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Sport Physiotherapy, Sports Therapy
TMJ pain – the sports physiotherapist’s perspective
December 20, 2019 | by Adrienne Chan, Physiotherapist

Your Temporomandibular Joints (TMJ) are involved with talking, breathing, eating and expression ⁠—⁠ they are the most used joints in the body.

These joints are located on each side of the face at the front of the ears where your mandible (lower jaw bone) connects to the side of your head (temporal bone on the skull). Together, they act as a hinge joint to help open, close and move the jaw.

Located between the hinge joint is a cartilage disc that provides lubrication to allow the joint surfaces to move easily together and acts as protection from excessive forces on the joint that can occur with grinding or clenching of the teeth.

But what happens when something isn’t working correctly with those joints? It could be Temporomandibular Dysfunction (TMD).

For an athlete, jaw pain is usually the last thing you expect to impact sport performance and take you out of the game. The key takeaway: know the signs and get treated early.

WHAT ARE THE SYMPTOMS?

Pain may not always be present with TMJ dysfunctions. Oftentimes, people do not seek care until they begin experiencing difficulty eating or speaking. It often manifests in symptoms such as:

  • Increased frequency of jaw clicking/popping with mouth opening
  • Limited jaw opening
  • Deviation of the jaw towards one side
  • Inability to fully close your jaw
  • Headache (on one side or both sides of the head)
  • Pain behind the eyes
  • Tenderness of the jaw muscles
  • Dizziness
  • Neck pain
  • Ringing of the ear or a sensation of “fullness”
  • Tingling and or numbness to one side of the face

WHAT CAUSES TEMPOROMANDIBULAR DYSFUNCTION?

TMJ dysfunction is considered a multifaceted musculoskeletal dysfunction.

The most common causes of TMD include:

  • Masticatory (chewing) muscle dysfunction (muscle tension)
  • Poor mobility or placement of the TMJ articular disc, leading to clicking or locking of the jaw
  • Bruxism: nocturnal teeth grinding which leads to increased pressure in the TMJ, often presenting as morning headaches and or facial pain
  • Occlusal problems: Asymmetrical or under/overbite

Other contributory factors include:

  • Prolonged mouth opening (eg. a dental procedure)
  • Poor posture
  • Stress (related to grinding/clenching of your teeth)
  • Trauma (e.g., blow to the chin, whiplash, sport activities)
  • Oral habits (e.g., nail biting, pencil chewing, gum chewing)
  • Eating habits (e.g., chewing only on one side of the mouth, eating large items)
  • Infection
  • Arthritis

HOW IS TMJ DYSFUNCTION DIAGNOSED?

Your dentist, oral maxillofacial surgeon and physiotherapist can help in diagnosing TMJ dysfunction. TMD is a clinical movement dysfunction diagnosis.

During your examination, your physiotherapist will conduct a thorough subjective and objective assessment of your:

  • Posture
  • Breathing pattern
  • Jaw range of motion
  • Muscle tone
  • TMJ coordination and movement patterns

It is also very likely that your therapist will don a pair of gloves and examine the inside of your mouth as well.

Your practitioner, be that a physiotherapist or otherwise, may recommend or refer you for imaging (dental X-rays, CT scan or MRI) to further investigate your condition.

HOW DO YOU TREAT TMJ DYSFUNCTION, AND HOW CAN PHYSIOTHERAPY HELP?

The best treatment for TMJ varies based upon the clinical diagnosis and the chronicity of the issue. As a general rule, TMJ dysfunctions will usually always involve the management of your dentist.

Outcomes are improved when it is treated with jaw exercises, soft tissue techniques, and dry needling/acupuncture, which can be provided by your physiotherapist.

Anti-inflammatory and or medications (as directed by your dentist or doctor) are used alongside your treatment in certain cases. Prognosis is very good in the majority of people treated.

If you are unsure what treatment direction is best for you, we recommend that you seek the advice of your health care professional who will refer you to the most relevant health care professional suitable for your condition.

Experiencing some of these symptoms? Visit our webpage or book an appointment with Adrienne today at 604.292.2500

References:

  1. Armijo-Olivo S, Pitance L, Singh V, Neto F, Thie N, Michelotti A. Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis. Phys Ther. 2016 Jan; 96(1): 9- 25
  2. Calixtre, L.B., Moreira, R.F., Franchini, G.H, Alburquerque-Sendin, F., Oliveira, A.B., 2015. Manual therapy for the management of pain and limited range of motion in subjects with signs and symptoms of temporomandibular disorder: a systematic review of randomized controlled trials. J. Oral Rehabil. 42
  3. Dickerson SM, Weaver JM, Boyson AN et al. The effectiveness of exercise therapy for temporomandibular dysfunction: a systematic review and meta analysis. Clin Rehabil. 2017 Aug 31(8): 1039-1048
  4. Gil- Martinez A, Paris Alemany A, Lopez de Uralde Villanueva l, La Touche R. Management of pain in patients with temporomandibular disorder (TMD): challenges and solutions. J Pain Res. 2018; 11(1): 571-587
  5. McNeely, M.K., Armijo Olivio, S., Magee, D.J., 2006. A systematic review of the effectiveness of physical therapy interventions for temporomandibular disorders. Phys. Ther. 86,
  6. Medllicott, M.S. and Harris S.R. A systematic review of the effectivess of exercise, manual therapy, electrotherapy, relaxation training, and biofeedback in the management of temporomandibular disorder. Phys Ther. 2006;86: 955-973