Why is my Jaw Sore?
Tempromandibular Disorder
This post comes to you fresh and piping hot from the oven courtesy of Collingwood’s newest Osteopath, James Campbell (who is, thankfully, somewhat more proficient as an osteopath than a pun master).
As we all know, the past year and a half has proved to be quite the battle. We’ve been forced to adapt in ways we never would have thought possible on New Year’s Day 2020 (can you imagine!?). Alongside the obvious changes to our lifestyles, the lockdowns and ominous shadow of COVID have affected our bodies in other ways. We’re not moving or exercising as much, we’re sitting more, we’re eating more, we haven’t been getting out to see friends and family or doing the things we love. We’re more stressed and highly strung. In short, it’s been more of the bad, less of the good. So where am I taking this? Well, there are two little-spoken of joints on either side of your head which connect your jawbone to your skull. These are known as the temporomandibular joints (TMJ) and can, along with their surrounding muscles, really be a headache during times like these. This article takes a look at the TMJ, what we use them for, how they can cause issues and what Osteopathy can do to help. Do you get jaw pain or clicking? Do you also suffer from headaches or neck pain? If so, then this article on the TMJ is for you.
What is the Temporomandibular Joint (TMJ)?
The jawbone (or mandible), is the bone that hangs from the front part of your skull, making up the lower part of your face and culminating with your chin at the front. It holds your lower teeth and the tongue sits on and originates from it. On either side of your head the mandible attaches to the temporal bones of your skull at (you guessed it) the ‘temporomandibular’ joints or TMJ’s. You can feel your TMJ’s in action if you place your fingers just in front of your ears in line with the ear holes and gently open and close your mouth.
The TMJ is what’s called a ‘ginglymoarthrodial’ joint, which is a fancy latin way of saying the joint’s unique anatomy makes it both a ginglymus (hinging joint) and an arthrodial (sliding) joint. This combination of hinging and sliding at the TMJ is what lets us open and close our mouths as well as move our jaw from side to side or front to back during activities like eating, talking, or pulling faces at people. When we consider how often we do these sorts of things, it’s hardly surprising that the TMJ is the most used joint in the body.
Four major muscles, known as the muscles of mastication (lol) control movements at the TMJ. Three of these (masseter, temporalis and the medial pterygoid) help close our mouths, while only one (the lateral pterygoid) assists with opening. This makes sense when you think about the way gravity works on the body and pulls our jaw open, while we need more help with closing our mouth and for biting into food. Other muscles in our neck do assist with jaw movements, however not as directly as the ones mentioned.
Problems with the TMJ
As with any joint in our body, problems can occur at the TMJ. When this happens, it is known as Temporomandibular Dysfunction (TMD), which is a broad term used to describe pain and dysfunction involving the TMJ. TMD is very common especially in younger folks, with women being at least four times more likely than men to suffer from it (talk about unfair!).
Problems can arise from the joint itself as well as from its associated structures. Muscles, ligaments, joint surfaces and a small disc of cartilage that sits between the jawbone and the skull can all be involved.
Muscle and ligament imbalances are the most common precipitators of TMD. These can cause our jaw to sit abnormally on our skull and move in ways it wasn’t designed to. The result of this can be stiffness or pain (or both) when opening and closing our mouths or even when we’re not using our jaw at all. Such imbalances could be a result of trauma to the jaw (for example being punched or hitting your chin during a fall), clenching your jaw during the day or grinding your teeth while sleeping (known as ‘Bruxism’), a neck dysfunction/ restriction, or from dental problems like an uneven bite, getting a cap/filling, or tooth extractions. Stress, anxiety and depression go hand in hand with TMD, as people experiencing these often clench their jaw during the day or have bruxism at night (or both!), which can lead to a chronically sore jaw and headaches. With this in mind, considering the impact COVID has had on us all it’s hardly surprising that our poor TMJ’s might be taking more of a beating than usual.
Another potential player in TMD is the small disc of cartilage that sits inside the joint itself. This disc is a shock absorber that slides and moves during jaw movements. Sometimes, it can become ‘displaced’ so that it doesn’t slide and move as smoothly as it should. This often causes the jaw to click or pop when opening or closing the mouth. For the most part, such a click is painless, however some people may experience pain along with a click and in some severe cases the jaw might temporarily lock. As you can imagine this would be quite a distressing experience and best to avoid!
Although more common in younger people, age-related degeneration of the TMJ (osteoarthritis) can cause TMD amongst our elder citizens. As a fun fact, it’s also worth keeping in mind that TMJ pain can sometimes disguise itself as ear pain.
How can your osteopath help?
Research has shown that Osteopathic treatment can assist with managing pain, discomfort and joint function in sufferers of TMD. To what extent and by what means your Osteopath can do so for you depends greatly on the severity and causes of your TMD specifically. For example, straightforward muscle and ligament imbalances affecting the TMJ can be addressed through hands-on techniques that release the jaw muscles and mobilise the joint itself. Corrective mobility and strengthening exercises can also be prescribed to help you do the same for yourself at home.
Unfortunately however, things are rarely straightforward.
In many cases TMD will be accompanied by problems in adjacent regions like the neck and shoulders. Because of the proximity of the jaw and neck, you rarely get dysfunction in one without the other. These problems may be muscle or joint restrictions, poor movement quality, or a lack of stability and strength. Where present, these problems need to be addressed to get your TMD under control.
This is just an example, and is by no means the only thing your Osteopath will consider to help with your TMD. As a minimum, an Osteopathic approach to TMD will include a thorough assessment of the head, jaw, neck, shoulders and even further afield to the mid/ lower back or hips (or beyond!). Your Osteo will also question you about your occupation and what it entails as well as your sleeping habits, hobbies, exercise and current stress/anxiety levels. All of these and more could play a part in your condition.
If your osteo believes your TMD relates to a dental issue, they may advise a visit to the dentist as sometimes problems can be resolved with input from both professions. If nightly bruxism is a problem, you may find it helpful to wear a mouth-guard to bed which will alleviate pressure on your jaw and teeth. We know they might be annoying, but can really help tip the scales in your favour! Daytime clenching related to stress, anxiety or depression can also be a big problem. Breathing, relaxation and mindfulness techniques can be a great way to help improve your awareness of the clenching, and assist with managing the stress/ anxiety itself. Don’t worry, your osteo will have some tricks up their sleeve for this, and always let them know if you feel like you need help with this aspect of your life.
The long and short of it is, TMJ’s can be great and we need them more than any other joint in our body. But, they can also be downright miserable at times and difficult to deal with if not managed properly. With lockdowns and COVID stress, our poor jaws have really taken a beating, so if you’re suffering headaches and neck pain you think might be related to your TMJ; don’t fret and cause your jaw to clench even more! Just talk to us at your next appointment, and get on top of it.
References
American Sleep Association. Night guard for bruxism: Teeth grinding and clenching. https://www.sleepassociation.org/sleep-treatments/night-guard/
Easterbrook, S., Keys, J., Talsma, J., & Pierce-Talsma, S. (2019). Osteopathic manipulative treatment for temporomandibular disorders. The Journal of Osteopathic Medicine, accessed via De Gruyter. https://doi.org/10.7556/jaoa.2019.071
Lomas, J., Gurgenci, T., Jackson, C., & Campbell, D. (2018). Temporomandibular dysfunction. Australian Journal of General Practice, 47(4).doi: 10.31128/AFP-10-17-4375
Nahian, A., Ünal, M., & Mathew Jr, J. (2021). Osteopathic manipulative treatment: Facial muscle energy, direct MFR, and BLT procedure: For TMJ dysfunction. In StatPearls. StatPearls Publishing. https://pubmed.ncbi.nlm.nih.gov/33231980/
