by Alton Ching, DPT, OMT, MS
and Deanne Smith, MPT, COMT, MS
Did you know that neck and shoulder pain or stiffness can play a role in TMJ disorders? If you are suffering with TMJ problems, stop for a moment to consider that the muscles of the neck and shoulders are connected to the jaw. If you have chronic stiffness or misalignment in your neck or shoulders, it can directly affect the function of your jaw joints.
Symptomatic TMJ dysfunction affects 28% of the adult population. Approximately 80 million people in the U.S. suffer from some form of TMJ disorder. Many people go to their dentist or orthodontist to treat TMJ with dental work or a dental appliance. But if you additionally have pain, stiffness, or misalignment in your neck and shoulders, you may want to consider getting some physical therapy to help treat the problem. Physical therapy will teach you how to improve your posture and joint motion, decrease muscle tension, and strengthen your neck and jaw. Physical therapy, along with a dental treatment, may greatly improve your situation.
An experienced physical therapist can perform a comprehensive evaluation of your TMJ, neck, thoracic spine and shoulder girdle to determine the structures causing TMJ symptoms. Based on his findings, he will implement a plan to treat your underlying bio-mechanical problems. Not all physical therapists are experienced in treating TMJ, so you need to search for the right practitioner. Start with your dentist, orthodontist, or oral surgeon — they can often refer you to someone. If not, search Google or Yelp to find a physical therapist who treats TMJ. When you have your appointment, don’t be surprised if your physical therapist puts on exam gloves and feels your jaw muscles and joints from inside your mouth — that is often part of a thorough TMJ evaluation!
What is the TMJ?
The TMJ (Temporo Mandibular Joint) is a joint formed between the temporal bone of the cranium (skull) and the horseshoe-shaped mandible, or jawbone. Everyone has two TMJs, one on the right and one on the left. Slide your fingers along the bottom edge of your cheekbone toward your ear, then stop just before the ear. Open and close your mouth to feel it move.
Proper TMJ movement is dependent on the position of your teeth, cranium, neck, mid-spine, and shoulder girdle. If you have suffered a loss of strength and motion in the spine and shoulders, the TMJ often compensates for the poor alignment. Like other joints in the body, the TM joint has muscles, tendons, ligaments, a joint space where the bones meet, and a joint capsule. Along with a semi-attached fibrocartilage disc in the joint space, all of these tissues produce and guide the movement of the TMJ.
Try this simple activity: sit comfortably, bring your teeth gently together, then slowly tip your head back. Do you feel a little more tension in your jaw? This is because the TMJ is no longer in its most relaxed position. Your jaw closure muscles must contract just to keep your mouth closed. If you do this unwittingly throughout the day at work, you can develop a lot of tension in this area without actively clenching your jaw!
Smooth, coordinated movement of both TMJs allows your jaw to open, close, move sideways, backward and forward. You make these movements to effectively chew, manipulate food, drink, swallow, speak and yawn. During normal opening, for example, the end of your mandible (condyle) rotates first, then slides forward and down along the temporal bone, with the disc coming along to make the movement smooth. The condyles of each end of your mandible should rotate and translate equally and simultaneously. When this does not happen, the unequal movements may cause excessive stress and strain on the muscles, ligaments and joint capsule of one or both TMJs.
Symptoms and Causes of TMJ Disorder
People with TMJ disorder usually have some or all of the following symptoms:
- jaw and facial pain/tension
- jaw cracking/popping
- neck tension
- ear pain
- headaches
- toothaches
- problems chewing, swallowing, opening your mouth, or yawning
- difficulty turning your head
- problems with “sitting activities,” such as working at the computer, or reading
TMJ disorder can be caused by misaligned teeth, poor dental work, incorrect swallowing habits, teeth clenching and/or grinding, poor jaw development, trauma, and degenerative disease. Your dentist, or a dentist who specializes in TMJ can tell you whether your problem can be corrected with dental work or a dental appliance. Be sure to tell your dentist if you experience chronic neck and shoulder pain, so he can evaluate whether physical therapy may additionally help treat your TMJ problem.
TMJ Treatment with Physical Therapy
When you come in for your physical therapy evaluation and treatment, you can expect your therapist to analyze your jaw mobility and release muscle tension in the head and neck region. Your therapist may insert a gloved hand into your mouth to treat the jaw closure muscles that are only accessible from inside the mouth. This technique allows your therapist to passively move the stiff TMJ in the proper direction and facilitate movement again.
The neck also often needs passive joint mobilization to fully restore jaw motion for opening, closing and chewing. Once your therapist gets your neck and jaw joints moving appropriately again, strengthening and stabilizing exercises are prescribed to maintain the new position of the TMJ. These exercises can include upper back and neck strengtheners to correct postural alignment, range of motion exercises to promote jaw mobility and isometric holding exercise to strengthen the TMJ. TMJ symptoms may present differently between patients, so your therapist will prescribe treatment that is specifically tailored to your needs.
Alton Ching, DPT, OMT, MS, founded Advance Physical Therapy, Inc. with the goal of building a community of specialized clinicians dedicated to providing the highest level of physical therapy care, education, and outreach to the community.
Dr. Ching combines extensive experience in human biomechanics, anatomy and exercise physiology after earning his Bachelors of Science degree in Exercise Science from UC Davis and Masters in Physical Therapy degree from the University of the Pacific. He continued his advanced training and doctoral residency and board certification in Orthopedic Manual Therapy (OMT) from the Ola Grimsby Institute and specializes in orthopedic physical therapy, sports physical therapy and neurological rehabilitation.
Dr. Ching served as a research consultant with the UC Davis Medical Center and the Orthopedic Surgery physicians on improving surgical techniques focused on repairing lumbar fractures. He has developed cardiac rehabilitation programs for post-operative care programs for cardiac patients at the UC Davis Adult Fitness Center and at California Pacific Medical Center in San Francisco.
Dr. Ching has served as the ergonomics consultant for UCSF Millberry Fitness Center and a consultant for physical therapists in orthopedic manual therapy in the Bay Area. He has established consultative relationships with biotechnology, sports medicine, nutrition and corporate companies. He continues to provide workshops for preventive injury care and screening for medical groups, physicians, dentists, Team in Training, corporations in Silicon Valley, sports teams, school institutions, and the local community.
Deanne Smith, MPT, COMT, MS, offers a comprehensive approach to physical therapy practice that combines advanced manual therapy training and scientifically-prescribed therapeutic exercise.
Deanne combines an extensive experience in chronic pain management, anatomy and exercise physiology after earning her Bachelors of Arts degree in Biological Sciences from Wellesley College, her Masters of Science degree in Physical Education/Exercise Physiology from the University of Wisconsin-Madison and Masters degree in Physical Therapy from Samuel Merritt College. She continued her advanced orthopedic specialty training and became certified as an Orthopedic Manual Therapist (COMT). She currently serves as an assistant instructor for the advanced credentialing courses in Redwood City, CA.
Deanne implemented research methodology at the Stanford Center for Disease Prevention studying “The Effects of Exercise and Erythropoietin In Hemodialysis Patients” and provided data for maximal exercise testing, muscle strength, muscle biopsies, and lactate analysis for participants. She served as the Clinical Exercise Physiologist in the Cardiopulmonary Rehabilitation Departments and provided continuing education on chronic disease management for medical staff and patients. Deanne has furthered her clinical specialty and interest in pain management. Her understanding of pain physiology and application of cutting-edge research has enabled her to provide patients with more effective treatment outcomes to resolve and minimize pain.
You can reach Advance Physical Therapy, Inc. at 650-551-0330 or visit www.advanceptinc.com. Their offices are located in Redwood City, CA and Sunnyvale, CA. You can email the practice at info@advanceptinc.com.