Pain and disorders of the temporomandibular joint (TMJ)

Do you feel pain in your head, teeth or cervical spine, but you can’t locate the source of the pain and therefore treat it as well? Did you undergo various different examinations by different specialists and they didn’t find any problem, but you are still troubled by migraines? The source of your problems can be in a small joint connecting the lower jaw with skull.

Big amount of people feel pain during the movement of the jaw (while chewing or talking), cracking sounds, squeaking, skipping: having problems with opening or closing mouth. The problems of the TMJ belong to very common complications - 40 to 60 % of people experience some form of this problem in their life, without even realizing it.

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TEMPOROMANDIBULAR JOINT

The temporomandibular joint is composed of joint head (which is part of the lower jaw) and the joint socket, which is located on the temporal bone. Between the head of the joint and capsule is a joint discus - cartilage disc, which works during the transfer of the chewing forces. The joint liquid secures the nutrition for the cartilage and at the same time it functions as a lubricant. The whole joint is firmly inserted in a joint capsule. Correct function is not secured just by the joint structure, but also ligaments, chewing muscles and hyoid bone. The jaw joint enables the jaw to move up and down, to the sides as well as extending and flexing.

Jaw or temporomandibular joint (TMJ) has several curiosities from other joints of the body:

  • As the only joint in the human body it performs two types of motions - turning (rotation) and shifting (translational motion)
  • It is the only pair joint, that is when two jaw joints are connected with the lower jaw and the movement is done simultaneously - disability of one joint is therefore often reflected onto the other joint as well
  • It belongs to one of the most burdened joints of the human body

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PROBLEMS CAUSING THE DISORDER

  • Pain doesn’t affect the person only while chewing or talking, but also during a peaceful regime, for example during sleep. Usually it is easily localized in the area of the joint below the ear, but it can expand into ear, upper but also lower teeth or throat. Usually it is manifested by headaches, which can be similar to migraines. These symptoms and especially difficult localization leads to incorrect diagnosis - patients are repeatedly examined by stomatologists, ENT doctors, neurologists and the root of the problem lies in the temporomandibular joint.
  • Sound phenomenons accompanying the jaw motion - manifested by cracking or by crepitation (grinding sound).
  • Mobility change of the lower jaw - manifested by restricted or even disabled option to open mouth or oppositely when you’re unable to close your mouth.

WHAT ARE THE CAUSES OF THE DISORDER?

The most common cause of the temporomandibular joint is generally speaking excessive overloading of the joint, which happens as a result of grinding the teeth, clenching them excessively or as a result of trauma (falling on the chin, hit,...).

Flawed occlusion can also put enormous pressure on the joint, as well as missing teeth, obstacles disrupting the correct contact of the upper and lower teeth, which can be caused by protruding teeth and inappropriate prosthetic replacements (dental implants, dental bridges etc…).

Overloading of the temporomandibular joint, especially clenching often happens during psychological pressure, therefore the disorder of the temporomandibular joint is manifested by repeated and excessively stressful situations. At this moment we talk about functional cause of the pain in the joint, caused by reflexive changes - localized by the trigger points, and big tension in the muscles which affect this joint.

Result of the above mentioned causes can be a structural degenerative change in form of arthrotic changes in the joint.

PHYSIOTHERAPY

With correctly performed physiotherapy, you can strengthen the stabilizers of the joint - muscles. You can optimize the range of movement and restore the optimal muscle coordination needed for correct movement of the jaw. We use the soft tissue therapy, gentle ischemic pressure on the trigger points and post-isometric relaxation of the chewing and hyoid muscles, which we consequently apply in a form which the patient himself could do later at home.

In most cases we involve in the therapy of temporomandibular joint also a therapy affecting the cervical spine and general posture (specifically correction of the protruded head, which increases the muscle dysbalance and consequent pressure on the cervical spine which may be affecting the temporomandibular joint - TMJ).

Important part is to educate the patient - explaining the causes and consequences of his problems, recommending the preventive measures such as controlling the mouth opening when we yawn, or eating softer food. If the patient suffers from nocturnal bruxism (teeth grinding), we recommend to wear dental night guard.

You should start to think about invasive treatment only if you first try all these conservative techniques and method.

VIDEO TUTORIALS OF PHYSIOTHERAPEUTIC TECHNIQUES

Relaxing jawRelaxing the NeckmusclesRelaxing facial musclesRelieving the jaw musclesRelieving muscles head



Author:
 FYZIOklinika physiotherapy Ltd., Prague, Czech Republic
Source: Clinical experience from a private practice in a physiotherapeutic field, FYZIOklinika

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