(Keywords: tmj exercises, exercises tmj, tmj anatomy, migraine headache, chiropractic)
First, a few preliminary thoughts about the Temporo-Mandibular Joint
These exercises will undoubtedly help reduce the pain you may be having from your jaw
joint, but … and it’s a big but … this is a very complex joint, and it
can produce a myriad of symptoms that you may not ordinarily associate
with the jaw joint.
So, if you are having pain that you think may be related to your temporo mandibular joint, a professional consultation is probably in order.
Like the sacro iliac joints in the pelvis which also have to work in tandem, to an even greater degree, because they are much more mobile, the jaw joints have to work in harmony when chewing, speaking, kissing, swallowing; like a good marriage, they enhance each other, and a bad marriage? Enough said. You get my meaning!
Tmj pain may be obvious, causing clicks and pops in the joint, difficulty opening the mouth, and pain over the joint. But just consider the following. The jaw joint can cause what appear to be eye and ear problems, facial pain, migraine headache, toothache, neck pain and many others. This is no simple problem. Tmj exercises will help, but choosing the right exercises and making the correct diagnosis you may really find requires the work of a professional.
A little Tmj anatomy
The Tmj joint is a common
cause of headaches. For a delightful story free from chiropractic
writer Bernard Preston, about a girl with Tmj headaches,
click here. Father Time.
Here are shown some of the major structures which are often involved. Firstly the highly complex disc, and four jaw muscles, on the side of the head, the temporalis, on the side of the jaw, the masseter, both of which are jaw closers. Biters.
The other two muscles lie deep in the jaw (the pterygoids).
They work in harmony every time you open your mouth, to speak, yawn, chew ... they are the strongest muscles in the body, strong enough to bite your own finger off if you chose! Think TMJ exercises.
The Trigeminal nerve which supplies the jaw joint, the face and jaw, and the upper neck, is the largest of the twelve cranial nerves. In fact it contains as much nerve material as all the other eleven cranial nerves put together. It's an important nerve. What are its parts? Soon you'll see why it is so important to chiropractors.
TMJ exercises are a vital part of the correct management of the temporo mandinular joint pain if you suffer from chronic headaches and facial pain. That's part of the philosophy of chiropractic; learn to look after yourself insofar as you are able.
The next picture is most interesting to chiropractors, because the sensory trigeminal nucleus reaches down into the spinal cord; it's that long thin heavy black structure in the neck, and it is also sensory to the upper 2-3 levels of the neck too.
Can you see it joining with the upper neck nuclei?
Ever had the odd experience that when you get sinusitis, or toothache, or jaw joint pain, you often simultaneously get upper neck pain?
So, this enormously important nerve supplies the face, teeth, jaw joint and upper neck and base of the skull. That's sensory; it feels. Then it drives the muscles of the jaw on top of that.
Is it any wonder that we get hopelessly confused with pain in the neck, jaw, teeth, around the face; this is a condition that really hurts. It makes people suicidal sometimes, that bad.
That cauliflower structure behind is the great coordinator, called the cerebellum. It enables all these complex structures to work in harmony.
I've only touched on this subject. It involves the lips, the cheeks, the neck muscles, the tongue, the swallowing muscles; really complex stuff. For example, the cerebellum is what enables you to chew without biting your tongue, lip and cheeks.
The thumb is truly an amazing little limb and, like the face and the jaw joint, it receives very high representation in the brain. I have to say that I agree with Sir Isaac. Just believing that the thumb, or the jaw came about by freak chance, is like believing the laptop you are reading this on was the result of a freak flash of lightening, melting bits of steel and glass and moulding into your computer. Ridiculous, huh?
"In the absence of any other proof, the thumb alone would convince me of God's existence."
- Sir Isaac Newton known as the most influential scientist who every lived.
I must stress: choosing the right TMJ exercises and doing them correctly, is paramount. Listen to your jaw. Some discomfort is to be expected in the beginning, but if your instincts tell you this is not helping, don't be silly and keep going. Seek professional help.
Tmj exercise 1
For your first Tmj exercise sit comfortably in a high backed chair with your head
back against the head rest, and your mouth lightly closed. Place the web
of your thumb and forefinger against the front of the lower jaw. Outside of your mouth.
Using your hand press on your chin, gently forcing your lower jaw backwards, and your head into the headrest, neither allowing your head and neck to flex nor extend and allowing the mouth to open slightly.
Done correctly you should feel the lower teeth moving backwards in relation to the upper teeth, as your whole lower jaw moves backwards.
Relax, and allow your jaw to move forwards again, keeping your chin on the same level. Avoid looking up and down. Repeat five times, several times a day.
It shouldn't be painful, and you will feel a light stretch deep in the jaw. As with any new exercise programme, do it gently to begin with. Is this new exercise helping or aggravating your jaw joint and facial pain?
Could it be worsening your migraine headaches? Are you getting more or less clicks and pops from your jaw joints?
Start with exercise 1, and do it for a few days. If you are feeling benefit, add 2, and then a few days later temporo mandibular joint exercise 3.
One or more of these exercises may not be beneficial, remember.
Tmj exercise 2
As in exercise 1, sit comfortably in a chair, resting against the back rest. Place the web of your thumb and forefinger again against the front of the lower jaw with the teeth slightly apart.
As before, using your hand press gently against our chin to force your lower jaw gently backwards. Done correctly you should feel the lower teeth moving backwards in relation to the upper teeth, just as in exercise 1. Don't open your mouth any extra.
You will feel a stretch deep with the jaw joint. Don't go too deep initially; the intention is essenially to stretch the muscles rather than the capsule of the jaw joint.
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Now gently push your lower jaw, not your whole head, forwards against your hand. Hold fast for a few seconds.
Then, relaxing your hand, use your jaw muscles to gently push your lower jaw forwards, so that the lower teeth protrude. Hold for a second or two.
Repeat by gently pushing the jaw backwards again with your hand.
Do this maybe three or four times, several times a day.
If your muscls ache during or after this period, use a little cream to massage the temporalis and masseter muscles before you start exercise 2.
You may also use alternating ice and heat if you have pain in the jaws after these exercises.
TMJ exercise 3
For the third of our TMJ exercises - with your teeth closed gently against each other - rest the tip of your tongue against the top of your mouth, just behind the front teeth.
Now run the tip of your tongue backwards along the top of your mouth, keeping the teeth closed, until you can just reach some soft tissue (the soft palate).
Lastly, and this is where you must be careful, slowly open your mouth, trying to keep the tongue against the soft palate. When you feel your tongue being pulled away from the soft palate, STOP. Don’t open any further. In fact, to start with, stop before your tongue leaves the soft palate, or if it hurts, or you get clicks or pops.
NB. Stop opening your mouth before the jaw pops if you have a popping jaw.
Hold this position for a few seconds and then relax. Repeat only once or twice to begin with.
GENTLY DOES IT, YOU'RE NOT GOING TO THE TMJ OLYMPICS! Your muscles will tire and feel sore quite quickly.
It remains controversial, but there has been research suggesting that chewing gum improves short-term memory.
However, research done at Cardiff University (Science Direct 48(2007) with sugarless, flavourless gum contradicts the earlier research. In fact short-term memory was worsened.
"Abstract: The experiment examined the prediction that chewing gum at learning and/or recall facilitated subsequent word recall. Chewing gum at learning signiﬁcantly impaired recall, indicating that the chewing of gum has a detrimental impact upon initial word encoding. The ﬁndings contradict previous research."
They reason that any improvement in memory is linked to the flavouring in the gum - which last a maximum of four minutes.
I have no research to confirm it, it's just an opinion, but I am under the impression that gum overloads the jaw joints, certainly in people with TMJ dysfunction. Chewing gum should not in my opinion be consided good TMJ exercise.
Massaging the three muscles, together with the TMJ exercises above, may also be beneficial. The temporalis on the side of the head is easy to locate. Press on it looking for painful nodules, massaging gently. Opening and closing the mouth a little at the same time may be helpful. The temporalis muscle, often in spasm in the TMJ syndromes, is a major cause of Migraine headache …
Repeat with the masseter muscle. It is located on the side of your jaw. Placing your thumb inside the mouth, and gently squeezing the nodules may be helpful.
To reach the pterygoid muscle is more difficult. Slide the tip of your index finger, pad facing outwards, between the upper teeth and the cheek, as far back as you can. You will reach a little crevice called the pterygoid pocket. Gently massage the muscle, pressing outwards, slowly moving the jaw. It is often exquisitely tender with TMJ problems and migraine headache.
From the chiropractic coalface
Mrs van den Hoek is a youngish woman, mid thirties. She consulted me on the recommendation of a friend. Body language told much of the story, this woman was in severe pain. She had had blinding headaches and severe pain on the side of her face for some six months. A neurologist diagnosed Trigeminal Neuralgia, one of the most painful conditions known to man, and she had to learn to live with the pain. Other than killing the nerve, there is no known treatment. Patients have been known to commit suicide.
She had a relatively simple Temporo-mandibular joint condition. The opposite joint was fixated, and the lateral pterygoid muscle, deep in the pteryoid pocket was red hot. We used to think it a coincidence that neck and jaw pain so often appear together, but now you understand the strong neurological link between the upper neck and the TMJ: she also had a severe subluxation of the axis bone in her neck. Chicken and egg.
Note: Not all chiropractors are trained in the treatment of the Tempero-mandibular joint. Phone your state association.
She had an extreme reaction to the first treatment, as I warned her, but within a 10 days was 50% better. It's now six weeks since her first consultation (8 treatments) and she has no facial pain any longer, though she is still having occasional headaches. We are into the rehabilitation phase of the care (I wrote this page so she could do the TMJ exercises correct) and she is a different person. TMJ pain can be very severe.
Hot Tip: Avoid biting hard things, like into a whole apple with your front teeth. Rather cut it smaller so that you don't have to open your mouth so wide.
STIFF NECK EXERCISES
Whilst doing your TMJ exercises consider a couple of stiff neck exercises, whether or not your neck is stiff. The neck and the TMJ are intimately connected.
And of course, while you are about it, every person in my opinion
should be doing some low back exercises. After the common cold, it's the
most common reason for a visit to your doctor ... These Maignes
Syndrome exercises are excellent for your back.
MAIGNES SYNDROME EXERCISES ...
Do you have a question about your jaw joint? Shoot!
The jaw joint is a major cause of severe facial pain and migraine headache and is often involved in trigeminal neuralgia.
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Interesting challenges of the day
1. Mr B has the trophy for the most acute neck in February. He has quite advanced lower neck arthritis for a forty year old, thanks to a severe fall on the head from a trampoline. But this is upper cervical pain. Right rotation is simply impossible. Luckily he is improving rapidly, eighty percent better he says after three treatments. See cervical facet syndrome.
2. Mrs C is a new patient with a long history of lower back pain, hip pain and pain in both feet. We'll see how we get on, Rome wasn't built in a day.
3. Miss U sprained her ankle two months ago, wearing high heels. She still has severe mid foot pain. Xrays and perhaps a CT scan.
4. Mr V is 86 years old and hurt his back helping his wife into the car. Just one treatment of the sacroiliac joint and he's eighty percent better. It's not always like that.
5. Mr W lay on his back knocking down a pillar. Turning his head causes severe vertigo. He needs the Epley exercises, not pills, research shows. Update, he's fine.
6. Mrs X, a young mother has severe lower back pain, with numbness down the posterior thigh, calf and side of foot. It started after a long drive in the car. Update, she's forty percent less painful after four treatments, but the leg is still numb. Update two; she 60% better, but it's slow and is going to take the full 6 weeks to heal. Further update; a setback, after lifting her child she now has leg pain. It's going to the be difficult.
7. Mrs Y, a 70 year old woman is on maintenance care fo a nasty lumbar stenosis despite having to do everything at home. Her husband has a hospital acquired infection in the shoulder. After 4 operations he is incapacitated and going rapidly down hill.
8. Mrs Z, an 78 year old woman is doing remarkably well with a bad sciatica. But at over 200 lbs she is not losing weight, in fact gaining despite my suggestions. She's high risk for a stroke. Referral to a dietician to crack the whip.
9. Mr A, a 73 year old engineer, still working, is doing fine after a long episode of lower back pain. Some pain on the side of the hip remains after five treatments. Reassured him it's not hip arthritis.
10. Mrs B, a 64 year old woman has had Scheuermanns disease; it's left with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment, provides she come every six weeks or so for treatment.
11. Mr C, a young engineer fell off his mountain bike injuring his cervical spine and pelvis. Luckily both responded very quickly to a few chiropractic adjustments. Update: his neck is sore again. It all goes back to a whiplash injury ten years ago when he was rammed by a fully laden truck carrying a load of stone. Time for Xrays.
12. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.
13. Both Mrs E and I can't believe how much better her lower back and leg pain are. Surgery for a scoliosis and spondylolysthesis three years ago helped greatly for one year. But then her leg went lame and weak. He was responded extremely well despite all expectations.
And so the day goes. Chiropractors shouldn't be treating the elderly? Bunkum.
Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?
Greetings, Dr B.
You helped me quite some time back with a soothing and professional
response which turned out to be exactly correct. I now consult a local chiropractor.
You write a superb newsletter, too.
Your own unresolved problem. Pose a question
Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.
You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.
The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.