Mastication! <… giggles ensue …> There I said it! We all do it. In fact if we don’t do it, our future may be a little … shall I say … flaccid?
Mastication … it’s the action of chewing. For some, this simple action of grinding our food, mixing with saliva and the first stage of consumption of much needed fuel – is painful, noisy and just plain uncomfortable.
I’m talking about Temporomandibular Joint Dysfunction – or TMJD. It might present as a stiffness in the jaw, pain on clenching, inability to open the mouth wide, clicking and popping when opening, an ache in the ear, jaw or teeth, stiffness in the neck …
So what exactly am I talking about here?
The TMJ is a complex but vital joint. Without it we cannot chew, verbally communicate, breathe deeply or yawn. It is the articulation of the very top of the jaw, just in front of the ear. I say complex because it is not a simple joint. It is what we call a gliding hinge joint. Did you think that when you open your mouth it simply hinges downwards? No. It’s a complicated action of first sliding forward and then hinging down, hinging back up and gliding back into the rest position.
Our jaws are insanely powerful too. The average person can generate 68kg of bite force, and the world record is over 400 kg of bite force! We’re talking about a tiny joint with comparatively small muscles, generating enormous forces in one of the most sensitive, calculated and harmonised parts of your body … your head.
We use our TMJs every single day. We use TMJ s much, and with so much pressure, that just like any part of the body, it can become sore and tired. But that’s not what I’m writing about here.
This small joint can develop dysfunction. Head trauma (say from a blow to the head), whiplash, dental work, intubation and opening beer bottles using teeth… there are a number of large mechanical forces that can disrupt the delicate movement of TMJ.
Dysfunction can also come from more subtle things too … like stress clenching which might be during the day and/or at night. Then there’s more complex conditions … like bruxism which is not just excessive clenching, but also teeth grinding, often at night when sleeping.
This special sliding joint can also develop more complicated conditions – for example, the small cartilage capsule that must glide with the action of the jaw can stick forward or behind the hinge, deviate from side to side or even wear out. OUCH! Often the clicking and popping sound we here with a person opening the mouth wide is this cartilage snapping from one position to another, instead of gliding smoothly.
While the TMJ itself can develop problems. The muscles that control TMJ movement can also become sore. Think about how your jaw muscles feel after a particularly chewy meal, or if you ever put anything too large in your mouth like a gobstopper.
The masseter which sits in the cheek is one of the culprits. Kilo for kilo this is one of the most powerful muscles of the human body. It relaxes to open the mouth wide, and then pulls the jaw shut. Temporalis which sits at the side of your head above the ear (temporalis) also helps to close the jaw. The digastric slings under the jaw and runs through a “pulley” bone – the hyoid – and performs complex movements. And then there are the pterygoid (winged) muscles – in particular the lateral pterygoid – the only muscle to start the opening movement of the jaw, helps in jutting your chin forward and also in moving your jaw from side to side.
Why talk about these muscles? They can all become tight, tired, tender and develop trigger points. The pain felt through these trigger pints can feel like burning, aching, stabbing, sharp and shooting pains that might be felt at the hinge of the jaw, in the ear, in the teeth, stiffness in the neck, ringing in the ears and dizziness.
WHO GETS TMJ PAIN
Other than TMJ pain from stress clenching and from head, neck and facial trauma, women are over represented in TMJ pain. There is a strange linkage between ovarian and uterine health and TMJ pain – particularly poly cystic ovaries, pelvic pain and heavy and painful periods.
With that – trauma to the pelvis can also result in jaw pain. That trauma might be from a crush injury, or it could be terrible human caused trauma such as sexual assault and rape. I am sorry that another human wounded you.
Apart from the connection between hormonal function, such trauma usually is followed by feelings of shame, denial, anger, submission, disempowerment and with that an inability or unwillingness to speak out.
AN EMOTIONAL CONNECTION
Think about how we talk about the jaw in relation to expression of feelings. “Shut your mouth”. “If you don’t have anything nice to say, don’t say it at all.” “Hold your tongue.” “Grin and bear it.” “Keep a stiff upper lip.”
Whether it be excessive stress from work place pressure, bullying, shame, victimisation – holding emotion in we know is not great for our health. Short term and long term. You can feel the tension rising in your jaw when all you want to do is speak your mind. Or perhaps you carry a sense of shame in your jaw – shame of not being able to stand up for yourself, excessive shyness or guilt from past choices, or shame from harm inflicted on you.
TREATING TMJ PAIN
Anyone who presents with TMJ pain in my clinic we refer to their dentist – particularly when the pain is from excessive clenching. It’s important that the teeth are protected as the teeth can start to break down under the constant biting and grinding pressure.
We also ask about reproductive health – there is such a strong link that we recommend a visit to the GP, naturopath, acupuncturist or chiropractor – so that correct treatment is administered – particularly to balance hormones.
We may also recommend that you see a counsellor to get proper help for past trauma, and to get strategies to deal with any work place issues.
Then there is massage.
MASSAGE AND THE TMJ
So why would you see a massage therapist if you have TMJ pain. Remember all those muscles I mentioned above? Muscles are what massage therapists work well with. Particularly therapists who have trained extensively in cranial anatomy and specifically jaw work.
When we treat TMJ, we treat the head, neck, shoulders, back and much more. Why? Well the jaw bones connected to the head bone, connected to the neck bone, connected to the shoulder bone …. Yes the anatomy of the song is not particularly brilliant. It’s important to realise that no muscle, works in isolation, and that the complexity of your make up is that a problem in one area may stem from another, and a problem in one area my act upon and cause problems in another.
What this means is that to ease pressure on your jaw we work s=extensively with the muscles of your neck – from the tiny fine movement muscles under the base of the skull to the big gross movers connecting to the shoulder, chest and upper back. We will work with the fine muscles around the skull, and the muscles of the face.
And with your permission, we are also trained to work with the tiny pterygoids, which we get to from inside the mouth. It’s the finger in the mouth technique – and usually these fine winged muscles are pretty tight and tender. But the relief they give … it’s wonderful.
WORKING INSIDE THE MOUTH
It probably sounds like something you probably would never think of having done!
Working inside the mouth is an intimate thing. You as the recipient need to have trust and relationship with your therapist. It’s a delicate area – and after all, we’re putting a (skilled) finger inside your mouth.
Intraoral (inside the mouth) treatment for TMJ can feel uncomfortable. The muscles are hardworking and are going to be tender on anyone, just for someone with TMJ pain, they are even tenderer.
The important thing for you is that working these small muscles should take time. We spend a good amount of time on all the other muscles preparing and softening, so that when it is time to work in the mouth you are already prepared to receive the work. Then we slide the small finger across the biting surface of the bottom molars, slipping outwards and following the angle of the jaw upwards towards the ear. And there we stay for several minutes. Waiting for this powerful muscle to soften.
HOW SHOULD I FEEL AFTER?
Relief should be the first word that springs to mind. More open, freer, more comfortable. Sometimes other symptoms such as headaches, ringing in the ears and dizziness also move on.
HOW OFTEN SHOULD I GET TREATMENT?
It depends. First up getting correct treatment from the right professionals is the first step to long term management.
We’ll usually recommend a course of treatments – perhaps 2 in the first week, another the following week, and then reassess. We don’t like to work the fine muscles of the jaw every treatment – it’s just too much.