Gabrielle Milot-Lavergne | Sun City Physiotherapy

What is a TMD and what are the symptoms?

What is a TMD?

The temporomandibular joint (TMJ) is the name of the joint located on either side of your head, just in front of your ears. These joints connect your mandible (jawbone) to your temporal bone (skull). The TMJ, which can rotate and move forward, backward and side to side, is considered by the Canadian Dental Association to be one of the most complex joints in the body.

The TMJ allows us to chew, speak, swallow and yawn. When you have a problem with one of the structures in the TMJ complex (muscle, bone, ligament or disc) you have a temporomandibular disorder (TMD).

What are Common Causes?

Studies suggest most TMJ problems are due to dysfunction of the masticatory muscles related with parafunction and/or emotional stress.

However, many factors can influence the TMJ function and lead to a TMD, such as:

Dental and orthodontic work
Inadequate occlusion
Cranial default
Psychological stress
Trauma
Postural stress
Systemic disease e.g. arthritis
Congenital defect

Considering this list, we can say that 80% of the time the TMD is caused by one or many of the above factors.

What are the symptoms when you suffer from a TMD?

The symptoms we hear the most amongst patients are the clicking or grinding of the jaw. Other common symptoms include pain in the ear, cheek, teeth and temples. Symptoms can also include stiffness of the neck, pressure behind the eyes or difficulty swallowing. In some cases people won’t consult until they experience pain, but all symptoms should be mentioned to your health professional.

If we take ear pain as an example, studies have shown that when an ear infection is ruled out, one third of patients had a TMJ disorder, one third of patients were suffering from a cervical spine disorder (CSD), and the final third of patients experienced pain from both areas. The same can be said for forehead pain. When the sinuses are ruled out as being the cause, the pain will come from the neck musculatures.

When someone is experiencing pain with their teeth, it is better to see the dentist first to ensure there is nothing wrong with a tooth or a nerve. A panoramic radiograph will be made in some cases, or medication will be prescribed by your doctor, but remember that teeth pain is also a symptom of TMD.

TMD diagnoses we find in Physiotherapy are hypomobility and hypermobility of the TMJ, anterior disc displacement with and without reduction, musculature syndrome, osteoarthritis, and post injection syndrome.

There is also an important relationship between TMJ function and posture. Studies point to the influence of an anterior head position as an important factor on the masticatory function. There is evidence to prove that changes in body posture influence the muscle tension on the TMJ. Furthermore, studies are discussing the relationship between the dental occlusion and the posture. Nowadays, the influence of the teeth in the orofacial balance and masticatory muscle is recognized.

Conclusion

To conclude, this is why an assessment and treatment of the TMJ includes neck function and posture as well as cranial mobility. It is a joint like any other in the body with a complexity added by the disc in the TMJ. Statistics say that 70% of people will have a TMD, but will not consult a professional until they experience pain.

TMD is manageable in Physiotherapy with manual therapy, electrotherapy, and specific exercises for this joint.

Gabrielle Milot-Lavergne

Gabrielle Milot-Lavergne M. Sc. PT, Vestibular Rehab, TMJ Rehab, Sports First Responder

Gabrielle graduated with a Bachelor’s and Master’s degree in physiotherapy from Université Laval in Quebec City. She started her career working in her father’s clinic, himself a Sports Physiotherapist, where she worked for four years treating a wide range of clientele, following multiple sports teams and covering many different sporting events.

She has a strong interest in head and neck dysfunctions and is qualified in treating vestibular and temporo-mandibular dysfunctions. Her course in Cranial Manual Therapy makes her specialized in treating concussions, headaches, dizziness, head and neck pain.

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Cervicogenic Dizziness

Dizziness is not necessarily vertigo!

Have you ever experienced dizziness and the Doctor tells you it is vertigo? Yet you are not responding to the vertigo treatment? There is a chance that the symptoms are not from a classic BPPV (benign positional paroxysmal vertigo) because there are many other reasons why you could feel dizzy.

There are other vestibular sources that can provide dizziness and to understand where it is from, you need to know more about the vestibular system.

Anatomy

In your body there are 3 systems to keep you in balance:

Eyes/vision
Vestibular system
Proprioceptive system

These 3 systems work together, so if one of them is lacking you might suffer from dizziness as a symptom. For example, if you have glasses and a stiff neck because of anxiety, your vestibular system has to work harder to compensate for the two others. If the 3 systems are not coordinated it might result in vestibular problem.

Cervicogenic dizziness is a diagnosis of exclusion. This means that when the medical and vestibular problems are ruled out you can consider this diagnosis.

The main characteristics of this problem are feeling imbalance and having neck dysfunction or pain.

Symptoms

Many people are surprised to know that their symptoms could come from their neck. Cervicogenic dizziness can provide symptoms such as faintness, disorientation, imbalance and perception of spinning (inside vertigo). Along with those symptoms you will have a lack of cervical spine range of motion (ROM) and probably pain. The dizziness can last from minutes to hours, compared to BPPV (seconds).

Causes

Studies put forward explanations to those symptoms and the first possible cause they agree on for cervicogenic dizziness would be a physical injury and/or psychological issues. For example, a physical injury could be falling, a whiplash or a head concussion. The psychological issues could be depression/anxiety, employment difficulties, fear of space etc. It is good to mention that you can find in some people cervicogenic dizziness combined with any other vestibular problem. For instance, people with BPPV could still feel dizzy even after getting rid of their vertigo.

To conclude, cervicogenic dizziness is all about the input (information) brought to the vestibular nuclei. With 6x more receptors in the neck versus the rest of the body, the information from the cervical spine to the head (here vestibular system and vision) is really important to feel balanced.

Now, how can we treat cervicogenic dizziness?

Some studies say that manual therapy has good result with this kind of problem. Usually when the neck ROM is restored and pain has gone, the dizziness symptoms will go away too. That combined with vestibular exercises can provide the patient with long term improvement. It is important to have a good assessment of the problem in physiotherapy to make sure the right diagnosis is identified. Some physical therapists are qualified in differentiating between the many vestibular problems. A neck assessment should be done in addition of the temporomandibular joint and cranial area if necessary.

Sources:

Yaseen, K. and al., The Journal of Physical Therapy Science, Vol. 30, No. 1, 2018
Reiley, A. and al., Archives of Physiotherapy (2017) 7:12
Wrisley, D. and al., Journal of Orthopaedic and Sports Physical Therapy, Vol. 30, No. 12, December 2000

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