The chewing action of jaw is often taken for granted, but this highly specialised joint is something that can have far reaching implications to sufferers. TMD (Temporomandibular Joint Disorders) or TMJ (Temporomandibular Joint) issues are often cited by medical professionals as a cause of all manner of symptoms and ailments. Like 'sciatica' many 'Dr Googles' lead people to believe that they have this condition that becomes a generic term describing any pain that may sometimes be inexplicable or undefinable.
The reason for this bibilical adherence to the term is that TMJ syndrome can have very wide reaching implications for other symptoms and pain patterns that range from headaches, teeth grinding, cranial, shoulder and ear pain. Misalignment of the TMJ can have far reaching effects on motor skills, balance and use of the arm and hands. Pain can often be debilitating for some people and even sensitivity to light can be attributed to issues here.
The TMJ is complex in that it can move in many planes of movement. It is unusually mobile and even stretches (a joint that stretches?) according to the position of the mouth. Hence the capacity for misalignment and consequential tension to occur here is great. LIke the knee, the temporal bone and the mandible are connected via a disc that cushions the articulation and it is often the misalignment of this disc that illicits pain and issues.
The main indicator for issues with this joint for a bodyworker is the Lateral Pterygoid muscle that lies just anteriorly (forwards) to the ear canal quite high on the jaw line. This muscle is important as it not only is active in mastication (chewing) but also depresses the jaw (opens the mouth) as well as connecting directly to the disc of the TMJ. It never fully 'relaxes' and isn't controlled by nervous ennervation, instead it is constantly held in tension like a spring to effect movement of the jaw. Hence this muscle is very prone to trigger points and adhesions that can cause TMJ pain. Constant tension in this muscle often acts on the internal disc that supports the TMJ and can result in a referred pain that can even lead to on onset of other conditions such as arthritis.
Many cases of TMJ pain are caused by direct trauma, either a blow or impact to the face such as in head clash, or sometimes to trauma in the spine, that can set off misalignment in the body and culminate in the pliable TMJ at the 'edge of the pond' as it were. As this joint is so flexible it stands to reason that misalignment here can be a common occurence and is directly related to trauma. Likewise, it is also logical to associate emotional distress in this joint. Stressful lifestyles and constant stress can directly lead to jaw and teeth clenching which directly effects this subtle and flexibile joint.
Clicking or popping in the jaw on movement is an oft cited issue, which usually directly relates to the misalignment of the joint and the disc that exists in the TMJ. A limited range of motion in the jaw can be detected with a simple test of inserting two fingers into the mouth. Usual range of motion being able to insert two fingers laterally into mouth cavity. Tension in the jaw muscles here could indicate some specific massage to relieve locking or shortened muscles of mastication. A secondary symptom can occur in the ear, with pain being illicited via the eustachian tubes which can have a direct correlation to the TMJ. Stiffness in the ear and loss of hearing can be a direct result of TMJ issues.
Headaches are also indicated with TMJ alignment. Over 2000lb per square inch of pressure occurs on the 2nd molar when the teeth are clenched. If this is maintained over a period (such as sleeping) the cranial bones are brought under stress as well as trigger points being evident in the jaw muscles that directly respond to cranial referral zones via the facial nerve (more specifically the posterior auricular nerve that controls scalp muscles).
The implications that TMJ tension has on cervical alignment is also evident. Where pain and tension transfers into the muscular tone of the neck and shoulder muscles (namely upper traps, sternocleidomastoid, scalenes etc). This can often be a 'magic key' for those who suffer from chronic neck tension and misaligment in the cervical vertebrae that isn't responding to regular treatment massage/manipulation. Without addressing the tension of the TMJ, these symptoms will continue to cause issues and remain not fully resolved. In this case, this is where constant treatment that isn't having the right effects and results indicates there is something else at play? A good therapist investigates all the options possible, even if they appear not to be initally presenting.
There are other pain conditions that can mimic TMD (which is the direct involvement of bony or cartilagenous deformation inside the joint capsule) or can be precursors to the condition. Myofascial Pain Syndrome, which develops with constant indication of tension or pain and where nerves become irritated due to stress/tension is the primary condition to discern against. This is where Trigger Point Therapy can be most useful in detecting and also treating the condition and getting results where chronic patterns are forming.
Other conditions to bear in mind with TMJ are the misdiagnosis of different nerve impingements. These can include Ernest Syndrome (relating to the stylomnadibular joint), trigeminal/occipital neuralgia (damage to specific related nerves) and osteomylitis (tissue death at site of extracted tooth after dental surgery) An MRI is usually the best way to effectively diagnose 1