A recipe for jaw pain by Nick Black, Physiotherapist

The fact of the matter is jaw pain can be down right miserable. Talking and eating are two of our most important functions in daily life and the jaw plays a large role in both. If wrapping your teeth around a big juicy Okanagan apple has lost its sweet satisfying crunch and been replaced by pain, then seek some help.
Many structures in and around the jaw can contribute to pain. The teeth and their attachment to the jaw and skull are obvious contributors that your dentist is well equipped in managing. Infection or dysfunction within the ears, sinuses, salivary glands or lymph nodes are problems best addressed by your family doctor. However, other structures such as the jaw joint (temporomandibular joint) and associated ligaments and tendons are common contributors to jaw pain that are often left untreated. Dysfunction in the neck can also refer pain and/or dysfunction to the jaw. Another, often overlooked contributor to jaw pain, is the effects of our mental health. It is well documented that stress, anxiety, exhaustion or depression will not only effect our head and neck postures but also how the nervous system reacts to messages sent from dysfunctional tissues, such as those in and around the jaw. A sensitized nervous system can increase one’s experience of pain.
Pain is complex but treatment doesn’t have to be. An assessment by your family doctor, dentist or physiotherapist with special interest in temporomandibular dysfunction will ensure you are referred to the correct health professional for managing your problem. If the problem relates to dysfunction of the jaw joint, the first step is to address any habits outside of normal jaw function, such as teeth grinding, pen chewing or jaw clenching. A restriction in joint mobility is common, affecting your mouths ability to fully open, in which case, the sleeve (capsule) of the joint is susceptible to strain and inflammation. Clicks and pops are very common but are rarely related to the cause of your pain.
Try this – gently place your finger tips about 3cm above your temples, then clench your teeth on and off. You will feel the temporalis muscle tightening under your fingers. Now gently place your fingers 5cm directly below your temples on the sides of your jaw and clench your teeth. You will feel the masseter muscles tightening. You have just located two of the most important muscles for eating. Both the temporalis and masseter muscles and their tendons are common contributors to jaw pain that respond well to hands-on soft tissue treatment techniques. In addition, many people can relate to how these muscles might be clenched a bit tighter in times of stress and anxiety, thereby contributing to the muscles overload.
The important message is that many structures, behaviours and feelings contribute to the experience of jaw pain and effective management is best achieved through identifying all factors involved.
Nick Black is a registered Physiotherapist with an interest in temporomandibular dysfunction at Sun City Physiotherapy Winfield. He can be contacted at the new Winfield location by phone: 250-766-2544 or email:winfield@suncityphysiotherapy.com

TMJ Dysfunction Series II by Vince Cunanan, Physiotherapist

Argh! You woke up with another headache, and your teeth hurt from clenching yesterday at work, as you just met another stressful deadline. As you massage your temples and face, which actually feels relieving, your significant other tells you about your loud teeth grinding last night. As you look in the mirror while brushing your teeth, you are always intrigued by how your jaw “wiggles” side to side when you open your mouth. It’s done that for years but hasn’t created any other problems to your jaw function. Sound familiar? You are presenting with Myofascial Pain Dysfunction (MPD) of the Temporomandibular Joint, the TMJ.

The TMJ is the ball and socket joint that connects the Mandible (jaw bone) and the Temporal bone (one of the bones of your skull). It’s the small joint located in front of your ear. There is a cartilage cushion in between the ball and socket, referred to as the Disc. The disc is supported by special Ligaments, which keep the disc in place. Movement problems of the disc can be responsible for creating many symptoms in the TMJ, such as clicking, crepitations, locking, muscle spasm, and pain. There are several muscles which support and control movements of the TMJ. Symptoms can often be related to these muscles. These include temporal pain, headaches, muscle spams, tinnitus and ear pain, and even teeth pain.

TMJ Disorder/Dysfunction, or TMJD/TMD, is seen more commonly in women than men. There is a 3:1 incidence in females to males, and can include one or both jaw joints. In most instances, the dysfunction is a result of an imbalance or change in the normal function of the bones, ligaments, muscles, disc, or nerve components of the TMJ complex.

MPD can be due to various causes of increased muscle tension and spasm. In some instances, MPD can be a physical manifestation of psychological stress. Often, there is no disorder of the joint itself. There is often a history of facial pain and temporal headaches, secondary to Nocturnal (night time) jaw clenching and Bruxism (teeth grinding). Dental issues may have influenced symptoms over time. This might have lead to the use of a nighttime splint. There may also be ear pain, fullness, or tinnitus. Erratic movement patterns of the jaw during opening and closing are related to lack of neuromuscular control, which requires re-education through physical therapy.

The TMJ specific muscles involved in MPD are the Temporalis and Masseter. The temporalis is a fan-shaped muscle that fills the temporal space, and inserts onto the mandible. Its function is to raise the mandible to close your jaw. The masseter is a thick and strong muscle attached at your cheekbone and runs to the angle of the mandible. Its function is to also raise the mandible to close your jaw. Try this: clench your teeth several times and press your fingers firmly on your temples; now on your cheeks. Did you feel tenderness? Aching? Maybe even a sensation like a toothache? WHAT IS THE SIGNIFICANCE? These muscles become subjected to fatigue and overuse with prolonged and persistent clenching and bruxism, which leads to MPD symptoms. It’s like these muscles are running a marathon without rest, everyday!

Proper assessment, diagnosis, and successful treatment rely on a skilled physical therapy practitioner, with expertise in TMJ management. Treatment of MPD is focused on desensitizing muscles through hands-on mobilization, restoration of normal functional movement pattern through exercise, and providing education regarding prognosis and self applied maintenance. Treatment may also include other muscle re-education techniques such as Intramuscular Stimulation (IMS). We look at other mechanical influences such as neck disorder and posture, to assist in maximizing treatment management. At times, we often work with your oral practitioner (dentist, orthodontist, oral surgeon), and other practitioners who deal with behavioural modification, to optimize results.

Vince Cunanan is a TMJ Specialist and registered physiotherapist and associate at Sun City Physiotherapy Downtown Kelowna. He can be contacted at downtown@suncityphysiotherapy.com.

TMJ Dysfunction Series Part I by Vince Cunanan

Did you wake up this morning with acute facial pain and inability to open your mouth? When you think to yesterday, you remember taking a big bite from an apple and experienced a sharp pain in your jaw joint. Today, you can’t really open or fully close your mouth. That unexplained clicking in your jaw that you’ve had for two years has suddenly gone away. Now, there’s just facial tenderness in front of your ear and you’re worried that you can’t eat! If you experience this, you likely have a “locked jaw”, or Acute Disc Displacement. This is one of the common disorders of the Temporomandibular Joint, more known as the TMJ.

The TMJ is the ball and socket joint that connects the Mandible (jaw bone) and the Temporal bone (one of the bones of your skull). It’s the small joint located in front of your ear. There is a cartilage cushion in between the ball and socket, referred to as the Disc. The disc is supported by special Ligaments, which keep the disc in place. Movement problems of the disc can be responsible for creating many symptoms in the TMJ, such as clicking, crepitations, locking, muscle spasm, and pain.

TMJ Disorder/Dysfunction, or TMJD/TMD, is seen more commonly in women than men. There is a 3:1 incidence in females to males, and can include one or both jaw joints. In most instances, the dysfunction is a result of an imbalance or change in the normal function of the bones, ligaments, muscles, disc, or nerve components of the TMJ complex.

Disc Displacement is a mechanical problem that occurs when the disc ends up in the wrong position within the ball and socket. In this case, it is likely that the disc has become displaced due to the wide opening, creating increased stress and strain on the ligaments, resulting in pain around the joint and spasm in the facial muscles. There is also a longstanding history of unexplained clicking in the joint, which may be a pre-disposing factor to this problem. In essence, the disc needs to be properly re-educated to find its’ normal resting position again, and the mechanics restored to the muscles and joint. Specialized physical therapy care would assist in restoration of disc position, to restore movement and function, as well as normalize the pain.

Dysfunction in these tiny joints can have many causes. These can include trauma such as blow to the head, whiplash, falls, sports injuries, arthritis, dental occlusion, dentures, history of joint noises, stress (clenching, grinding), poor habits (posture, physical, oral), and many others. Signs and symptoms may include facial pain, headache, neck pain, ear pain, sudden changes in bite, tooth pain, ringing in the ears, shoulder pain, and facial tingling or numbness.

A physical therapist can help you understand and manage your TMJ dysfunction. Often it is obvious that the TMJ is the cause of symptoms you experience. However, for many people, the symptoms they experience can be widespread, and may not make it so obvious. As mechanics for the human body, physical therapists can properly assess, diagnose, and treat the TMJ and most of the possible influences. We provide a specialized hands-on approach to treatment, education, and exercise program. Treatment may also include other muscle re-education techniques such as Intramuscular Stimulation (IMS). In many instances, we often work with your oral practitioner (dentist, orthodontist, oral surgeon) to ensure the best outcome possible for your TMJ. Treatment can be very effective in a short period of time. A self-applied approach with a little guidance from specialized physical therapy practitioners will help with long-term benefits.

Acute Disc Displacement is only one of several diagnoses of TMJ dysfunction. Keep connected to read about other problems that these tiny joints can give you. Don’t stop eating apples though…

Vince Cunanan is a registered physiotherapist and associate at Sun City Physiotherapy’s Downtown Kelowna and Glenmore clinics. He can be contacted at info@suncityphysiotherapy.com