Among the most complex joints in the body are the two connecting your lower jaw to your skull. They slide and rotate in front of the ear, allowing the lower jaw, or mandible, to move up and down, side to side, and forward and back. Properly aligned, all this occurs without a hitch. When they’re out of alignment, watch out; you may be in for trouble, spelled TMD. The most common form of myofascial TMD is myofascial pain–discomfort in the muscles, and connective tissue covering the muscles, that control the jaw, neck, and shoulder. Another kind of TMD is internal joint derangement, which means a dislocated jaw, displaced disc–the cushion of cartilage between the jaw bone and skull–or injury to the jaw. And the third kind of TMD is degenerative joint disease, including osteoarthritis or rheumatoid arthritis in the jaw joint.
In physical therapy, our goals are to decrease pain, improve range of motion, strength, and function. Since the jaw and neck have a close relationship, we will perform an evaluation of the neck and jaw to determine which areas may be contributing to that individual’s symptoms.
If a patient has pain that is preventing them from participating in a more active program, we can use modalities such as heat, ultrasound or laser to help reduce their symptoms. If a patient has had pain for a long time, or chronic pain, the patient may also be experiencing central sensitization which is a condition of the nervous system contributing to their pain response. We can provide basic education about pain and the anatomy of the temporomandibular joint to help the patient understand what is going on.
In physical therapy, we often utilize manual therapy techniques. Some patients benefit from massage techniques to the over used muscles of mastication or joint mobilization techniques to their jaw or neck to improve mobility and reduce pain.
I provide instruction on an exercise program that is specific to the individual’s needs. Often, patients will benefit from jaw relaxation or breathing exercises, exercises to improve jaw range of motion and coordination, or activities that will improve posture or core strength.
Since temporomandibular disorders can be a complex condition, best results can be obtained by working with a multi-disciplinary team. Physical therapy can be a great conservative treatment approach for appropriate individuals. It is very rewarding as a physical therapist, to make improvements in the quality of life or your patient, especially if they have had their symptoms for years or even decades.
