One Joint, Many Complications

If you have ever suffered from Temporomandibular Joint Dysfunction (TMJD), you know how difficult it can be to bite, chew, yawn and even speak with your friends, family and co-workers! With how often we use the temporomandibular joint (TMJ) in our daily life, a dysfunction with such a small joint can sometimes be quite debilitating when it comes to eating and participating with those around us.

Common symptoms of TMJD include:

• jaw pain and/or tightness
• reduced range of motion (particularly when opening)
• crepitus (clicking or popping) in the TMJ
• headaches
• upper neck pain
• balance issues
• locking open or closed (*NOTE: this is considered a medical emergency and requires immediate assessment and treatment in the ER. If you experience a jaw that locks in position and you are unable to actively open or close it, please seek attention at your nearest hospital emergency room)

What is TMJD?

The term ‘dysfunction’ is an umbrella term that refers to some sort of (usually) mechanical problem with the joint that changes the axis of the joint or the way the muscles around it control the joint, creating abnormal movement. This includes hypomobility (reduced movement) which can be a result of muscle tightness, joint stiffness or a combination of the two. It can also involve hypermobility (excessive mobility) which can be caused by lack of muscle control or structural laxity in the ligaments surrounding the joint. It can also be caused by a dislocation or subluxation of the disc that is meant to cushion and protect the joint surfaces as it moves through its full range of motion. Typically, with significant clicking and locking, the disc is either dislocating completely, or dislocating and spontaneously reducing.

What Causes TMJD?

One of the causes of dysfunction or injury to the TMJ is through direct trauma. This can include sports injuries where this is a whiplash mechanism or blow to the head/face, as well as motor vehicle collisions. Just like any other joint in our body, a trauma to the TMJ can result in muscle strain, joint sprain or dislocation of the joint or disc. Any traumatic injury to the head or neck should be assessed by a physician to determine if diagnostic imaging or immediate medical attention is required as well as to perform concussion screening.

Another cause of TMJD is poor posture. When we slouch in our chairs or have a particular occupation that requires being in a hunched position, the weight of our head becomes too heavy for our neck extensors to overcome and the head/neck slide forward in to a ‘head forward posture’. This is commonly seen in patients who spend significant time bent over laptops, tablets or smart phones at their workstation or who spend a lot of time reading physical documents. ‘Head forward posture’ will shift a patient’s gaze downward and if stiffness in this position develops, it makes it difficult for our gaze to remain forward. For our body to overcome this so that we can see the world in front of us, our chin needs to poke forward so our head can rotate farther up, bringing our gaze with it. This ‘head forward + chin poke posture’ changes the positioning of the temporal bone within the TMJ creating a chain of events that prevents the jaw from opening as well or as easily as it should.

Lastly, TMJD can also be caused by psychological issues such as stress, anxiety and depression, which can sometimes result in clenching or grinding of the teeth. These habits can increase the amount of TMJ compression as well as muscle tightness and, especially when they are chronic, can begin the cascade of dysfunction in the TMJ.

What To Do If You Think You Might Have TMJD?

A good place to start is to see your dentist to ensure that your jaw pain is not a dental issue. Some tooth-related problems can cause referred pain to the TMJ, so it is important that a dentist perform an assessment to rule out a serious tooth issue. A dentist will also be able to determine if the dysfunction requires some form of appliance like a splint or night guard. In some particularly acute cases, the dentist may also recommend and prescribe medications such as muscle relaxants and NSAIDs (non-steroidal anti-inflammatories).

If tooth issues have been successfully ruled out, a collaborative orthopedic care approach can be initiated. This approach involves care provided by at least one, but often a few practitioners including physical therapy, massage, chiropractic and dental. The benefit of seeking care at a multi-disciplinary clinic like Momentum Health is that the practitioners are familiar with treating patients collaboratively already and have a keen sense on when a referral is required, so whichever practitioner you see will be able to assess you and give you the appropriate advice and treatment plan. If you do not have a multi-disciplinary clinic in your area or if you are unsure if your current clinic takes a collaborative approach, it is best to call and ask if there are any practitioners in the clinic that have experience treating TMJD on a regular basis to ensure that you are getting care from a competent and confident practitioner. Based on the initial assessment with your primary practitioner, your treatment plan for TMJD can include: massage and soft tissue release, joint mobilization and manipulation, dry needling, pain relieving modalities (heat, ice, TENS) and therapeutic exercises for the jaw, head/neck and posture.

As previously mentioned, jaw dysfunction can limit many simple yet important uses of our jaw/mouth that we often take for granted until pain and dysfunction are present! In any case, if you are experiencing pain and/or dysfunction in your jaw, it is best to seek care as quickly as possible so remember to ‘chews’ your clinic and practitioner wisely!

Article by Carlee Anderson, PT, MScPT, BKin, BDN, Physiotherapist at Momentum Health Westbrook