Jaw Pain – Temporomandibular Disorders
Pain and functional limitations in our jaw are described as Temporomandibular Disorders (TMD). Common temporomandibular disorders include joint disorders resulting from arthritis or internal disc derangement, and pain disorders that arise from myofascial structures around the joint. Common causes of TMD include inflammation, trauma (direct hit, whiplash, etc.), age related degeneration, prolonged chewing, poor neck, and upper back posture, or related to dental issues like missing teeth, grinding, teeth misalignments, prolonged jaw opening for dental procedure or surgery.
Presentation of TMD
Joint disorders are often presented with clicking or popping of the jaw with movements, joint noises, reduced jaw opening, jaw deviations, and sometimes associated with the jaw locked in closed or open positions. Patients experience clicking, popping, or locking of the jaw resulting from an atypical displacement of a cartilage disc present within the joint.
Pain disorders are presented as pain localized to the jaw muscles or as widespread myofascial pain and headache related to jaw movements/chewing or direct pressure on muscles. Often pain and myofascial restriction can lead to constant pain and reduced jaw movements.
How can you manage TMD?
You must seek treatments if you experience localized or spreading pain or headache with chewing/jaw movements and symptoms like jaw clicking, locking, limited opening (less than ~3 fingers wide opening or 40mm). Conservative treatments that consist of manual therapy, exercises, and modalities (ultrasound, LASER, acupuncture, etc.) have been found to be effective in the management of acute and chronic TMD. You may also need assistance from your dentist for occlusal splints and other dental issues. Physiotherapists are trained to assess TMJ pain and provide you with a treatment plan. They can liaison with your dentist for an issue that cannot be addressed with physiotherapy or dental treatments alone.
The most successful tools that we use include manual therapy (myofascial release and mobilization for neck and jaw, including intra-oral mobilizations), motor-control and mobility exercise, postural correction, and home exercise program as well as education. LASER and acupuncture are other treatments we use that have shown to have effective in reducing pain.
Nejin Chacko PT, BPT, MSc(Sports Medicine), MSc(OMPT), FCAMPT.
- Calixtre LB, Moreira RFC, Franchini GH, Alburquerque-Sendín F, Oliveira AB. Manual therapy for the management of pain and limited range of motion in subjects with signs and symptoms of temporomandibular disorder: a systematic review of randomised controlled trials. J Oral Rehabil. 2015 Nov;42(11):847–61.
- Shukla D, Muthusekhar MR. Efficacy of low-level laser therapy in temporomandibular disorders: A systematic review. Natl J Maxillofac Surg. 2016;7(1):62–6.
- Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet J-P, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: Recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache. 2014;28(1):6–27.
- Wu J-Y, Zhang C, Xu Y-P, Yu Y-Y, Peng L, Leng W-D, et al. Acupuncture therapy in the management of the clinical outcomes for temporomandibular disorders. Medicine (Baltimore) [Internet]. 2017 Mar 3 [cited 2021 Feb 13];96(9). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5340435/