What's causing that jaw pain?

If you have ever had jaw pain, you will know how uncomfortable it is,  A pain that stops you from eating anything that isnt blended isn't much fun.  Having temporo-mandibular pain (jaw pain) stops you from doing anything that requires opening of the mouth and even small movements can cause clicking and locking in the jaw.

The temporo-mandibular joint (or TMJ) is made up of 2 bones with round surfaces (the mandible and temporal) with a disc in between that allows the glide and movement so you can yawn, eat, chew and talk.

This way this joint can get messed up in a number of ways including, bad teeth, grinding habits, poor bite patterns and neck issues that might relate to posture.  With all that we now we have a very angry disc. 

So what are the signs of temporo-mandibular pain?

There are a number of different signs and each person will be a little different but the main things you will notice if you have temporo-mandibular pain are:

• Shifting, clicking, clunking or locking of the jaw
• Pain localised in the jaw joint or diffuse pain around the side of the head or neck
• Mouth feels tight when opening or unable to open fully
• Headache around the temples or side of head
• Jaw doesn’t appear midline / asymmetry to the jaw 

So what are the different types of TMJ pain?

The differnt types really boil down to 3.

• Myogenic or muscle related, when there is weakness, tightness or there is poor muscle control of the jaw muscles. When there is tightness the jaw will get pulled towards that side. When there is weakness or poor coordination the jaw won’t open and close like it should.
• Discogenic or disc related, when the disc does not glide normally when opening or closing the mouth. The disc can shift out of place “sublux” or dislocate causing locking issues. In other words it feels like the disc rides over a speed hump when opening or closing the mouth creating a click or clunk.
• Growth issue: where there are uneven jaw growth issues or trauma to the jaw

What causes it?

In most cases there are a few factors that often lead to jaw problems.  An expert in jaw pain can explain which ones you have after doing an assessment.  Some of the more common are:

• Excessive chewing of gum making the chewing muscles overworked and tight.
• Resting your hand on one side of your face – you are putting pressure on your TMJ and squashing your disc.
• Sleeping on your jaw – again you are putting pressure on your disc.
• Poor posture affecting the neck
• Grinding your teeth during sleep (often related to stress and anxiety)
• Dental issues
• Poor bit patterns 

What can I do about it?

the first step in treating it is identifying and addressing the factors above.  After that treatment can include a number techniques to assist the mucle and joint function:

• Functional massage of the jaw muscles: temporalis, masseter, lateral and medial pterygoids
• Correction of neck posture
• Trigger point release techniques
• Manual therapy techniques: joint traction, compression
• Motor control training
• Western acupuncture to relax the tight muscles
• Corrective exercise for imbalanced / dysfunctional jaw muscles
• Self – massage techniques: I can teach you how to massage the muscles of the jaw; intra-oral (some of the muscles of the jaw are accessed within the mouth) and extra-oral

Typically with treatment you should get less pain or improved opening and closing ability from the first session. Sometimes it will be a good idea to see your dentist to see if there are dental reasons for the pain.

Colin Sau, 
Senior physiotherapist and jaw pain expert at Eagle Vale and Liverpool