Temporomandibular Joint (TMJ) pain and dysfunction often result from imbalances in the soft tissues (muscles and fascia); both those crossing the jaw itself and those in other regions of the body. In this article I want to give a brief overview of how they can be treated effectively using Neuromuscular Therapy (NMT).

A rather bad tempered woman, whom I’ll call Sue, came to our clinic hoping that a massage would relax her and help get through a stressful week. During the pre-treatment interview she mentioned many problems, including almost constant jaw pain, frequent headaches and most recently, toothache. Initially she did not expect me to be able to help with any of these symptoms, only seeing massage as a way to relax. However, after explaining further about the way trigger points in muscles could cause the type of symptoms she was experiencing, I persuaded her to give NMT a try. It was good to see her whole demeanour change when gentle palpation of various parts of the temporalis muscles was able to reproduce all her most debilitating symptoms. 

Neuromuscular Therapy has its origins in bodywork, incorporating the best skills of massage therapists, together with trigger point therapy, stretching, mobilisation, heat and ice. NMT therapists, differ from other body-workers in that they work intra-orally (with gloves obviously), to make lasting changes in the muscles, alleviating pain and helping correct faulty movement patterns. We take a holistic approach to find out the actual causes of symptoms and identify any perpetuating factors, such as bruxism, low nutritional status, postural imbalance and stress (often associated with jaw tension). 

Postural analysis is an essential part of our assessment of TMJ disorders. Forward head posture increases the downward pull on the mandible, thus placing additional stress on the elevators - masseter and temporalis - as well as causing increased intra-articular pressure in the TMJs.  Overworked muscles tend to develop trigger points (see below). The head may be forward as a result of peering at a computer screen, or bad driving position, or can stem from a forward or backward rotated pelvis. While it is not immediately obvious that short hamstrings or quadriceps could cause TMJ pain, I often find that this is the case.

Trigger points are often the cause of TMJ dysfunction. Trigger points are hypersensitive taut bands within muscles, which when compressed cause referred symptoms, often far removed from the site of the trigger point. Pain is not the only effect of trigger points; they can, for example, cause weakness in the affected muscles. Thus if the jaw muscles on one side only are involved, trigger points can alter the biomechanics of the TMJ. Headaches and dizziness are some of the many other symptoms of trigger point activity, which are commonly seen in our TMJ patients.

So how did I treat Sue? What NMT tries to achieve is a balance between the nervous and muscular systems. Four years previously, Sue had been involved in a car accident and sustained whiplash. Such trauma can often cause the receptors in the nervous system to send confused signals to the brain. If this does not resolve itself, the person may be left with over-short muscles and/or pain, despite the initial injuries having healed. 

Sue’s whiplash-related neck pain had resolved itself within six months of the accident. It was only when she was several months into a new high stress office job that the jaw pain started, followed by headaches. This is often the type of history that I see with TMJ cases. The whiplash was an underlying precipitating factor, which when added to the postural and emotional stresses of the new job, triggered the symptoms. NMT seeks to put together the pieces of the puzzle to find the appropriate approach to treatment.

Although Sue was initially too tender to get deep into the muscles housing the trigger points, ice and gentle stretching were employed. As she improved, I was able to work deeper, working intra-orally on the trigger point-laden pterygoids and masseter. Meanwhile, work to lengthen short muscles at the front of her neck helped to reduce Sue’s forward head posture, which was aided by changes at her computer workstation. The treatment was enhanced by ‘homework’ consisting of stretches and mobilisations, together with relaxation techniques to aid in a more relaxed stance with her jaw. It was really rewarding to work with Sue over the next few weeks: to see the positive changes in her body and perhaps more dramatically, the change in her personality from grumpy to light-hearted as the pain receded.

The bottom line is that Neuromuscular Therapy gets very successful results, often when many other treatments have failed. NMT therapists recognise the importance of a multidisciplinary approach to treatment, so work with other health professionals where appropriate. If you suffer from jaw pain or other problems, it would be in your interest to seek treatment from a Neuromuscular Therapist and see the results for yourself.
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