How does Physical Therapy help TMJ pain?

What is temporomandibular joint (TMJ) pain?

Even though most people think temporomandibular joint (TMJ) alone is what causes jaw pain and dysfunction, this term is actually under a group of pathologies affecting the masticatory muscles, the joint itself and related structures.

These compromise a more global term called temporomandibular disorders (TMD). TMD is the most common source of orofacial pain of a non-dental origin. Myofascial pain is the most common temporomandibular disorder.

TMJ is a main sources of chronic orofacial pain that can affect daily activities, such as yawning, chewing, talking, reading aloud and even yelling! These disorders also are commonly associated with other symptoms affecting the head and neck region, such as headache, ear-related symptoms, neck pain and bad head and cervical posture.

TMJ can also have symptoms, such as joint sounds. These include clicking or crepitus, which can restrict jaw motion.

• The joint pain originates from elongation of the discal and capsular ligaments and/or compression of the retrodiscal tissues.

• TMJ clicking seems to be related to ligament problems and condyle-disc assembly alterations during jaw movement.

Why is Physical Therapy used to help TMJ pain?

Physical therapy is commonly used treatments for TMJ and TMD. Therapists focus on decreasing neck and jaw pain, assisting in pain-free jaw opening, improving range of motion (ROM), and promoting exercise to maintain healthy function. We help all of these impairments that can lead to your pain and inability to do movements of your jaw without pain medication, injections or surgery.

Physical therapy is much more than massaging sore muscles. It is a comprehensive approach to decrease pain and improve your flexibility, range of motion and strength. At PhysioFit of North Carolina, we utilize manual therapy as a window of opportunity to improve your strength, flexibility and range of motion so we can help you with self-management techniques and exercises to get longer term relief.

Physical therapy is also much more effective than ultrasound therapy, laser therapy, heat therapy and TENS units. Even though these modalities have been used for decades, we are finding them to provide suboptimal results. We do have recommendations for utilization at home as products are much more affordable and easily obtainable by patients online now. However, at PhysioFit of North Carolina, we utilize your time to be directly 1:1 with our therapists to maximize your time and value in your treatment sessions.

A detailed assessment of your problem by our physical therapists include:

• Pain

• Pain free opening and path of mouth opening

• Maximal assisted opening

• Opening pattern (the presence of corrected or uncorrected deviation during mouth opening)

• Postural assessment of your jaw, neck and shoulders

• Mobility assessment of your cervical and thoracic spine

• Muscle function assessment of your jaw and cervical spine

Findings of your assessment then lead to a direct approach of manual therapy, patient education and therapeutic exercise.

What is Manual Therapy?

Manual therapy techniques are skilled hand movements and skilled passive movements of joints and soft tissue and are intended to improve tissue extensibility; increase range of motion; induce relaxation; mobilize or manipulate soft tissue and joints; modulate pain; and reduce soft tissue swelling, inflammation, or restriction. (from American Physical Therapy Association)

Manual therapy includes:

1. joint mobilization

2. joint manipulation

3. myofascial mobilization (including intraoral myofascial therapy and massage)

4. fascial manipulation of the soft tissues (i.e. muscles)

5. trigger point therapy

6. dry needling

Manual therapy has been used to:

1. restore normal ROM

2. reduce local ischemia

3. stimulate proprioception

4. stimulate synovial fluid production

5. and reduce pain.

What is Therapeutic Exercise?

Orofacial physical therapy is a specialized type of physical therapy focusing on improving pain in the neck, jaw and shoulders for individuals who have TMJ. The exercises are used to correct head and neck posture and active and passive oral exercises can be effective for reducing musculoskeletal pain. Exercise therapy has been used for decades for its clinical effectiveness in improving function and reducing pain.

Exercises are targeted to improve strength and flexibility of specific muscles that are affecting your pain and function.

Therapeutic exercise is used to:

1. increase mouth range of motion (ROM)

2. improve posture

3. improve oromotor function

4. improve strength

5. improve flexibility

6. reduce pain.

Physical therapists can work alongside your dentist or orofascial specialist to determine if treatment of the jaw and/or neck is right for you. We aim to subgroup patients with TMJ, as they have distinct functional profiles with respect to the cervical and masticatory systems. This leads to more specific, individualized treatments tailored to your presentation.

Treatment can be in isolation or in combination with splint (occlusal or mouth guard) therapy that your dentist has recommended or provided for you. Some individuals do best to combine both physical therapy and occlusal (splint) therapy while some just need physical therapy.