TMJ Pain and Physical Therapy
Can Physical Therapy Help Me With Temporomandibular Joint Dysfunction (TMJ)?
Temporomandibular Joint (TMJ) disorder is a condition that affects one or both sides of a person’s jaw, leading to pain, discomfort, and restricted movement. In over 80% of cases, the articular disc of the TMJ displaces anteriorly due to degeneration of the posterior joint capsule. This displacement creates an imbalance in the muscles of mastication, causing various muscles to become atrophied, hypertonic, overused, or prone to trigger point formation.
While the causes of TMJ disorder can vary from person to person, the symptoms often manifest in the muscles surrounding the jaw, including the lateral pterygoid muscles (superior and inferior heads), temporalis, and masseter. Pain arises as the superior head of the lateral pterygoid slackens, pulling the disc forward. This results in pain and clicking of the disc over the front part of the condyle with any jaw movement. Despite these challenges, incorporating physical therapy and dry needling into rehabilitation protocols provides relief.
One of the main goals of physical therapy in TMJ disorder rehabilitation is to restore optimal function and alleviate pain. Through manual techniques including dry needling, joint mobilizations and soft tissue mobilizations, physical therapists address imbalances in muscles of mastication, improve joint mobility, and reduce pain factors leading to decreased pain when moving the jaw. By focusing on the affected muscles, such as the lateral pterygoids, masseter, and temporalis, which aid in jaw movement, our physical therapists at Symmetry Physical Therapy in the Downtown Miami/Brickell area, make treatment plans to address specific impairments and promote healing.
Why Is My Jaw Clicking and Painful?
In TMJ dysfunction, there are two chewing muscles that are directly related to the joint capsule itself. The inferior and superior head of the lateral pterygoid muscles. As shown int the photo, the superior head is attached to the front of the intraarticular disc and is responsible for keeping the disc in the right position as the mouth is closing. The inferior head is responsible for moving the mandibular condyle forward as the mouth is opening.
Degeneration, trauma, or wear and tear of the joint typically affects the posterior aspect of the capsule, which attaches to the back end of the disc. This degeneration allows the disc to slip forward leading to an ineffective tracking of the disc by the superior head of lateral pterygoid. As a result, the inferior head tries to compensate and becomes overworked which leads to hypoxia, inflammatory factors and trigger-point formation. This leads to pain within the joint and in the chewing muscles. In addition, the mandibular branch of trigeminal nerve innervates the chewing muscles, and the cells of this nerve overlap with the nerves that receive pain information from the upper neck. Research shows that many pts that have TMJ disorder also have upper neck issues and potentially headaches which increases hypertonicity of chewing muscles and leads to more pain.
How Can Physical Therapy Help Relieve My TMJ Disorder?
You can easily avoid the high costs of surgical interventions with conservative management. There is significant evidence that mobilization of the TMJ, dry needling with electrical stimulation, Winback (Tecar) Therapy, Soft tissue mobilization and upper cervical manipulation is all effective in pain elimination of TMJ disorder.
Dry Needling and Physical Therapy for TMJ
Dry Needling is a treatment used within physical therapy to assist the reparative response of tissues. Used in combination with electrical stimulation, dry needling increases the opioid production by the body, increases adenosine which helps to block pain in tissues, and increases blood flow. These benefits combined act to decrease pain and drive more efficient repair response by the body. The most recent evidence suggests that running electric stimulation is important to maximize the results of dry needling. Dry needling of the lateral pterygoid musculature would allow for improved oxygenation, decreased tone and guarding, and less trigger points, leading to optimal and increased jaw movement, decreased pain and improved healing of the affected tissues. Other muscles such as the temporalis and masseter tend to compensate and would benefit from dry needling as well as Tecar therapy and soft tissue mobilization to decrease muscle guarding.
WinBack Tecar Therapy for TMJ
Physical therapy is essential in managing the pain associated with temporomandibular joint dysfunctions. With the use of dry needling and electrical stimulation in combination with soft tissue mobilization (STM), WinBack Tecar Therapy and joint mobilizations, physical therapy can help to decrease pain and regain mobility in the affected jaw. Dry Needling in combination with Winback TECAR therapy specifically can be used to alleviate pain and inflammation while creating a favorable environment for healing to improve healing time frames and decrease length of the overall rehabilitation process.
As physical therapists also use joint mobilizations to improve joint spacing, joint health, regain mobility and assist in normal opening and closing of the TMJ. Education on proper posture and body mechanics to prevent future injuries is another important step necessary to avoid re-aggravation of rotator cuff muscles after the healing process has begun. Manipulation of the upper cervical spine has been also shown to improve TMJ pain, increase mouth opening, decrease pressure sensitivity, and improve joint arthrokinematics in patients with Temporomandibular dysfunction (TMD).
Physical Therapy and TMD
Temporomandibular joint dysfunction can lead to pain during talking, eating, or any other daily use of your jaw due to the loss of the TMJs normal joint arthrokinematics functions of and stabilization. If you experience TMD, limitations in jaw opening and closing can cause compensation patterns in other mastication muscles, leading to further degeneration of the joint structures and muscles in the area This can result in painful movements during any sort of jaw opening or closing. Addressing TMD properly and quickly through appropriate physical therapy and other conservative treatment and rehabilitation is essential to quality of life and TMJ health.
Dealing with TMD can significantly impact your daily life and abilities. However, with the help of physical therapy, you can reduce pain, improve mobility, and prevent future issues. By addressing the root causes, decreasing pain, and promoting better movement, physical therapy plays a crucial role in managing Temporomandibular joint dysfunction. If you suspect you have any sort of clicking or pain when opening and closing your jaw and are looking for conservative management from a Physical Therapist, come see us at Symmetry Physical Therapy, located in Miami/Brickell downtown area, where we provide an in-depth assessment and treatment strategies so we can help you return to a pain free lifestyle.
Feel free to give us a call at (305) 331 2277 to schedule an appointment.