Your dentist or your doctor told you that you have a TMJ problem.
In other words, you have a diagnosis of
temporomandibular joint dysfunction.
They told you to do exercises.
But how exactly should you do exercises for the TMJ problem?
Today I’ll explain to you what the TMJ is and how to treat it.
What are the most common causes of TMJ dysfunction?
And finally, I’ll demonstrate massage and exercises to relax the muscles that move the
jaw. So, let's talk about TMJ dysfunction today.
The temporomandibular joint is where the jaw articulates with the skull to open and close
the mouth.
This is the most used joint in our whole body.
We use it when we talk, eat or drink something.
It gets its name because it connects the temporal bone in the skull to the mandibular bone,
also known as the jaw.
So, it is the temporomandibular joint.
The temporomandibular joint is right in front of the ear.
The mandible does 5 basic movements and
combinations them:
Depression Elevation
Protrusion Retrusion
Grinding, or lateral movement
Depression of the mandible occurs just by gravity.
If you just relax the facial muscles, the neck muscles and the tongue, the mandible
depresses a few centimetres.
But if you want to open the mouth more than 2 centimetres,
then you need to activate the
muscles under the mandible, they will pull the mouth open, but they will also pull the
mandibular head outside of its place.
If you place your fingers on your TMJ, now you notice that the ball is outside of its
socket.
There is a hole in front of the ear.
That is the space that was being occupied by the mandible head.
So, the opening of the mouth is a combination of two movements: depression and protrusion.
Closing the mouth is a combination of elevation and retrusion.
The muscles that are involved in the movements of the jaw are very complex and they are located
under the mandible, in the front of the neck.
on the face, outside of the mandible. in the mouth, on the inside of the mandible.
and in the skull.
The TMJ is a synovial, condylar, and hinge-type joint.
There is an articular disc, and this is very
important, because this disc may become degenerated
and move out of its proper place.
Very rarely, when there is a TMJ dysfunction, the jaw will stay locked in that position,
which is very painful and the patient needs to go to emergency for the dentist or doctor
to reduce the dislocation.
So, TMJ dysfunction or TMJ disorder occurs when the joint, the muscles or ligaments around
the mandible are not functioning properly and there is inflammation or irritation, causing
pain, noise, popping sounds, locking and dislocations.
The pain can be localized in the joint itself, or it can radiate to the teeth, ear, neck
or head.
What causes TMJ dysfunction?
Before I continue, let me remind you that this video is for educational purposes only,
and if you think you have a problem with your TMJ you need to ask your doctor or your dentist.
They need to examine you and give a treatment plan for you.
If there is an emergency, please go to the nearest emergency department or call an ambulance.
TMJ dysfunction can be the result of various factors, and it is usually difficult to detect
only one cause.
These are conditions that affect the joint itself.
We call them intra-articular problems : - There might be a problem with the disc.
- Arthritis that can damage the cartilage that protects the bones.
- Or an injury like a fall or a car accident.
But there are other structures around the joint, outside of the joint itself that can
lead to dysfunction and pain.
We call these extra-articular problems: - It could be a chronic grinding or clenching
of teeth.
- A systemic auto-immune inflammatory process like rheumatoid arthritis,
- A connective tissue disease that causes hypermobility and collagen laxity.
- Or Muscle tightness, tension, and myofascial trigger points.
How do we know if the person has a TMJ dysfunction or if there is another problem?
The diagnosis is mainly by the symptoms of pain, local tenderness to palpation, noise
and clicking of the joint, and also difficulty to open the mouth.
A TMJ that only makes noise, without any other symptom is not TMJ dysfunction.
That is normal.
Making noise is not a problem and there is no need to do any investigation or treatment.
Just leave it alone and stop paying attention to the noise.
The normal mouth opening varies from person to person, it depends on the size of the person
and the size of their mouth.
So, we ask the patient to make a fist and try to insert the knuckles of their index,
middle and ring fingers in their mouth.
The normal mouth opening is about 2.5 to 3 knuckles.
In cases where there is an injury or trauma to the TMJ, we need to take an X-ray, maybe
a CT scan or an MRI to look at a specific structure.
If there was no trauma or injury, then we don’t need to order an imaging test.
Now the interesting part, how do we treat TMJ dysfunction?
First, it is important to identify if there are any factors perpetuating the symptoms,
like bruxism, or grinding the teeth at night.
They may need to see a dentist for a bite plate.
Also, people who talk a lot might need some mouth rest or reeducation.
During the acute phase, patients may need to change to a soft diet and avoid eating
hard foods that require a lot of clenching.
The person may apply moist heat, like a hot damp towel, or apply a cold compress.
Your doctor may need to prescribe some pain
medications. Or you can take acetaminophen, anti-inflammatories
or muscle relaxants.
In some chronic cases, when the person is developing sensitization of the pain system,
it is important to include some mind-body therapy like cognitive-behavioural therapy,
mindfulness or meditation.
When there is a structural problem of the joint, their doctor might need to book an
injection, arthroscopy or even surgical correction.
One of the most common causes of TMJ dysfunction is the tightness of these muscles.
The patient may do some exercises to relax, and stretch the muscles, especially the muscles
that close the mouth.
These are very strong muscles.
The main muscles are the masseter and the temporal muscle.
These two muscles are so strong, probably the strongest muscles of the body relative
to their small size.
Have you seen the Iron Jaw Girl?
Her name is Maria Romanova.
Just take a look!
If you want to see her full video, click on this link here.
You can feel these two muscles.
Place your fingers on the side of your head, above your ear.
Now close your mouth and press tightly, like if you were breaking a popcorn kernel.
Do you feel the temporalis muscle here?
Now place your fingers on the sides of your jaw, and press tightly again.
Here you feel the masseter muscle.
You can do a self-massage of these muscles.
You can start with a massage on the side of the face and side of the head.
You find the muscle, the fibres go up and down, so you apply a massage perpendicular
to the muscle.
Like this.
Then you can massage the temporalis muscle.
So, find the muscle again. You find it by closing your mouth very tight.
Now you can massage the muscle with your knuckles.
Like this.
Another way to massage these muscles is by inserting your finger into your mouth
Make sure you wash your hand, or you may wear a glove.
Find the painful points and apply pressure between your thumb and index finger on the
opposite side.
Once you find the tender spot, apply pressure for 5 seconds.
Repeat on the other side.
If this causes too much pain, you may apply an ice pack after this massage.
Sometimes you cannot do this intra-oral massage because you cannot insert your finger in your
mouth, the mouth opening is too small.
Don’t worry.
We will do some exercises that will help to open your mouth, then you will be able to
do this self-massage exercise.
The reason why we apply resistance is to relax the opponent muscles.
Every time that you move a joint with opposing movements, like the elbow, it does flexion
and extension.
If your brain sends an order to the biceps to contract and flex the elbow, there is a
reflex that will send an order to the triceps to relax.
So we are using this reflex to relax the masseter and temporalis muscles.
When you contract the muscles under the jaw to open the mouth, there is a reflex that
will send an order to the masseter and temporalis to relax and let the mouth open.
But do not put too much force, especially if you have not been able to open your mouth
for a long time, then you may need to be patient and wait a bit longer.
So, let's do the exercise for the jaw muscles.
First we do some relaxation and self-massage.
Find a comfortable position Preferably in front of a mirror.
Relax your shoulders and your neck Do a chin tuck
Keep your tongue relaxed We are going to open and close the mouth slowly.
If there is pain, you are going to
breath through your pain. And count to 10 with me.
1, 2, 3 4,5,6,7,8,9, 10
While you are doing this, you are counting loud.
Breathing out. Open your mouth Just let it relax.
Just like when you are in the back seat of a car. And you take a short nap.
Just let gravity pull down the muscles of your face.
Your tongue Your neck
And relax.
So, when you are breathing out. Your muscles relax.
A lot of TMJ dysfunction is caused by stress in our lives.
Think about any emotion that you have right now. Are they connected to your pain?
Do you feel more pain when you are under stress? When you are afraid, anxious or sad?
It is very common for our body to express our emotions.
Some people have difficulty to name their emotions.
Or to speak about their emotions.
They internalize their emotions.
Then the body will externalize these emotions and pain is a very common symptom.
The TMJ is very commonly affected.
Did you notice, when you are tense?
You clench your teeth. Well, a lot of people do that.
The other exercise is called resisted mouth opening and closing.
Find a comfortable position, preferably in front of a mirror.
Relax your shoulders and your neck. Do a chin tuck.
Keep your tongue relaxed. Make a fist with both hands
Place the back of your fingers under your jaw.
Your hands will apply a slight pressure up.
Not too much.
While your hands are pushing up, you try to open your mouth slowly down.
Bring it to the maximum opening possible.
Hold for 5 seconds
In the end, with one hand, pull your jaw very
lightly down Just 1 millimetre down
If you gain 1 millimetre per day, in 20 days you gain 2 centimetres.
I had a patient a couple of years ago, she was 78 years of age and she was eating puree
foods for years because she could not open her mouth more than 1 centimetre.
After I treated her myofascial pain in her masseter, I had to do a trigger point injection
and she did the daily exercises at home, she
came back to me in follow-up and she was very happy.
She told me she was able to eat meat with bones, which she had not done for years.
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Bye