You’re going through a stressful time in your life. Whether it’s work, relationships, finances, your health, traffic, there is always something that can trigger your stress response and send you down the road of holding that stress somewhere in your body. For many, it’s the upper shoulders and neck. Others hold stress in their stomachs or restrict their breathing, whereas the jaw can also become the involved tension holder leading to TMJD, or temporomandibular joint dysfunction, a fancy way of saying the jaw muscles and joint architecture ain’t workin’ right!
The jaw is comprised of the mandible bone which articulates with the temporal bones via the temporomandibular joints anterior to the ear canals. “The mandible is the largest, strongest, and by far the most mobile bone in the cranium (1). Pound for pound, the masseter muscle is the strongest muscle in the human body (2)!
According to the National Institute of Dental and CranioFacial Research, the prevalence of temporomandibular joint and muscle disorder (TMJD) is between 5% and 12% with younger adults experiencing higher rates (3). I postulate that younger adults are not only sitting more in class with poor posture, are using mobile technology more often placing undue stress on their necks, and may “hold” fear against speaking up or expressing themselves in their jaws.
According to Hugh Milne, DO, there are several potential causes of TMJD:
Trauma to the Face and Mouth
Diet and Oral Health
Use of Seat Belts
Work Life and Habits
Constant-On Engram (tend toward always being busy possibly with the habitual use of caffeine, alcohol, and smoking).
Treatment protocols consist of decreasing myofascial tension in the head, neck, chest, shoulders, and spine followed by balancing the pelvis. Intra-oral massage can also be beneficial to help decrease tissue tone in the masseter and pterygoid muscles (5).
In addition to direct manual therapy, I have found CranioSacral Therapy effective for promoting myofascial balance but also for releasing deeply engrained stress holding patterns. An observed pattern over the last year working on patients receiving Naturopathic care for chronic illness such as Lyme Disease with several co-infections, has been the positive support CST and manual therapy has for assisting detoxification pathways. Dr. Klinghardt describes how swallowing while sleeping allows for adequate lymph drainage from the brain to the thoracic inlet (6). I have witnessed that patients who are suffering from bruxism (clenching or grinding of the teeth) are likely not gaining the benefit of swallowing while sleeping because there is observable fluid retention and swelling around the throat, cheeks, and eyes in some patients. Once the suboccipitals, jaw, and cranium balance there is a noticeable increase in swallowing during the session. This may be an area of further study for patients who are in ongoing treatment for chronic illness such as Lyme Disease. Massage and CST could be an adjunct treatment for assisting the detoxification process.
There are 3 main head and jaw muscles strongly associated with TMJD: the masseter, lateral pterygoid, and medial pterygoids. It’s also worth spending time with both the temporalis and SCM muscles as well. After seeing how the client responds to direct manual work to these structures, I instruct them how to self-release on their own using The Trigger Point Therapy Workbook techniques, by Clair Davies, NCTMB (5).
Tongue position is also important to practice for those who suffer from TMJD. By placing the tip of your tongue on the roof of your mouth directly where your two front teeth meet, one can feel and practice maintaining a relaxed jaw while also experiencing the energetic benefits of this position. Head, shoulders, and body posture are also vital to correct. For example, if someone tends to stand and sit with their pelvis predominantly anteriorly tilted, this creates an excessive lordotic curve, which can lead to a compensatory extended upper cervical spine. This pattern can occur due to many reasons such as anterior core weakness, a constant stress response, or a lack of body awareness in space. Once the cervical spine is hyper-extended, the suboccipitals become hypertonic and the jaw juts forward tightening the surrounding myofascia.
“The temporomandibular joints have been allocated a very large motor and somesthetic area in the cerebral cortex and have a considerable nerve supply, both afferent and efferent. 38% of the neurological input to the brain comes from the face, mouth, and temporomandibular region; 36 muscles above and below the mandible pivot the jaw, also moving it forward as the mouth opens. The total neurological input to the brain from sensory and proprioceptor nerves during mandibular motion acts as a dominant pattern setter for the motor cortex. That is, mandibular motion sets the pattern for at least 38% of the motor muscles in the body, particularly the neck, chest, and pelvic regions. Normalizing mandibular and TMJ function is a wise prerequisite to any attempt at normalizing the neuromuscular mechanisms of the rest of the body” (1).
According to Guzay’s Theorem, an often overlooked but integral source of mandibular motion is located in the upper neck. Guzay’s Theorem states that when the jaw opens the cervical spine becomes more lordotic lengthening in the front and contracting in the back. This axis or rotation shows us the intimate relationship the mandible, temporal bones, and cervical spine (specifically C1/C2) has with one another and informs our treatment approach (1).
“The temporomandibular joints normally float loosely within their capsules. With anxiety, the mandible is tightly compressed into the temporal fossae, eventually leading to deterioration of the joint, cervical arthritis, and muscle-contraction headache” (1).
When it comes to TMJD, treating locally and globally while listening both technically and intuitively offers treatment strategies at various levels. Deepening the individuals awareness of their stress holding patterns is a vital component to long-term relief.