Tight Jaw? Tight Hips!

Many people experience jaw pain or popping, you may grind your teeth, or have ringing in your ears, perhaps chronic headaches or other issues related to muscle tension and misalignment in the temporomandibular joint (TMJ). 

A therapist treating TMJ disorders presented with these symptoms would logically look and treat the TMJ, the muscles you use to clench the jaw (muscles of mastication) and perhaps the muscles around your neck and shoulders - easy and logical as these are the muscles that may be causing the pain. But what if I told you they may be looking in the wrong place? It’s important to consider looking at the whole body, gait, posture, and perhaps their hip alignment? Hips?!?!

TMJ disturbances can arise from imbalances anywhere in the body - from the face, cranium, neck, right down to your diaphragm, pelvis and feet. The body functions optimally when all of its joints, bones and muscles are in harmony, and its non other than our fascia that holds everything in balance. But what is fascia?

Fascia is the soft tissue component of the connective tissue system (fasciacongress.org) found everywhere in our body. It forms an uninterrupted three dimensional matrix, a connective fabric extending from head to toe, front to back, interior to exterior that holds everything in place. It envelopes every major structure in the body, surrounding our muscles, muscle fibres, blood vessels, nerves, bones and organs. It’s everywhere, maintaining structural integrity and allowing the body to move and function as an integrated whole biotensegrity system.

The role of this system has been under-appreciated for many years. The tendency has been to write it off as simply another static connective tissue. Only in the last 40 years have we begun to appreciate the vast role that fascia plays in overall health as it integrates posture and movement.
There are three main types of fascia: superficial (under our skin), visceral (enveloping organs and glands), and deep. Deep fascia is a tough, fibrous connective tissue that surrounds our muscles. It contains many sensory receptors that communicate pain, proprioception and various other feedback mechanisms to our brain. As it envelopes the muscles, deep fascia forms myofascial chains that cross several joints and can reach the whole length of our body. Tom Myers, the structural integration expert, mapped out twelve myofascial chains running through the body. The most important of these are the two that could hold the key to unravelling symptoms pertaining to TMJ, these are the Superficial Back Line and The Superficial Front Line (Anatomy Train, Myers 2001).

The Superficial Back Line starts at the soles of our feet and continues up over the back of our body right the way through over the top of our head, ending at the brow ridge. If we imagine this line as a set of muscles wrapped entirely in cling film, it’s easy to see how tugging on one part of the cling film would pull and tug elsewhere in the chain. When any area of this fascia in between your feet and head gets irritated or loses its functional capacity and becomes unbalanced, your body compensates. These adjustments can be triggered by trauma, poor posture, static posture, or movement imbalances, all of which can affect how someone chews, bruxates (grinder their teeth) or holds their jaw.

This connectedness is for me why fascia is so important and endlessly fascinating. I had a patient who presented with plantar fasciitis, pain in the sole of his foot. This overuse injury was causing the plantar aponeurosis (it’s fancy fascial name) to tighten which was changing his gait (due to the pain) and in turn having a resounding affect on his jaw, which to him were completely separate. Yet treating him as a whole through myofascial release and trigger point work (see January 2017 issue pg. 55 for my previous blog on trigger points and TMJ), I was able to alleviate the symptoms and eventually, through exercises, completely resolve both issues.

Compensations can also happen structurally. Let's say the arch on the left foot has fallen, rotating the lower leg inwards and making this leg functionally shorter than the other. The result is that the pelvis tilts to the left to compensate and the body shifts the thoracic region to the right in order for the head to remain level. This compensation in the thoracic region not only causes an ‘S’ shape in the spine, but as the shoulder lifts from the thoracic compensation and pulls the trapezius (which is of course attached to the head) it pulls on the temporal muscles affecting the TMJ.

The same happens with the Superficial Front Line which starts on the top of the feet at the toes and travels up the legs, through the pelvis, continuing up through the diaphragm and ends behind the ear at the mastoid process (note the proximity to the jaw). In my clinic I have found many temporomandibular dysfunctions (TMD) originate in misuse of the diaphragm or further down in iliopsoas and pelvic imbalances (I’m also finding this particular fascial line to be more common in women than men). 

Several scientific studies support this link between the jaw and the hip. A 2009 study conducted in Germany showed that myofascial release of the TMJ significantly increased range of motion in the hip joints. Additionally, voluntarily clenching the jaw reduced hip joint mobility for all subjects (Fischer MJ, et al, 2009). Another study measured cranial angles in relation to angles of the spine and pelvis, and correlated jaw angle with both pelvic alignment and with curvature of the lower back (Lippold C, et al, 2006). Then there’s the Belgian Chiropractor, Dr. Jean-Pierre Meersseman, who discovered quite accidentally that if he had a patient with one “short” leg, usually indicative of an un-level pelvis (similar to the fallen arch I mentioned above), he could level the pelvis, i.e. correct the leg length temporarily, by placing test cotton rolls between the patient’s back teeth!
I was fascinated to learn of research linking the pelvis to the jaw, as countless times while working in releasing tensions in my patients hips, their jaw would be moving ever so slightly from side to side, presumably shifting to find its new home to mirror its counterpart. The more I worked with this link the more I found a connection with the two. If the right side of the jaw is more clenched I find that the right side of the hip muscles are often more tense. Similarly, if the mandible protrudes forward, it is common for the pelvis to also be tilted forward. For me this was a revelation - releasing tension in the pelvis can improve mobility in the jaw and vice versa!

More recently I’m finding that treating women in their third trimester, around the 39-40 week mark, by releasing their TMJ muscles I’m helping to release the muscles of their pelvic floor and hips preparing them for labour.

It’s clear from the above just how important it is to take a good look at the whole body when treating someone for temporomandibular joint dysfunction. Do you have a forward head posture, do you have a sedentary job, rounded shoulders, an unbalanced walk, do your feet slump inwards? The jaw may be the missing key that’s not been looked at. We will look at all these pieces of information to make a more effective diagnosis and design a better treatment plan. Find out where your nearest clinical massage therapist is, because establishing a two-way relationship is the key to success.