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Pain of TMJD

Your head and neck pain could be TMJD

TMJD is the more common and easily-used name for Temporo-mandibular Joint Disorder suffered by more than 30% of adults (women more than men). This joint attaches your lower jaw (or mandible) to the temporal bones of your skull, which are situated on either side of your head just in front of the ear canal.

TM JointNormal-TMJ-Open2
These joints serve as hinges for the lower and upper jaws to work together to create up-and-down, side-to-side and back-and-forwards movements. Most of us can go through life without ever having to experience this painful disorder, but when you do, it will feel like your whole head is suffering and you may end up with an incorrect diagnosis, due to the wide-range of symptoms.

In this article, we will look at the symptoms of TMJD, the causes and then consider what treatment options are suitable.

The reason we’re covering this topic is because physiotherapy can help to reduce and even eliminate the pain experienced, but do remember, that only a physiotherapist trained in the management of this disorder can clinically diagnose and treat this condition.  At Lamberti Physiotherapy, the resident physios are all trained in treating this condition.

TMJD indications

Common Symptoms of TMJD

Headaches or Head Pain

•    Aching facial pain (not to be confused with fascial pain)
•    Pain in the cheeks or numbness in the chin
•    Pain, swelling or a lump in the temple area
•    Shooting pains up the back of your head
•    Hair and/or scalp painful to the touch

Jaw, mouth and tooth problems

•    Jaw pain or tenderness.
•    Difficulty chewing or discomfort while chewing.
•    Misalignment or locking of the joint in your jaw, making it difficult to open or close your mouth.
•    Pain at the base of the tongue.
•    Clenching or grinding teeth at night.
•    Locking or unstable jaw when opening mouth wide (eg when yawning widely). This is known as lockjaw.
•    Tooth ache.
•    If you experience a clicking, popping or grating sound when opening/closing your mouth or while chewing, but there’s no pain or limitation of movement, then you probably don’t have TMJD.
•    If you have persistent pain or cannot open/close your mouth properly, then consult your physio/doctor/dentist.

Neck and throat issues

•    Tight, stiff, or sore jaw and neck muscles
•    Lack of mobility
•    Shoulder aches
•    Difficulty in swallowing
•    Sore throat, without evidence of infection

Eye and ear restrictions

•    Aching pain in and around your ear, with no infection evident.
•    Ear pain or cracking sounds in the ears.
•    Ringing or popping sounds in your ears are most likely tinnitus.
•    Blurred vision, vertigo or dizziness.
•    Pain behind the eyes or sensitivity to light.

Causes of TMJD

The temporomandibular joint combines a hinge action with sliding motions. Those parts of the bones which interact with the joint are covered with cartilage and are separated by a small shock-absorbing disc, which usually keeps the movement smooth.

However, natural functioning of the joint can be disturbed if:
1.    The joint is damaged by a direct blow or other impact to the jaw/head eg whiplash, contact sport.
2.    The disc erodes or moves out of its proper alignment.
3.    The joint’s cartilage is damaged by arthritis.
4.    Your teeth do not align properly causing an uneven bite.
5.    Ongoing stress results in teeth grinding/clenching and tension in the muscles of the face/neck.
6.    There is over-use of the joint from frequent gum chewing or favouring one side of the mouth when biting or chewing (eg when you have teeth missing on one side of your mouth).
7.    You have known (or undiagnosed) problems with the spine due to poor posture and/or tight joints/muscles.
8.    You have arthritis or another inflammatory musculoskeletal disorder.

TMJD symptoms

In many cases, however, the cause of TMJ disorders isn’t clear and specific diseases could account for this condition eg fibromyalgia, rheumatoid arthritis and even gout.

Diagnosis and treatment of TMJD

It is important to see a qualified medical person as some other conditions have similar symptoms.
If you are being seen by a physiotherapist, the first examination will include taking a full history, together with a (i) neuro-muscular-skeletal (ii) postural (iii) lifestyle and (iv) dietary assessment. Particular attention will be given to movement limitations and abnormalities, and areas indicating muscular spasm eg neck, TMJ’s and surrounding areas. Treatment will aim at reducing the symptoms and restore normal function and mobility.

Your physio may include the following treatments in your therapy:
a)    Mobilisation and stretches of the neck and TM joints and muscles
b)    Strengthening and stretching exercises
c)    Postural correction
d)    Stress management
e)    Dry needling
f)    Patient education, advice on lifestyle/dietary changes and a home exercise programme

As there is no specific test to diagnose TMJD, your doctor may send you to a maxillofacial specialist, an Ear, Nose, Throat (ENT) surgeon or a dentist specialising in jaw disorders.  Medication (anti-inflammatories, muscle relaxants, painkillers) may be prescribed.

Your dental practitioner may recommend a bite plate to reduce damage to teeth from grinding or orthodontics.
In extreme cases, it may be necessary to do an MRI of the temporomandibular joint to check if there is any damage to the cartilage, disc and to rule out any other medical problem. Surgery is often the last option and seldom performed.

If you have any concerns about pain you are experiencing and are worried it may be TMJD, contact your physio for an assessment.

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