Physical Therapy for TMJ related pain

If you have clicked on this blog you are probably looking to better understand treatment options for pain that you or someone close to you associates with their TMJ. TMJ (Temporomandibular Joint), or jaw, pain or loss of function is referred to as “TMD” (Temporomandibular Disorder or Dysfunction). TMD can come from many structures within or around the TMJ, including muscle tissue, ligaments, the cartilaginous disc that helps cushion the joint, connective tissue, boney tissue, or even pain referred from the neck. Anyone who has suffered for any length of time from pain in this area knows that it can have a considerable impact on their daily life. Most often TMD is something that can be conservatively managed by an oral appliance made by a dentist and/or by seeing a physical therapist with a speciality in head and neck disorders. If conservative care fails there are surgical options. In my experience 80-90% of people who suffer from TMD do very well with conservative care only.

I have specialized since 2006 in cervical and cranial dysfunctions. Earning my CCTT (certified cervical and temporomandibular therapist) in 2006 through the PTBCTT (Physical Therapy Board of Craniofacial and Cervical Therapeutics). Over the years I have treated many people with TMD getting the majority of them back to optimal function, with minimal or no pain. Most people are still surprised to learn that physical therapy is an option. At KNÓSIS we luckily work with excellent dentists and doctors who value the contribution physical therapy offers their patients and bring us in on many of their cases.

What Does Physical Therapy Treatment for TMD Look Like?

Initial Consultation

Your first session will be an initial evaluation where we discuss your symptoms and the history of your chief complaint then do a physical examination of your jaw, head and neck. Your story is very important and often listening closely to you will give us clues as to what structures we need to focus on in our physical exam. During the physical exam we look at your jaw and neck mobility, the quality of your movement, the strength of the muscles that control the movement, at what point of the movement your pain comes on, depending on your story we may be looking at other things as well. By the end of the initial session we will start to come up with an individualized treatment plan or at least an initial plan of action. It may take a few sessions together to tease out what the best treatment will be depending on how complicated your case is.

Follow Up Sessions

Subsequent sessions (anywhere from 6-20 sessions, it’s case to case dependent) will be a combination of manual therapy (soft tissue massage, joint mobilizations, nerve mobilization around the head, neck and perhaps even the thorax if we deem that an important component of your symptoms), exercises (stretching and strengthening exercises for the jaw and neck, postural exercises to improve alignment and reduce strain), modalities (ice, heat, ultrasound are the most common), education and self care (we will teach you techniques tomanage stress and reduce muscle tension, instructions on proper jaw alignment and posture, guidance on avoiding habits that exacerbate symptoms).

What are the Benefits of Physical Therapy for Sufferers of TMD?

Pain Reduction

Since pain is most often the main complaint and what drives someone to seek help at the initial evaluation we will try to hone in on what structure(s) is/are causing the pain (muscles, ligaments, intra articular disc, pain referred from the neck, if the pain has become centralized etc). If you have pain because your disc is displaced but the physical therapist is just massaging your jaw muscles without addressing the disc you will probably not feel much better. If problems with your neck posture are the primary driver of your pain then a treatment that focuses on the TMJ disc without addressing your neck will likely give you no relief at all. If your masticatory muscles (masseter, temporalis) are determined to be the source of pain but they are tight because they are trying to stabilize an underlying hyper-mobile joint then PT will need to include manually releasing your muscles AND teaching you how to improve control in the joint. Just releasing the muscles will unmask the excess movement within the joint and likely lead to more pain. Any physical therapist you go to should spend the first session with you sleuthing out what the main driver of your symptoms is and coming up with an individual treatment plan.

Improved Function

Whether your complaint is limited mouth opening, clicking or popping every time you open, or intermittent locking physical therapy can help. If your pain is related to movement or faulty posture we are the experts. Physical therapists are movement specialists first and foremost. We are trained to determine faulty biomechanics. We have to know the general shape of every joint, how the two bones involved (in this case the fossa of the temporal bone and the condyl of the mandible) should most efficiently work together, how the overlying muscles (in this case the pterygoids, masseter and temporalis) should be firing to create the smoothest movement within the joint (we term this “motor control”) thus maintaining the health of the joint. Faulty jaw biomechanics will cause undo wear and tear in the TMJ and undo strain on the surrounding muscles. That strain results in pain. Most patients with limited opening, clicking/popping or intermittent locking respond very well to PT noticing a minimum of a 50% reduction of these symptoms through a combination of manual therapy and motor control exercises. Since most patients who suffer from TMD tend to have some postural component we will be sure to address that with you too.

Long-term Management

You will be discharged from physical therapy with strategies to maintain your improvements and prevent recurrence. You will likely work with your therapist for 6-12 weeks. That gives us plenty of time to get you better and get you independent with self management of yourcondition. Throughout your treatment you will be taught how to do self release on any chronically tight muscles, how to do a self joint release if needed, specific motor control exercises, habit modifications, postural exercises, progressive stretching and strengthening exercises of your jaw and neck. Getting you better is an important goal for us. Getting you better AND able to successfully manage or avoid any future flares is THE goal.

I Would Like to Try Physical Therapy. How Do I Proceed?

Find a clinic within your area that specializes, or at least has one staff PT with advanced training, in craniocervical disorders. One resource to check is the Physical Therapy Board of Craniofacial and Cervical Therapeutics (www.ptbcct.org). You can also ask your dentist if they have someone they like working with. When looking for a physical therapist to treat your TMD you should look for practices that offer one on one treatments for a minimum of 20-25 min. At KNÓSIS our sessions are one on one in private rooms for 40-45 min.

If you live in the New York metropolitan area please feel free to reach out to us at KNÓSIS Physiotherapy and Wellness.