Often synonymous with jaw pain, the basic diagnosis of TMJ pain includes jaw clicking, jaw popping, limited mouth opening, and “lock jaw.” These symptoms are often the result of a displacement of the articular disc of the TMJ. This displaced disc then becomes an obstacle for normal jaw movement, frequently producing joint sounds with mouth opening and closing. While this condition may sound severe, it rarely requires surgery and is very often fully managed with physical therapy TMJ treatment. Education as to the changed mechanisms of the TMJ and maintenance strategies are key factors in the rehabilitation process. Additionally, the resulting limited mouth opening and “lock jaw” are symptoms that are very successfully treated with skilled physical therapy. Stretching both the joint capsule and surrounding muscles facilitates jaw range of motion, allowing a return to normal chewing and talking.
The Basis of TMD Rehabilitation
Resolving TMJ pain is often found in the cessation of parafunction, to the layperson, this means "stop irritating your jaw." Nail biting, excessive gum chewing and snacking on hard foods are all activities that irritate the TMJ. Instruction on the proper position of the jaw, teeth and tongue are essential components in both the immediate reduction of symptoms and lessening the possibility of recurrence. Additionally, poor posture can directly produce stress on the jaw. Although it is most often observed with the use of electronics; workstation, sleep and driving postures uniformly contribute to TMJ pain.
Cessation of parafunction activities will greatly reduce the stress on the jaw and ultimately TMJ pain. Posture is also an essential component of jaw pain and is consistently emphasized throughout physical therapy treatment. Slight modifications to daily activities and a conscious awareness of the position of the jaw and neck produce long term pain relief.
Decreasing Acute TMD Inflammation
The immediate goal in the physical therapy treatment of TMJ pain is the reduction of acute symptoms. Most patients report moderate to severe pain which often limits eating. The use of moist heat, electrical stimulation and cold laser provides a localized increase in blood flow and subsequent reduction of pain. While these interventions are not the permanent solution to TMJ pain, the resulting reduced symptoms prepare the area for more advanced interventions.
Additionally, iontophoresis is another modality which may be utilized to reduce inflammation on the cellular level. This process involves the application of a pain-free current to the jaw region, which applies a prescribed steroid trans-dermally (through the skin). This is administered during physical therapy treatments and in conjunction with your dental professional. It is often recommended when the jaw regions are severely tender to palpation or when a patient has been unresponsive to other interventions.
Remodeling Soft Tissue
A comprehensive assessment and manual treatment of the muscles and skeletal structures of the orofacial region is essential with TMJ pain. A skilled TMD physical therapist is often the first healthcare provider who assesses and addresses the soft tissue in the TMJ regions. This includes the muscles of mastication, which are responsible for both opening/closing the mouth and chewing. Research has consistently shown that trigger points in these muscles can result in tooth pain, headache and facial pain. Furthermore, the cervical structures are often overlooked when determining TMJ pain. Similarly, contemporary research confirms the direct relationship between muscles in the neck and TMJ pain.
Skilled TMD physical therapists address the muscles and soft tissue structures of the neck and jaw to reduce TMJ pain. Utilizing soft tissue mobilization and myofascial release techniques, muscle adhesions are reduced and normal movement patterns return. The neck and jaw muscles are comprehensively manipulated both superficially and intraorally. The temporomandibular joint is also mobilized to stretch the joint capsule and surrounding ligaments, which often tighten with the onset of pain. Cranial distraction and stretching of the cervical paraspinals is often utilized to reduce compression and tightness.
An Advanced Treatment
In some cases, the resolution of muscle knots and myofascial adhesions require more aggressive treatment. Dry needling is a minimally invasive procedure in which a solid filament needle is inserted into the muscle directly at a persistent trigger point. While the needle used is similar to acupuncture needle, the technique and methodology varies greatly. The sole purpose of dry needling aims to decrease contraction knots, which are related to the production and maintenance of the pain cycle. These very thin needles are inserted through the skin and can affect deep layers of muscle tissue. Dry needling in the orofacial region also allows TMD physical therapists to address muscles unreachable by the fingers.