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 most of us, it’s the upper shoulders and neck. Others hold stress in their stomachs or restrict their breathing. If you’re anything like me, your jaw often becomes the involved victim of stress and tension leading to TMJD.
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).
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 (2). 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.
“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).
Most know and feel that motion from our jaw comes from our Temporomandibular joints slightly in front of the ear. However, according to Guzay’s Theorem, the true source of mandibular motion is located in the upper neck. Guzay’s Theorem postulates 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 (3).
“The temporomandibular joints normally float loosely within their capsules. In anxiety, the mandible is tightly compressed into the temporal fossae, eventually leading to deterioration of the joint, cervical arthritis, and muscle-contraction headache” (1).
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, smoking, or drugs).
When treating TMJD holistically, aiming to decrease pain levels quickly, my first go-to is treating the whole person. I enjoy listening to their whole story, their current life stressors, stress-management techniques, and what their history has involved in regards to any of the listed topics above. I’ve seen quick and lasting results first and consistently listening to the client, addressing their stress level by dialing down their sympathetic nervous system and treating the local jaw muscle and fascia. I then proceed to observe and work with the entire system to offer relaxation, myofascial balance, and enhanced awareness. I’ve had good success combining myofascial work with Tuina and CranioSacral therapies.
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 (4).
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 and instruct. 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.
When it comes to TMJD, treating locally and globally while listening both technically and intuitively offers healing at multiple levels.