Temporomandibular Joint (TMJ) Dysfunction is a disorder that affects one in four people. It’s no wonder really when you consider that these little joints are the most frequently used in our body - constantly working whilst we laugh, talk, chew, sing and yawn.

This article will look at how clinical massage can alleviate many TMJ symptoms through myofascial trigger point work. And the opportunities that arise when a friendly two way relationship is established between dental practice and massage therapist.

THE BASICS

The variety of symptoms linked to TMJ disorders (TMD) can vary from being mild and going unnoticed to becoming acute or chronic, debilitating and significantly changing a person’s quality of life. These include:

Pain, particularly in the muscles of mastication and/or in the joint itself
Radiating pain in the face, neck or behind the eye
Tenderness in the joint on touch and/or movement of the joint
Bruxism
Crepitus
Trismus / Limited range of movement in the jaw / Inability to open mouth in a straight vertical pattern (slips to one side) - making it difficult for a dentist to do any necessary work
Malocclusion
Headaches / Migraines
Tinnitus / Ear pain
Visual disturbances
Undiagnosed toothache
Tight neck and shoulders

Treatment varies from self-care advice such as eating soft foods, to over the counter pain medication. Alternatives include saline solution injections, acupuncture and Cerezen, with the most invasive and final resort being surgery. As a dental practitioner, a bite guard or splint can be recommended to help relieve their grinding habit, while bite adjustments, orthodontics and restorations are also often used. All of these methods are useful for achieving some improvement, but they are only treating the symptom and not the cause.

What is perhaps not as widely known, is that soft tissue manipulation through clinical TMJ massage is an effective, non-invasive solution to TMD. As massage is grounded in it’s philosophy of treating the cause and not the symptom, it can be a useful means to address many of the issues gently, effectively and holistically.

As a clinical massage therapist I work in collaboration with dentists around Bristol, treating many people suffering from TMD pain. Successfully reducing the pain and symptoms drastically, often after only one treatment. Subsequent treatments completely resolve, if not dramatically improve the pain. I have also worked successfully with malocclusion, undiagnosed tooth pain and treated patients following long dental appointments to alleviate any aches and prevent further symptoms.

ASSESMENT

Prior to treatment three steps are taken increasing the effectiveness of the massage and outcome.

There are important components which must be present for TMJ dysfunction to occur. An in-depth consultation enables the therapist to pin point which of these are present; genetic predisposition, trauma, tissue alteration and stress.
Postural assessment allows the therapists to see which muscle imbalances may be affecting the TMJ for example forward head posture, scoliosis or hyperkyphosis. In some rarer cases the problems start further away in the pelvis or even feet!
An assessment of the joint itself, intra-orally and through the ear enables the therapist to examine whether there are any problems with the articular disc, retrodiscal tissue and the muscles of mastication.

TREATMENT

Treatment uses a combination of modalities including hydrotherapy and myofascial trigger point work, stimulating the parasympathetic nervous system inducing relaxation (essential if stress is one of the components).

Trigger point therapy is one of the greatest discoveries of the western world, giving us the necessary tools to effectively treat pain. Trigger points are hyper irritable spots of pain within a taut band of skeletal muscle and its associated fascia. The spot is painful on compression, causing local pain, or it can cause characteristic referred pain in a predictable manner that has been charted by the legendary Janet Travell (MD and physician to President Kennedy).

There are two types of trigger points; primary and satellite. Primary trigger points are the main cause of the patient’s pain - which in turn refer to satellite trigger points. For example, trigger points in the trapezius muscle refer pain to the temporalis muscle where satellite trigger points then develop (see picture A). If only the satellite trigger points are treated and not the primary trigger points, then the pain is likely to return (Fairweather 2015). Many patients that I’ve treated have come to me as a last resort, having already been treated by TMJ specialists who have only treated the muscles of mastication - the satellite trigger points. Too often, the primary trigger points in the neck and shoulders are neglected.

Knowledge of the trigger point referral patterns can help explain many pain conditions relating to TMD:

Undiagnosed Toothache - I had a patient who had excruciating pain in the upper right (UR) molar area. The dentist found minor decay in the UR second molar, the existing filling was removed and a crown placed, yet the pain continued. Root canal treatment was eventually done, but still the pain remained. The pain was felt in the upper right side but it wasn’t localised. As the pain persisted the patient eventually convinced her dentist to remove the tooth altogether and yet her pain didn’t subside. She eventually came to me for a relaxation massage, as she had been so stressed from the continuous pain. Treatment along the right masseter mimicked the pain she had been feeling and after three sessions the pain in the UR had completely gone.

Headaches and Migraines - Trigger points in trapezius, SCM, sub occipitals

Face Pain - Trigger points in the SCM, lateral pterigoid or temporalis

Aside from localised pain and referred pain, trigger points also cause sensory, motor and autonomic phenomena. This includes things like spasms, sweating and tearing of the eyes. In relation to TMD trigger points in the SCM can cause tinnitus and visual disturbances.

This process of treatment not only releases and relaxes the tissues, bringing functionality back into the body, but effectively treats TMJ pain. Treating in this way is a non-invasive means to help to reduce the need for extensive traditional dental treatment, while also helping to address the over use of pain killers.

When a constructive two-way relationship is established between dental practice and massage therapist, the scope for providing certain patients with a holistic and wholly more pleasant experience can improve drastically.

Printed in Private Dentist Magazine January 2017 VOL 1

References:

Travel, Janet G., and David Simons. 1983 Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore: Williams and Wilkins.

Fairweather, Rachel and Mari, Meghan. 2015 Massage Fusion: The Jing Method for Treatment Of Chronic Pain. UK: Handspring Publishing