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TMJ Series: How Specialized Physical Therapy Can Help With the Treatment of Patients With TMJ

Written by Tom Christ PT, DPT

In dental and oral health care, referring patients to physical therapy services may not often be a common practice.  Physical therapists can be a vital part in the treatment and management of patients with temporomandibular joint (TMJ) dysfunction. In fact, minimum competence of entry-level trained physical therapists includes knowledge and practice of the TMJ anatomy, function, biomechanics, and pathology, as well as clinical examination and treatment.  Advanced trained physical therapists are well equipped to collaborate with oral health care practitioners to help treat TMJ and other biomechanical related dental pain and dysfunction. Below are some key areas that our advanced trained physical therapists at Motion Stability are able to help with.  

 

Relationship between the cervical spine and TMJ: The presence of TMJ has been shown to frequently be associated with cervical spine and postural dysfunction, with studies showing up to 70% of patients with TMJ also reporting neck pain.  This association can be due to pathology of the cervical spine referring pain to the jaw and face, as well as the altered mechanics of the TMJ with habitual poor cervical spine posturing.

  • Posture:  A commonly seen postural dysfunction treated in physical therapy is the forward head posture.  Forward head posture has shown to be associated with hypermobility of the TMJ potentially leading to pain and dysfunction.  Additionally, minor alterations in resting head position will change the resting occlusion contact, again potentially contributing to TMJ pathology.
  • Hypomobility: Decreased motion of the cervical spine has shown to decrease maximal mouth opening of the TMJ.  
  • Cervical muscle dysfunction: Dysfunction of both the upper trapezius and sternocleidomastoid (SCM) muscles has shown to lead to over activation and development of trigger points in the masseter muscle, a key contributor in TMJ of muscular origin. 
  • How does PT help? Treating the cervical spine can reduce referred pain from the spine to the jaw, and can help posture the head and neck in optimal position reducing strain on the TMJ.  Exercises and manual therapy have shown to help improve posture, reduce pain, and improve TMJ range of motion.

 

TMJ from myofascial pain: Studies show that myofascial pain is the second most common cause of orofacial pain and is highly associated with TMJ.  Trigger points in the cervical and orofacial muscles cause facial and jaw pain, headaches, impair jaw motion, alter muscle function, and can even cause earaches, dizziness, and quite frequently tinnitus.  

  • SCM muscle referral pattern: The SCM refers to the ipsilateral ear and posterior auricular region and will often cause sensations of ear fullness and tinnitus.  Trigger points in the SCM have shown to lead to trigger point development in the masseter muscle, making it vital to treat the SCM.
  • Masseter muscle referral pattern: The masseter refers to the cheek and jaw, deep into the ear, the molars and gums, and also can cause tinnitus.
  • Medial and Lateral Pterygoid referral patterns: The Pterygoids refer to the TMJ, cause ear pain, molar pain, the maxillary sinus, and can also cause tinnitus.
  • How does PT help? PTs are well trained in treating muscle.  Utilization of manual techniques, exercises, modalities, dry needling, and relaxation techniques have shown to help relax hypertonic cervical and masticatory muscles, restore cervical and TMJ motion, and reduce pain.

Tinnitus: Somatic tinnitus is often related to dysfunction of the cervical spine or TMJ.  This is due to connections between the somatosensory system of the cervical spine, TMJ, and the trigeminal nucleus.  Dysfunction of the cervical spine or its associated muscles can cause dysfunction in the Trigeminal nerve, thus generating symptoms of tinnitus.  Sustained activity of muscle like the SCM, masseter, and pterygoids influences the severity and intensity of somatic tinnitus.  

  • How does PT help? Manual treatments such as cervical and TMJ joint mobilizations and manipulations, postural exercise, relaxation techniques, and elimination of trigger points have shown to improve tinnitus intensity and severity.

 

Why Motion Stability? At Motion Stability we strive to set ourselves apart from other physical therapy clinics in the Atlanta area by way of customer service and advanced practice.  Our practice features a true one-on-one patient-to-therapist experience with each visit, ensuring each patient is provided exclusive commitment from their therapist during each appointment.  Patients do not need to compete for their therapist’s attention, allowing for excellent patient-therapist rapport.  

At Motion Stability we are committed to clinical development of our staff.  Each of our therapists has completed, or is in the process of completing advanced orthopedic residency training, ensuring that each patient is in good hands no matter which therapist they work with.   

If you have any questions, or would like to learn more about how physical therapy can help in the treatment of patients with TMJ, please contact us! 


References

  1. Armijo-Olivo S, Pitance L, Singh V, Neto F, Thie N, Michelotti A.  Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: A Systematic Region and Meta-Analysis.  Phys. Ther. 2016;96(1):9-25. 
  2. Higbie EJ, Seidel-Cobb D, Taylor LF, Cummings GS.  Effect of head position on vertical mandibular opening.  J. Orthop Sports Phys Ther.  1999;29(2):127-130.
  3. Rocabado M, Johnston BE Jr, Blakney MG.  Physical therapy and denstistry; an overview.  J Craniomandibular Pract. 1982;1(1):46-49. 
  4. Clark GT, Browne PA, Nakano M, Yang Q. Co-activation of sternocleidomastoid muscles during maximum clenching. J Dent Res. 1993;72(11):1499-1502. 
  5. Donnelly J, Fernández-de-las-Peñas C.  Travell, Simons & Simons Myofascial Pain and Dysfunction: The Trigger Point Manual. 3rd ed.  Philadelphia, PA: Wolters Kluwer; 2018. 
  6. La Touche R, Fernandez-de-las-Penas C, Fernandez-Carnero J et al.  The effects of manual therapy and exercise directed at the cervical spine on pain and pressure pain sensitivity in patients with myofascial temporomandibular disorders.  J Oral Rehabil. 2009;36(9):644-652. 
  7. Vier C, Barbosa de Almeida M, Neves M, Soares dos Santos A, Bracht M.  The effectiveness of dry needling for patients with orofacial pain associated with temporomandibular dysfunction: a systematic review and meta-analysis.  Brazilian Journal of Physical Therapy. 2019;23(1):3-11. 
  8. Min SH, Chang SH, Jeon SK, Yoon SZ, Park JY, Shin HW.  Posterior auricular pain causes by the trigger points in the sternocleidomastoid muscle aggravated by psychological factors – A case report. Korean J Anesthesiol.  2010;59. 
  9. Michaels S, Naessens S, Van de Heyning P, Braem M, Visscher C, Gilles A, De Hertogh W.  The Effect of Physical Therapy Treatment in Patients with Subjective Tinnitus: A Systematic Review.  Front. Neurosci.  2016;10: 545. 

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