7 Temporomandibular Joint (TMJ) Questions (and how modern physical therapy treats it)

Written by: James Gill BOst GOsC 6039. Registered Osteopath, Founder & Clinic Director

Medically Reviewed: Yannick Gracia, M.Ost GOsC 10475. Registered Lead Osteopath

What is the TMJ?

The TMJ, short for temporomandibular joint, refers to the joints inside your mouth that connect your jawbone to your skull. You have two of these joints, located on each side of your head. Both joints work together, along with a complex system of ligaments, muscles, nerves, discs and bones to create different movements allowing you to chew food and speak!

When damage or injury occurs to any part of the complex TMJ system then this can create localised pain around the mouth, head or neck. This is known as temporomandibular joint syndrome or temporomandibular disorder (TMD).

“If you are struggling with jaw clicking, tightness, or tension headaches, our multidisciplinary team can help. Book an appointment today or learn more about our specialised TMJ & Jaw Pain Treatment in London.”

What are the symptoms of TMD?

Common symptoms of TMD include:

What are the common causes of TMD?

There are many causes of TMD ranging from the anatomical to the traumatic and even the psychological. However in some cases symptoms can appear with no obvious reason. The list below explains a few common causes for TMD.

Anatomical: The temporomandibular joint is made up of a hinge joint which allows for the opening and closing action of the mouth. Between the hinge joint is a shock absorbing disc which allows for the smooth movement of the jaw. In some cases the disc can be affected be it due to the misalignment of the disc, upper cervical spinal tension (C1-C3), or the presence of osteoarthritis in the TMJ. (If you are unfamiliar with these clinical terms, you can look them up in our comprehensive MSK musculoskeletal glossary).
Traumatic: Any trauma or injury to the jaw, TMJ, neck or muscles of the head and neck such as from a car accident can cause TMD. This can impact the normal alignment of the TMJ, in turn causing dysfunctional movement of the jaw.
Psychological: Bruxism is the term used to describe excessive teeth grinding or clenching. This can happen both during the day and at night and subsequently increases the tension in the muscles surrounding the TMJ. The cause of excessive teeth grinding has been linked to increased levels of stress and anxiety. In high-pressure London environments (like Canary Wharf or the City), postural strain from long desk hours significantly exacerbates this nocturnal tension.

How is TMD diagnosed?

During your consultation your osteopath, chiropractor or physiotherapist will take a precise case history of your symptoms and carry out a thorough physical examination. This will aid in diagnosing and understanding the cause of your TMJ pain.

During the case history the practitioner may ask you questions such as;

During the physical assessment the practitioner may carry out a series of tests including a full postural and upper cervical spine assessment. They will also have a feel of the jaw for any areas of tenderness and observe the range of motion as you open and close your mouth.

In some cases and depending on the severity of the symptoms, imaging such as X-rays or MRIs might be needed to understand the exact cause of the TMJ pain.

What are the treatment options for TMD?

There are many treatment options for TMD. The type of treatment depends on the severity and cause of the symptoms. While many patients try dental splints or muscle-relaxing injections, a physical hands-on approach treats the structural and muscular root causes directly.

Conservative treatment includes:

Osteopathy, Chiropractic and Physiotherapy: Visiting a physical therapist such as an osteopath, chiropractor or physiotherapist can help with relieving your discomfort and pain associated with TMD. At Bodytonic Clinic, our integrated care combines spinal adjustments, cranial work, and intraoral (buccal) muscle releases. The treatment includes a range of different hands on techniques that aim to:

Improve blood flow and circulation to the TMJ, which helps improve the body’s natural healing response.
Release and stretch tight muscles (including masseter and pterygoid trigger points) to allow for improved movement and function.
Release endorphins. These are hormones that circulate the body and act as natural pain relief.
Reduce tension in the neck and shoulder area using soft tissue massage and gentle articulations of the neck and upper back. Your physical therapist may also give postural advice and may prescribe a few exercises to help increase the strength and flexibility of your neck, shoulders and TMJ.

Your osteopath or chiropractor will also advise you about pain management techniques, including the use of hot and cold therapy. Using a heat pack on the muscles around your neck, shoulders and jaw is a great way to help relax the muscles.

Focused Shockwave Therapy (FSWT): Focused Shockwave Therapy (FSWT) provides the ideal blend of precision and gentleness. For patients suffering from Temporomandibular Disorders (TMD), FSWT’s unique converging wave allows practitioners to target the joint capsule, the joint disc, and deep-seated trigger points in the surrounding muscles (masseter and temporalis) without causing unnecessary superficial discomfort. FSWT promotes anti-inflammatory processes and tissue regeneration, providing significant pain reduction and improving the maximum range of pain-free mouth opening without requiring invasive procedures.

Medication: if you decide to visit your GP, depending on the severity of your pain your GP may prescribe you with some oral medications to help relieve your symptoms:

Lifestyle alterations: reduce stress, eat soft foods, keep hydrated, get enough sleep and participate in regular physical activity.
Acupuncture: is classed as an alternative therapy and may reduce stress and tension in the body. Fine needles are placed in certain areas of the body, including the neck, shoulders, face and jaw.
Counseling: Counseling is one method that can be used to understand your triggers and behaviors that aggravate your pain. Once you know what they are you will be able to avoid them. Triggers can include teeth grinding, clenching or nail biting.
Stress and anxiety is one trigger for teeth clenching. Meditation or taking time out of your day to concentrate on deep breathing are great ways to help reduce stress.
Mouth Guard Mouth Guard & Dental Consultation: While a custom dental mouthguard from your dentist protects enamel against grinding wear, combining it with physical therapy ensures the underlying cervical posture and muscle tension are also addressed.
Visit your dentist: your dentist may be able to ascertain whether corrective dental treatment is required. This may include procedures to improve your bite and align your teeth.

Surgical treatments include:

When conservative treatments haven’t worked your dentist or doctor may suggest surgery to help with your pain. (Note: Over 90% of TMJ cases resolve with conservative physical care prior to considering surgery). Below are a few surgical options for TMD:

Arthrocentesis: this is the least invasive type of surgery for the TMJ. It involves insertion of a small needle into the joint. Once the needle is inserted fluid is passed through the joint to help remove any debris or inflammatory waste products. The fluid also lubricates and reduces friction of the joint.
Arthroscopy: This procedure is a little more invasive than arthrocentesis. An arthroscope is a tiny camera that is inserted into the joint through a cannula. This allows the surgeon to have a look at the integrity of the joint. The surgeon can then pass small surgical tools down the cannula to remove scar tissue, smooth the bone or reposition the disc if needed.
Open joint surgery: This procedure is very invasive and is usually only performed if all other treatment options have not been successful. An incision is made over the joint so that the surgeon can:

How long does TMD last?

The prognosis for TMD is dependent on the cause. For some patients symptoms may occur for a few days to a few weeks, this is known as acute TMJ. For others it may be a more long term pain with episodes or sharp pain that may occur for a few months to years. With targeted Osteopathy, Chiropractic care, Physiotherapy, and Focused Shockwave Therapy, recovery times can be significantly accelerated.

Suffering with TMJ pain? Book in for a consultation with one of our osteopaths, chiropractors, or physiotherapists at our Canada Water (SE16) or Stratford (E15) clinics to see how we can help.

What are the best self massage techniques for TMD?

Masseter self release: place each hand on the side of your face making sure your fingertips are at the level of the joint in your jaw. Gently sink your fingers into your cheeks. You might feel slight tightness or tenderness in your jaw or cheeks. Slowly pull your fingers down the side of your face, this will help stretch the masseter muscle.

Pterygoid release: insert your index finger into the upper cheek. Place the tip of your finger where the upper and lower jaw meet. With a light pressure, press your finger against any tightness or tenderness in the cheek. Hold for 30 seconds and repeat 5 times.