Temporomandibular Joint Dysfunction (TMD) refers to a group of conditions that affect the temporomandibular joint (TMJ) and the associated anatomical structures and muscles surrounding it. This can lead to pain and discomfort in the face, head and neck, and limited jaw movement. Other symptoms related to TMD are headaches, facial pain, clicking in the jaw, tinnitus, and fullness of the ear.

Pain can be caused by several factors including:

• Acute inflammation of TMJ caused by direct trauma (blow to the jaw), whiplash, grinding or clenching teeth.
• Arthritis of the TMJ can be degenerative (osteoarthritis) due to age or previous trauma occurring at a younger age. Inflammatory diseases such as rheumatoid arthritis can also affect the jaw.
• Structural changes within the joint can affect the disc tissue that sits within the TMJ. This disc can become displaced causing an audible click and occasionally locking of the jaw.
• Hypermobility or excessive movement of the TMJ can also cause clicking and locking especially in open positions (open lock) with yawning, singing and prolonged dental procedures.
• Muscle spasms around the jaw (masseter, temporalis, pterygoid muscles) can occur with prolonged dental procedures, stress, excessive clenching of the jaw.
• Poor neck posture for prolonged periods, most often while working at a computer or looking down a tablet or phone.

Just like many other joints and muscles in the body, physiotherapists with specialized training can effectively assess and treat the TMJ and its surrounding muscles. Physiotherapy assessment of TMD involves a thorough history taking, posture assessment, observation of the positioning of the jaw and cervical spine, palpation of the TMJ and neck as well as assessment of the range and quality of movement of the TMJ and neck.

Physiotherapy treatment of the TMJ often involves the treatment of the cervical spine as well with the goal of improving joint function, reducing pain, and restoring normal jaw movement. Patient education, hands on techniques and exercises are used to help with symptoms.

Treatment for TMD may include:

Patient education:

• Education on the nature of TMD, what causes it and contributing factors.
• Discussion of lifestyle modifications to reduce stress to the TMJ and surrounding muscles.

TMJ exercises:

• Gentle range of motion exercises to improve jaw mobility.
• Strengthening exercises for the muscles around the jaw that are not functioning effectively.
• Relaxations and stretching exercises to reduce muscle tension in muscles that are overworking.

Manual therapy:

• Soft tissue release (massage) to reduce tension in the muscles of the jaw, neck, and shoulders.
• Joint mobilizations to improve the movement at the TMJ and cervical spine.

Posture correction:

• Assessment and correction of poor posture of the upper back, neck and TMJ as they may contribute to TMD.
• Provide guidance on maintaining proper head and neck alignment.

Modalities:

• Heat therapy is often used to reduce pain and inflammation as well as soothe tense muscles.
• Ultrasound or electrical stimulation (TENS) can also be used for inflammation and pain management.

Dry needling:

• Acupuncture in the head, neck and jaw can be used to reduce pain, reduce inflammation, and increase the general sense of well-being through stress reduction.
• Intramuscular Stimulation (IMS) is a very effective technique using an acupuncture needle to release taut bands in the muscles to normalize muscle tone and reduce pain.

Orthotic devices:

• Referral back to the patient’s dentist or orthodontist is occasionally required to have the dental professional create a custom oral splint or mouthguard. These devices can help stabilize the jaw as well as reduce the incidence of clenching and grinding which prevents excessive wear on the teeth, especially at night.

Stress management:

• Your physiotherapist may also incorporate stress management techniques such as relaxation exercises, deep breathing exercises and mindfulness to reduce overall tension.

Home exercise program:

• Most patients will be provided with a customized home exercise program to continue with their rehabilitation between physiotherapy sessions.

Nutritional guidance:

• There are many dietary factors that may contribute to TMD such as chewing gum, eating foods that are too hard, too chewy, or too crunchy as well as eating foods that require opening your jaw very wide (i.e. eating a whole apple).

It’s important to note that the specific physiotherapy approach may vary depending on the individual’s symptoms and the underlying causes of their TMD. A comprehensive evaluation by a qualified physiotherapist is crucial to developing an effective and personalized treatment plan. Additionally, collaboration with other healthcare professionals, such as doctors, dentists, orthodontists, or oral surgeons, may be necessary for comprehensive care.