to stress and anger.

Conclusion
Because of the jaw’s unique physiology, it’s important to treat the root cause of your pain as soon as possible. As a practitioner, what I love about treating TMJ patients is that clients respond really well. Some find immediate relief if acute and some find gradual overall relief if more chronic, with regular and consistent treatment.  “Craniosacral Therapy has the potential for being the most effective holistic therapy of all for TMJ by restoring homeostasis”. (Dr. Wojciech Tarnowski - Dentist).

Here are some comments clients have texted me after their appointment.
“Thank you Dorine. Amelia felt amazingly relaxed and released after last session”. (Amelia - 9 years old)
 
“Today was amazing, thank you so much. I can almost get two knuckles in! Feeling very positive about this and looking fwd to seeing our progress. Thanks again”. (DM)
 
“Thank you very much for yesterday. I am feeling a lot better today!  My muscles in my jaw/cheeks are a lot more relaxed, my neck feels less tense and I have had minimal headaches today”. (JF)
 
References
Thomas Attalee D.O., R.C.S.T (2016)– Face to face with the face
Dr Upledger, J. (1987) – Beyond the Dura
Dr. Wojciech Tarnowski – The biomechanics of Dentistry – Fulcrum – issue 65 - 2015