Everything I’ve Learned About TMJ Dysfunction Part 1: Self Care for TMJ Relief
I’ve had a TMJ issue ever since I was 16 (among many other issues) and have been on a quest ever since to find an answer for it. For me, the TMJ issues presented as a popping on my left joint and extreme facial pain. I had severe Bruxism (jaw clenching) and extreme tightness in my jaw and face. This would lead to headaches, more popping and clicking, and eating became extremely difficult. Chewing would tire my face out dramatically, and the ensuing lactic acid from the overworked muscles would burn my face and cause extreme fatigue.
The purpose of this post is to write everything I’ve researched and learned about TMJ through the years, what has helped me, and what I found to be the most promising. I will present it in the order of least intrusive to most intrusive. TMJ can be caused by a variety of factors, and as with anything with health, it is always best to start with any therapy that is the most natural, and if needed, progress to the more intrusive therapies.
For this reason, I never tried splints, guards, or had Occlusal work done because they did not seem natural. It didn’t really explain (at least for me) why the issue was present in the first place, and the various stories of the inefficacy of these devices and treatments didn’t inspire much hope. It also didn’t help that they cost thousands of dollars. Nonetheless, they shouldn’t be put off as potential remedies, but should be tried later, when other options have been exhausted.
Thankfully, my TMJ has improved dramatically. For full disclosure, I still suffer from a TMJ problem, but I am continuously improving and it has become more of an inconvenience rather than a detriment to my life.
This will be the first part in a multi part series in which I discuss the different remedies that could potentially help with TMJ dysfunction and symptoms. I will start with the most basic and simple to implement and work towards more complex treatments in subsequent posts.
The Temporomandibular Joint
If you’re seeking an answer for your TMJ problem, then you most likely know what it is and how it functions. For those who may not be familiar, the TMJ is a joint connecting the temporal bone with the mandible (jaw) through a socket. The ends of the mandible contain Condyles, and when you open your mouth, these Condyles slide out of the socket. When you close your mouth the Condyles slide back onto the socket. There is a disc between the Condyle and socket in the temporal bone which makes the transition in and out of the socket more efficient. A TMJ issue is a problem with either the joint itself, or the associated muscles causing pain, discomfort, and other symptoms.
What Causes TMJ Dysfunction or TMD?
TMJ Dysfunction and TMD refer to a set of symptoms associated with the TMJ, but do not refer specifically to a cause. As a result, the causes of TMJ Dysfunction are extremely varied and are different for each person. According to some estimates as well as successful treatment or reduction of TMJ symptoms, it is estimated that as much as 85% of TMJ Dysfunction arises from neuromuscular issues, rather than an issue with the joint or joints themselves.
The good news is that if this is true, there is a very good chance that there is a remedy out there that will help with your TMJ dysfunction that will not require surgery. The key is to find the one that works for you, and the suggestions outlined in this post and subsequent posts will hopefully help you in some meaningful way.
Self Care and Maintenance
While seemingly very basic and simple, self-care and maintenance can make the world of different in TMJ dysfunction and associated symptoms. They are the least invasive and lay the groundwork for improvement of TMJ function. For some people, these steps alone may be enough to resolve their TMJ issues completely. Others may not experience a complete resolution of their symptoms, but will certainly experience an improvement in the way they feel and their quality of life. They are the simplest and least invasive, so it is a wonderful place to start.
Releasing the Muscles of Mastication
Releasing the muscles of mastication or muscles used for chewing, is one of the quickest ways to reduce the symptoms of TMJ. The vast majority of symptoms produced by TMJ dysfunction are muscular in nature, and the muscles are either the cause themselves or they exponentially aggravate existing symptoms. For one thing, prolonged overexertion of the muscles through clenching and/or the extra effort required to chew fatigues these muscles and eventually causes them to spasm. This produces pain in the muscles locally, but muscle spasms can also compress nerves and blood vessels which then refer pain to other parts of the face and head. The fatigued muscles also begin producing lactic acid as a byproduct, which can cause burning, facial fatigue, and other symptoms.
Just imagine how your arm would feel if you were to continuously flex your bicep every second of every day. Whether you are holding something or not, whether you are asleep or awake. Just flexing it as tight as you could. That is exactly what is happening with your muscles of mastication when you are clenching or when they are in spasm.
It is also important to remember that the muscles are what actually keep the jaw in the position that it is in, and dictates the trajectory in which it opens and closes. Tight muscles pull the jaw in that direction, whether it be to the left, right, front, or back, altering the jaws default rest position. The same effect occurs when opening or closing the jaw. When there is a tight muscle or muscles, the jaw will have a tendency to veer towards the tight muscle(s), altering the function of the jaw. As these muscular asymmetries continue, it compounds the muscular dysfunction as the tight muscles work even harder and become even tighter. Eventually, prolonged muscular dysfunction and improper position of the jaw can cause the joint to function abnormally, producing the clicking or popping sound experienced by many TMJ dysfunction sufferers.
Ironically, continued muscles spasms in the muscles of mastication can cause even more Bruxism and jaw clenching. As the muscles stay in spasm for a prolonged period of time, they begin to guard and the body begins to have a natural tendency to clench even harder. Releasing the muscles of mastication can actually help break or significantly reduce the feedback loop and the body’s habit of clenching the teeth. Whether this occurs or not depends on the specific individual, but virtually everyone experiences some sort of relief from releasing the muscles tension even if it doesn’t resolve their issues.
The four muscles of mastication are the Masseter, Temporalis, Lateral Pterygoid, and Medial Pterygoid. Each of these muscles can be affected with a TMJ dysfunction, and can cause extreme pain locally and referred to other areas of the head. Googling and searching Youtube for pain referral patterns and trigger points will provide many resources on the trigger points themselves and how to release the trigger points. The thing to keep in mind when working on trigger points is to keep consistent pressure on the trigger point. Do not rub the trigger points back and forth in a quick motion or apply pressure and then quickly releasing the pressure in an on and off or pulsing manner. This can stimulate the muscles spindles further, causing the muscles to tighten and spasm even more. Consistent pressure is key.
The Masseter and Temporalis can easily be worked from the outside of the head, while access to the Pterygoids is only from the inside of the mouth. It takes some work to find and to release, but can produce very powerful results. The Pterygoids can be in such spasm that light touch can produce immense pain sensations. When I first started working on my Pterygoids, putting pressure on them would be so painful that I would start tearing up uncontrollably. Nonetheless, working through the pain is sometimes necessary for improvement. However, it is important for you to use your own judgement. The pain experienced is usually a good kind of pain, where as you will know if the pain experienced is an indication to stop. With any of these exercises and releases, it is important to stop if things don’t feel right or things get worse.
Here is a good resource discussing the Lateral and Medial Pterygoids:
Trigger Points and Pain Referral Patterns
Tongue Thrust, Tongue Position, and Poor Swallowing Habits
Believe it or not, there is a proper posture for the tongue. There is a proper place for the tongue to rest, for the tongue to contact when swallowing, and even a proper place for the tongue to contact when speaking. When the tongue is not utilized in the way it was designed to, it can cause compensation by other muscles, put undue stress on the structure of the skull, and can even cause or contribute to TMJ dysfunction.
When the tongue is at rest, the natural position of the tongue is against the roof of the mouth. The tip of the tongue should be resting slightly above and behind the top teeth, at the point where your tongue would be when making a clucking sound. The rest of the tongue should rest on the roof of your mouth against the palate. Keeping the tongue in this position allows the face and jaw to rest in a comfortable neutral state free of tension.
For many people however (myself included) the rest position of the tongue is not touching the roof of the mouth. Instead, many people rest their tongues against their teeth, between their teeth, or just have their tongue resting on the bottom of their mouth. This automatically changes the tone of the tongue, which is a muscle, which can then change the tone of the structures of the face and head.
Many people with their tongues in an unnatural resting position also experience what is known as tongue thrust when speaking and swallowing. Tongue thrust is produced when a person pushes their tongue against the teeth when swallowing and speaking. Doing so puts immense strain and tension on the structures of the mouth as swallowing and speaking are not biologically designed to be carried out this way. This causes compensations by other muscles and over time, can cause pain and discomfort in other parts of the head.
Rather than pushing against the teeth, proper use of the tongue when swallowing is to anchor the tip of the tongue to the roof of the mouth where you would make a clucking sound, and using the rest of the tongue to push the food back into your throat so you can swallow.
When tongue thrust is present, the tongue will also push against or between the teeth when saying the letters t,d,z,l,or s, rather than touching the clucking point on the roof of the mouth.
If you find yourself with any of these habits when either swallowing or speaking, there is a good chance that you have a tongue thrust, and this can have a great effect on your TMJ dysfunction and symptoms. The key is to relearn to use your tongue and there are exercises that can be performed which will help you achieve this. If your issue is too difficult to correct on your own however, working with a therapist can help you relearn to use your tongue.
I first heard of tongue thrust, proper swallowing, and tongue position from “The TMJ Healing Plan” by Cynthia Peterson, PT. It introduced me to the concept of the tongue and TMJ connection leading me to do more research on the subject. I would recommend purchasing the book as it contains a lot of good basic TMJ self-care pointers which can help with TMJ symptoms.
Interestingly enough, keeping the tongue on the roof of the mouth is an integral part of many Yoga, Meditation, and Self Development practices. It is supposed to complete the body’s natural energy circuit allowing energy to flow freely. Whether structural, energetic, or a combination of both, using your tongue properly can lead to many benefits for you and your TMJ dysfunction.
Releasing the Surrounding Muscles
In addition to the muscles of mastication, other muscles within the head, neck, and shoulders become implicated with a TMJ Dysfunction. In some cases, these muscles have been recruited to compensate for a deficiency elsewhere, such as with poor swallowing habits or with structural imbalances because the muscles of mastication are in spasm and not functioning properly. This can cause other muscles to perform tasks such as swallowing which they are not meant to perform. Over time, these muscles become fatigued, go into spasm themselves, further complicating the situation.
When working on the surrounding muscles, the one thing to keep in mind is that they can either be the symptom or cause. If they are indeed compensating because of deficiencies in swallowing and/or weakness of the muscles of mastication, then releasing them should provide sustained relief over a period of time. However, if you find that issues with these muscles continue to arise, especially even when you have addressed swallowing and the muscles of mastication, then there is a good chance that there is a larger structural and postural issue going on. At this point, the TMJ dysfunction and deficiencies in the muscles of mastication can be a symptom of this larger structural problem rather than the cause. In other cases, both the TMJ and larger structural issue may just be present simultaneously and need to be addressed together. I will go into body structure and posture in part 2 of this TMJ series.
In either case however, working these muscles should provide significant relief to your TMJ dysfunction and symptoms. Just keep in mind of the possibility of a larger structural issue that needs to be addressed if working these muscles provides temporary relief which returns even after repeatedly working on them.
In addition to the muscles of mastication, other muscles in the face can form trigger points which then produce symptoms associated with TMJ dysfunction. These include the Buccinator and Digastric. Working with these muscles can relieve symptoms if these are your problem muscles.
The muscles of the head and neck can also become implicated with a TMJ issue. As mentioned, these muscles can be recruited and compensate for any dysfunction arising from TMJ issues. The most problematic of them all is probably the Sternocleidomastiod (SCM), which can produce many different pain and neurological symptoms. Issues with the SCM can cause headaches, dizziness, sinus issues, sore throats/throat tightness, tinnitus, visual disturbances, and many more. Working the SCM can produce dramatic results of any of the mentioned symptoms so it is a good place to start. The SCM branches into the Clavicular head and the Sternal head, so it is more like 2 muscles in one. There are many SCM trigger point release guides that you can find online. As a quick tip, the easiest way to locate your SCM is to push your hand against your forehead while pushing your head back against your hand. The muscle which protrudes along the side and front of your head is your SCM.
The second biggest problem muscle for most people is the trapezius muscle which is more of a shoulder and neck muscle. While relatively far away from the TMJ, the trapezius can refer pain directly into the head and face.
These two muscles are usually the most problematic, though any and all of the other neck and head muscles can potentially produce or contribute to symptoms. This includes the suboccipitals, splenius capitis, semispinalis capitis, levator scapulae, and more. In fact, as you work through one problem spot, you will usually uncover more and more problem spots. This is especially true as you get past the superficial muscles and into the deeper muscles. The one thing to remember is that if after working these muscles for a long time in additional to addressing the muscles of mastication and with proper tongue position and swallowing habits, your symptoms and TMJ dysfunction may be a result of a larger structural problem. I will go over this in the second part of this TMJ series.
In the meantime, using a Theracane which you can find on Amazon will help you reach those problem muscles that are hard to reach or difficult to work on by hand. I also highly recommend “The Trigger Point Therapy Workbook Self Treatment” which can be found on Amazon. Here are the links for both the Theracane and the book on Amazon.
Looking Towards the Future
Using the tips outlined in this post should dramatically improve TMJ dysfunction and if not, should provide temporary relief at the minimum. While these tips seem simple and almost trivial for a TMJ issue which seems larger than life, they are very effective and shouldn’t be taken lightly. At the very minimum, it will provide a good foundation for anything else that you try.
As I mentioned earlier, this is the first part in a multipart series on Everything I’ve Learned About TMJ Dysfunction, and I will post other parts on deeper treatments and therapies for dealing with TMJ dysfunction. The second part will be on Structure, Posture, and TMJ, so stay tuned. In the meantime, hope this helps!
I wish you the best!
