TMJ & Jaw Pain

What is the TMJ?

The ‘TMJ’ or ‘temporomandibular joint’, is more commonly known as the jaw joint. There is one joint on either side of your jaw and it is responsible for holding your jaw to your skull and likely the cause of your jaw pain.

We all use our jaw joints repetitively every day, to help up eat, talk, breathe, show facial expressions, and occasionally express our anger or frustration (by clenching). The jaw is a focal point of physical activity and because of its repetitive use, and sometimes with overuse dysfunction can occur.

What is TMD?

Temporomandibular dysfunction describes a wide range of conditions that occurs when our jaw is not functioning at its best. The TMJ is a complex joint and is guided by a series of muscles, ligaments, and an articular disc. It is also very closely linked to the posture and positioning of our cervical spine (the neck!), and our upper back.

What causes TMD?

TMD is often caused by a variety of factors including:

• Inflamed jaw joint (often secondary to overuse from clenching or prolonged dental procedures)
• Stiff jaw joint (commonly secondary to overuse from clenching or grinding)
• Displaced disc (clicky or locked jaw)
• Poor motor patterning
• Over flexible jaw joint
• Stiff neck
• Forward head posture
• Clenching and/or grinding (often secondary to stress)
• Jaw muscle spasm (commonly secondary to prolonged dental procedures)
• Altered bite position (e.g crown or filling that is too high/low)
• Obstructive sleep aponea (if untreated)
• Trauma to the jaw (e.g knock to the face)
• Osteoarthritis of the jaw

TMD Symptoms

• Pain in or around the jaw or face at rest or upon movement
• Clicking of the jaw joint upon opening
• Locking of the jaw (when you are unable to open wider than 2 finger-widths)
• Crepitus (sandpaper grinding type noise upon opening/closing the jaw)
• Difficulty and/or fatigue with chewing
• Difficulty opening wide
• Uneven jaw movements when opening to eat or speak
• Headaches
• Facial pain
• Ear pain, ringing in the ear
• Dizziness
• Neck pain and stiffness

TMD Treatment

TMJ is overlooked by many health professionals and due to its lack of awareness, it is often not well managed. We exclusively treat jaw, neck, and headache related cases. We understand the complexity of the joint/s and the various mechanical, environmental and social factors that may be contributing to the current overload. In doing this we can create an effective approach to managing TMJ disorders, this approach includes:

• TMJ joint mobilisations
• Spinal joint mobilisations
• Neck and jaw muscle release
• Dry needling
• Motor pattern relearning
• Prescription of an individualised home exercise program for the jaw and/or neck to help ‘normalise’ muscle length and strength
• A full explanation of your TMJ condition and contributing factors and discussion around your treatment plan
• Recognising different lifestyle factors that may be contributing to the jaw dysfunction and how to best manage these factors e.g. high-stress periods, chewing gum, etc.
• Recognising different postural factors that be contributing to overloading the jaw e.g. forward head posture when on a laptop at work
• Working in close conjunction with your regular dentist, specialist dentist, or GP (or any other specialist) to coordinate any other treatment required e.g. splint therapy, botox, jaw surgery

How can TMJ physiotherapy help?

We exclusively treat jaw, neck, and headache-related conditions. We understand the complexity of the joint/s and the various mechanical, environmental and social factors that may be contributing to the current overload.

Your initial consult will typically go for an hour and include an in-depth discussion about your symptoms, a full individualised assessment, and treatment. During this consult, we will assess your TMJ, surrounding musculature, motor patterning, and most likely your neck to determine the likely source/s of your condition. We aim to find the source/s of your problem so we can target our treatment at fixing the underlying conditions and not just the symptoms. Often this will involve working with other health professionals such as your regular dentist, specialist dentist, or GP. 

Once the source/s of the condition has been identified treatment will include a variety of modalities including; TMJ and spinal joint mobilisations, muscle release, and motor relearning. These treatments are aimed to help relieve your symptoms and aid in the recovery process.

Treatment will always include a full explanation of your condition, the structures involved, and a treatment plan. All patients will receive an individualised exercise program to assist with further rehabilitation of their condition between appointments. Ongoing treatment and future appointments will be discussed to ensure the best possible treatment outcomes.

We have a passion for and vast experience in treating jaw dysfunction and facial pain. If you have any concerns around your jaw, whether be stiff, clicky, painful or it just doesn’t feel ‘right’ please give us a call today or book online.

Clenching, bruxism, grinding and TMD

Chronic teeth clenching, bruxism, and/or grinding is a problem for many patients suffering from TMD. The masseter muscle (the big muscle you can feel when touching your cheeks) is one of the strongest muscles per fiber in the human body. When working together the masseter muscles can create an immense amount of force through clenching. Clenching is commonly responsible for:

• Jaw pain
• Facial pain, headaches
• Tooth wear/cracking
• Tooth sensitivity
• Gum recession
• Ringing in the ear/s
• Unexplained ear pain

Not everybody is aware of their clenching habits, while others are hyperaware, but have no tools to assist them in minimising it. Our job at the Queensland TMJ & Headache Centre is to help you identify whether clenching is primary or secondary to your TMD and treating your symptoms appropriately.

Primary clenching: Primary clenching is not related to a medical condition and has no underlying known cause 

Secondary clenching: Secondary clenching has a cause and is often the side effect of something else e.g. muscle imbalance, medication, neurological, stress, anxiety, etc.

Causes of secondary clenching

• Muscle imbalance in the TMJ
• Poor stability and control of muscles in the TMJ
• Weakness in the anterior muscles in the front of your neck
• Stress
• Anxiety
• Depression
• Lifestyle factors such as:
• Tobacco use
• Excessive alcohol consumption
• Recreational drugs
• High amounts of caffeine
• Sleep disorders (obstructive sleep aponea, sleep walking, etc.)
• Medical conditions such as; fibromyalgia, ADHD, and Parkinson’s disease.
• Medications
• Malocclusion (misalignment of the teeth)
• Chronic pain
• Breathing difficulties eg. Enlarged adenoids

Clenching Treatment

Primary clenching has no known cause and consequently no ‘treatment’. Management best involves extensively ruling out no secondary cause (secondary clenching), improving your awareness and TMJ posture during the day, and wearing a splint at night to help protect the underlying teeth and gums. Alternative treatments can also include botox therapy.

Secondary clenching is best managed by identifying the underlying cause and treating it appropriately. This can include exercise prescription for TMJ and neck muscles, self muscle release, botox therapy, addressing your breathing disorder eg. Removal of adenoids or CPAP for sleep aponea, managing stress, and reviewing your current medications.

How can jaw physiotherapy help?

After identifying the cause/s of your clenching we will go through an individualised management plan to help alleviate contributing factors to your clenching, this may include exercise prescription, stress management techniques and often involves liaising with other health professionals such as your GP or dentist. If your clenching is causing you jaw pain, we have vast experience with key physiotherapy modalities to help alleviate your symptoms while working on actively reducing your clenching.

Clicking Jaw

A clicking jaw, also known as an ‘anterior disc displacement with reduction’, is often described by patients as an audible click or pop upon jaw opening, followed by a smaller click on closing. The click can be so loud sometimes that people across the table can hear it, and is often louder when chewing harder foods.

What is a clicking jaw?

A clicking jaw occurs when the disc (the cartilage of the joint) slips forward in front of the mandibular condyle (jaw bone) preventing a smooth movement. The condyle then jumps forward quickly over the disc causing a clicking noise upon opening. This is often followed by a smaller clicking on closing when the disc slips back in front of the condyle.
Clicking jaws are often pain-free, although can be associated with acute pain and are often a warning sign that something isn’t right in the jaw.

My jaw just started clicking, is it a problem?

A recent onset of clicking <3months is often a warning sign that something isn’t right in the jaw. The click does not always have to be associated with pain, however, pain often develops as the clicking progresses. If unstable, the click can progress to more serious jaw conditions such as a locked jaw.

Clicking can start spontaneously, however often begins secondary to increased load on your jaw. Clicking often begins after;

• Braces have been removed
• Periods of high stress/clenching
• Prolonged dental procedures
• Postural overload/poor posture
• Poor desk set up
• Starting back at a desk job after a period of time off or a more active role

It is important to seek out guidance from an expertly training physiotherapist in TMD if you have a recent onset of a clicking jaw. The Queensland TMJ & Headache Centre will do a full assessment of both your TMJ and your neck to investigate any likely causes of your clicking and provide you with appropriate treatment, which may include hands on treatment and exercises to complete at home.

My jaw has clicked for years and years, is it a problem?

A chronic history of clicking >9months is not necessarily a problem if the click is stable and remaining unchanged. Your click should be consistent and easy to move past when opening your jaw. If you click is:

• Painful
• Sticky or you feel like you have to force your jaw to move past the click
• Increasing in intensity
• Changing in severity (click is becoming much more audible)
• Increasing or decreasing in frequency

It is often a sign on an unstable click. An unstable click is often a predictor for a locked jaw and requires immediate attention from an expertly training physiotherapist at the Queensland TMJ & Headache Centre.

We will do a full assessment of both your TMJ and cervical spine to investigate any likely causes contributing to your unstable click. We will then provide you with appropriate treatment, which may include hands on treatment and exercises to complete at home to assist in stabilising the click back to its ‘normal’.

Locked Jaw

A locked jaw is when the disc (the cartilage of the joint) slips forward in front of the mandibular condyle (jaw bone) and forms a mechanical block, preventing the jaw from sliding forward to open. This is very different from a clicking jaw when the condyle can jump forward in front of the disc to open.
Locked jaws are very scary, almost always painful and patients are often unable to open wider than about two finger widths making eating very difficult.
Any locked jaw requires immediate referral to an expert physiotherapist at the Queensland TMJ & Headache Centre and a referral to an oral maxillofacial surgeon.

Locked Jaw Treatment

Treatment from physiotherapy initially focuses on reducing surrounding muscle spasms and reducing the disc. Pharmacological interventions are also initially helpful in reducing inflammation and pain.

If your physiotherapist is unable to reduce your disc within 3-4 appointments a procedure called an arthrocentesis is often performed by the Maxillofacial Surgeon. Following reduction (whether conservatively or surgically), ongoing rehabilitation for the TMJ will be required to restore function and minimise the risk of reoccurrence.

Treatment often involves muscle release, joint mobilisations, and motor pattern retraining to assist in regaining proprioceptive awareness in the joint. Following an arthrocentesis procedure patients often attend physiotherapy twice/week for two/weeks before their appointments are gradually spread apart over the coming 2-5 months as function and stability is restored.

Dislocated Jaw

TMJ dislocations required immediate medical attention and occur when the mandibular condyle detaches from the mandibular fossa. A dislocated jaw is often relocated in the emergency department, however, if your doctor is unable to relocate the joint surgery may be required. Following reduction, an expert physiotherapist from the Queensland TMJ & Headache Centre can assist in restoring function, strength, and stability.

Degenerative Disc Disease/Osteoarthritis of the Jaw:

Degenerative disc disease or osteoarthritis of the TMJ is often associated with pain, crepitus (grinding/sandpaper like sound during jaw movements), and altered movement patterns. It usually only affects one side of the jaw and occurs when the disc (articular cartilage) begins to wear down and changes occur to the bony surface. Although we cannot fix or stop the degenerative process an expert physiotherapist at the Queensland TMJ & Headache Centre can assist with pain management and maintaining jaw function and stability.

Treatment for TMJ/jaw osteoarthritis and degenerative disc disease often consists of:

• Jaw joint mobilisations to reduce pain and improve movement
• Muscle releases
• Strengthening and control based exercises to assist in reducing pain and improving and/or maintaining function
• Activity modifications to reduce pain
• Recognising different postural factors that be contributing to overloading the jaw e.g. a forward head posture when on your phone, laptop or reading
• Working in close conjunction with your regular dentist, specialist dentist, or GP (or any other specialist) to coordinate any other treatment required e.g. splint therapy, botox, occlusal concerns, jaw surgery

Jaw Fractures/Trauma

Jaw fractures/trauma can occur in different locations through the jaw. Depending on the type and location of the fracture surgery and/or a period of immobility may be required. Throughout this period of immobility, patients are often required to have a liquid diet and minimise all jaw movements. During the initial healing process physiotherapy primarily focuses on the cervical spine (your neck), which is often overlooked as a source of pain, however frequently suffers from trauma and/or whiplash alongside your TMJ trauma. Once the immobilisation period for your jaw is over, physiotherapy is aimed at restoring jaw function with joint mobilisations, muscle release, and motor relearning.

Learn about other jaw, headache & neck conditions…