The TMJ (Temporomandibular Joint) is a joint formed between the temporal bone of the skull and the jawbone. Everyone has two TMJ, one on the right and one on the left. If you slide your fingers along the bottom edge of your cheekbone toward your ear, then stop just before the ear, then open and close your mouth, you will feel them move.
The TMJ are among some of the most frequently used joints in the human body. They allow us to talk, chew, yawn, swallow and even sneeze. Approximately 80 million people in the U.S. suffer from some form of TMJ disorder. Many people go to their dentist or orthodontist for treatment of the TMJ through dental work or the use of a dental appliance. This has been proven to be a very effective strategy, however another common factor contributing towards TMJ disorders that is often overlooked is the presence of neck and shoulder dysfunction. The muscles of the neck and shoulders are connected to the jaw, if you have stiffness or misalignment due to abnormal posturing in your neck or shoulders, it can directly affect both the position and the function of your jaw joints, causing irritation to one or both of the TMJ. Physical Therapists are licensed healthcare professionals, who specialize in human anatomy, biomechanics and the assessment and treatment of musculoskeletal pathology. So it only makes sense if you suffer from TMJ pain and discomfort and additionally have pain, stiffness, or misalignment in your neck and shoulders, you may want to consider getting a consultation from a Physical Therapist.
If you have a history of TMJ pain or dysfunction, you should start your referral process with a consultation from your general practitioner, dentist, orthodontist, periodontist or oral surgeon, they can refer you to a Physical Therapist for treatment. An experienced Physical Therapist will perform a comprehensive exam of your head, jaw, neck, thoracic spine and shoulders and determine the biomechanical factors affecting your TMJ disorder. Then the Physical Therapist will develop a treatment plan including the use of physical modalities to reduce joint inflammation, manual therapy techniques designed to reduce joint compression and improve joint mobility, and teach stress reduction activities to decrease muscle tension throughout your neck and jaw to improve your posture. Physical therapy in conjunction with dental treatment is usually most effective. However not all physical therapists are experienced in treating TMJ disorders, usually your dental practitioner can point you in the right direction and knows the resident expert therapist in your geographic region for evaluation and treatment of the TMJ.
Both TMJ must work in coordination with each other in order to allow normal movements of the jaw to occur. The basic motions of the TMJ are to allow the jaw to open and close, protrude (move the bottom jaw forward), retract (move the bottom jaw backwards), and laterally move the jaw right and left. Normal opening of the jaw should be about 35-40 mm. A good test to determine normal opening is being able to fit 2 or 3 of your knuckles into your mouth. If you cannot open your mouth this wide, you may have a hypomobile (stiff) TMJ, which can be the cause or be contributing towards your TMJ problems.
The main muscles acting on the TMJ are also known as the muscles of mastication, they allow the jaw to move for the purpose of chewing and speaking. The primary muscles involved are the: temporalis, masseter, medial pterygoid, and lateral pterygoid muscles. These muscles must work together synchronously every time the jaw opens and closes, if not dysfunction occurs, and may lead to muscle spasm, pain, inflammation and even subluxation of the joints. If bad enough, it can even lead to a situation where the jaw may even become locked open or closed.
A few common causes of TMJ dysfunction may include; a trauma to the joint, including a blow to the jaw or head, excessive stress to the joint from gum chewing, fingernail biting, yawning, or grinding teeth, poor bite pattern or malocclusion, postural abnormalities especially due to a forward head posture, and a previous history of a whiplash injury. Some of the common signs and symptoms of TMJ dysfunction include; a clicking or popping with opening or closing the jaw, pain at rest in one or both of the TMJ, decreased ability to open the jaw, neck pain, tooth sensitivity, uncomfortable bite, forehead or temple headaches.
A new treatment that has been found clinically to be very effective in the treatment of TMJ disorders especially in the cases of severe pain or where a TMJ becomes either locked opened or closed is called Integrative Dry Needling. Integrative Dry Needling, also known as trigger point dry needling, is a minimally invasive procedure by which fine gauge (34-38 gauge) solid filament sterile needles are inserted into areas of chronic soft tissue dysfunction, trigger points, and other symptomatic tender points that are identified during a physical therapy examination. Dry needling works on the premise that during the phases of healing soft tissues become adhered to one another, scar formation limits mobility, and blood and lymphatic vessels become blocked, resulting in inflammation, pain, and the formation of trigger points and chronic soft tissue dysfunction. The interruption of normal function leads to atrophy, aggravated irritability, and sensitivity. When a needle is inserted into the symptomatic area, a tiny lesion(s) is created stimulating tissue relaxation through mechanical stimulation of the trigger point/symptomatic tissue. The tiny lesions stimulate a local healing response as well as activate neural pathways that control and decrease pain. There is a local release of molecular proteins that rebuild tissue and neurotransmitters, that block the transmission of pain signals, facilitate healing, and result in improved joint mechanics and a reduction in discomfort.
Professional Rehabilitation Services, is a group of privately therapist owned Physical Therapy Practices in Pawleys Island, Surfside Beach and Myrtle Beach, South Carolina that treat a wide variety of musculoskeletal conditions using the latest in evidence based therapies including TMJ dysfunction provided by highly credentialed Physical Therapists. In addition to being licensed Physical Therapists, our providers have additional specialty certifications and training in orthopedics, manual therapy, sports therapy, strength and conditioning, vestibular treatment, and now dry needling.
For further information on this or other related topics you can contact Brian P. Kinmartin PT, DPT, MTC, OCS, STC, CWcHP, Cert. DN, (Pawleys Island) (843) 235-0200, Richard A. Owens, PT, MS, OCS, Cert. SHT, CWcHP, Cert DN (Surfside) (843) 831-0163 at Professional Rehabilitation Services, Richard DeFalco, DPT, OCS, CSCS, CWcHP, Cert. DN (Myrtle Beach) (843) 839-1300, or visit our website at www.prsrehabservices.com where you can learn more about the company and even download a referral form for your physician to fill out. You can also call and schedule a free 15 minute consultation!