For a tiny Joint, the jaw joint (or ‘TMJ’) can cause a lot of problems. If you have pain in the jaw, clicking, or difficulty opening or closing your mouth, read on to find out causes, symptoms, and what can help.

In this article

The TMJ: small but mighty
Jaw joint anatomy
Symptoms of jaw joint problems
The posture connection
Mixed signals, tics and tinnitus
So what’s the answer?
The osteopathic approach

The TMJ: small but mighty

If you’ve ever had dysfunctional TMJs, you’ll really appreciate these hardworking little joints. Clicking and pain in the jaw whenever you open your mouth can make a misery of life.

These little articulations are between your jawbone (‘mandible’) and the temporal bones of your skull. Technically, their names are the ‘temporomandibular’ joints (or TMJs).

These tiny joints work harder than any other joint in the body. They’re active whenever you eat, speak or move your mouth.

You can easily feel them working – place your fingertips just in front of and below your ears and open your mouth. The bulge you feel is the top of the jawbone (the ‘condyle’) moving down and out of its socket in the temporal bone.

As with so many things, we tend to take these small but important joints for granted while they’re working well. But when something goes wrong, we really know about it.

Now that you know where they are, let’s take a closer look at the TMJs.

Jaw joint anatomy

The curved top ends of the jawbone (the condyles) sit into small hollows in the temporal bones of the skull.

Like most other joints, the TMJs are enclosed in a fibrous capsule that’s filled with fluid. The thicker, outer part of this capsule is the ‘lateral temporomandibular ligament’. It provides strength and stability to the joint.

Smaller ligaments connect the jawbone to the skull and a little bone in your throat (the ‘hyoid’). These ligaments send signals to the brain as they stretch, becoming pain if your jaw starts to move further than it should.

Inside the joint is a small piece of cartilage – an ‘articular disc’ – that splits the joint space into two. This disc provides cushioning and smooth movement as the jaw moves.

And passing just behind the joint are small blood vessels and a nerve (the auriculotemporal nerve). We’ll talk more about why this is important later on.

The jaw joints move in complicated ways. They hinge, but also slide back and forwards and sideways. The clever design of our TMJs means we can chew, chat, sing, laugh, and many other daily movements.

You can feel the larger muscles that close the jaw. Place your hands over the angles of your jaw and clench your teeth. You’ll feel your ‘masseter’ Muscle working here. Then move your hands to your temples – the muscles you feel here are the ‘temporalis’ muscles.

There are also a pair of small muscles in your cheeks, called the ‘pterygoid’ muscles. They help open and close the jaw and move it sideways and back and forward. Like other muscles, they can develop knots or become tight. The lateral pterygoid muscle attaches directly to the TMJ’s articular disc. As we’ll see later, this makes it significant in the development of TMJ disorders.

Symptoms of jaw joint problems

You might think that TMJ problems simply mean pain in the jaw. But the more we understand these little joints, the more we find out that they can lead to surprising symptoms!

Here are some of the symptoms that can develop from TMJ problems:

• Pain around the jaw when opening and closing the mouth
• Clicking or locking of the jaw joints
• Face, neck and back pain
• Headaches and migraines
• Fatigue
• Wry neck (‘torticollis’)
• Difficulty swallowing or sense of fullness in the throat
• Tinnitus
• Blurry vision
• Tics and movement disorders

So for such small joints, the effects can be really huge!

How do TMJ disorders cause so many problems?

The TMJs are complex, and the things that go wrong can be complicated too. Let’s take a look at some common symptoms of TMJ problems and how they happen.

Muscle pain

Pain in the jaw and cheeks can simply be a sign that the muscles are overworking. This can cause painful muscle knots (called ‘trigger points’) to develop.

Knots like these mean the muscle can’t function properly, and sometimes this will make other muscles work harder. You may find generalised aching around the face and head.

On top of that, trigger points can also refer pain to other areas. For example, knots in the temporalis muscle can cause pain that spreads over the brow, to the back of the head, and down to the front teeth.

Overworked jaw muscles may be a sign that you’re clenching or grinding your teeth (bruxism). Many people who grind their teeth are unaware that it’s happening. It can be related to stress or anxiety.

Beyond pain in the jaw muscles, bruxism can lead to neck pain and headaches, and damage the enamel on your teeth.

Pain, clicking or locking when opening and closing

Sometimes, there can be a problem inside the joint itself. This is usually to do with the articular disc.

The disc should sit neatly over the top of the condyle of the mandible. It moves back and forward as the joint opens and closes.

However, sometimes the disc gets pulled out of position. A blow to the face or spasm of the muscle that attaches to it (the lateral pterygoid) can yank it forwards.

The central area of the disc itself, which normally sits between the bones, isn’t pain sensitive. But when it shifts forward, the disc pulls the tissue behind it into the joint space. This tissue is very sensitive. The bony surfaces of the joint can squash it, causing a lot of jaw pain and inflammation.

The disc can get bunched up in front of the condyle. As the jaw opens, the condyle slides down and forwards. The disc can suddenly pop backwards over it, causing a click.

You may also have a click as you close your mouth, and the disc shifts forward again.

Sometimes, the disc can get stuck, causing the joint to lock. You may find you can only move your jaw a little.

Arthritic pain

Just as with other joints, the TMJs can be prone to arthritis. In fact, studies suggest that between 8% and 16% of the global population have jaw arthritis. This might be osteoarthritis, which is a degenerative, ‘wear-and-tear’ condition. Or it might be rheumatoid or psoriatic arthritis, which are both auto-immune disorders.

Symptoms of arthritis overlap with those of other TMJ disorders. They include pain in the jaw, which may be aching or stabbing, restricted movement, clicking or grating sounds, pain that spreads to the face, ear or teeth, neck pain and headaches.

The TMJs are complicated. Disorders of the TMJ are also complicated. The symptoms of different TMJ problems can be very similar. And sometimes, distant or apparently unrelated symptoms can originate in the TMJ.

The posture connection

You’ve probably heard of a ‘forward head posture’ or ‘text neck’. It looks

But how can poor posture affect the jaw?

We humans are very visual creatures. Sight is our primary sense, and our brains will prioritise it over most other things.

If you bend your neck forward, your eyeline drops down. Then your brain will compensate by tilting the head backwards on the top of the neck to bring the eyes back up. Unfortunately, this tensions some of the muscles of the throat, which normally act to pull the jawbone down.

You can feel this effect for yourself. Keep looking at a point in front of you and stick your head out as far as you can. You’ll feel your jawbone pull back and down a little – this is ‘retraction’.

A retracted jaw wants to hang open. To counteract this, the big jaw-closing muscles come into play – the masseter and temporalis. These strong muscles become hyperactive, driving tension and headache.

Alongside this is the sustained pressure on the muscles of the neck, shoulders and upper back. They are balancing the weight of the forward head. The TMJs are misaligned, and the joints of the top of the neck are compressed.  Nerves and ligaments are pinched or stretched. It’s no wonder we begin to see so many symptoms beyond jaw pain arising in this spiral of dysfunction.

Mixed signals, tics and tinnitus

The tiny auriculotemporal nerve stems from the main nerve that provides sensation to the face and works the muscles of the jaw. It runs just behind the TMJ, tucked between the jawbone and one of its ligaments.

When the mandible shifts backward (see The posture connection), it can compress the auriculotemporal nerve.

As well as poor posture, this shift, or ‘retraction’, can result from oral problems. As a child grows, the roof of the mouth (palate) should widen sufficiently to allow space for the tongue and jawbone to rest naturally.

If the arch of the mouth stays too narrow, it can ‘fence in’ the mandible, preventing it from sitting in its ideal position. The mandible shifts backward, risking jaw pain, TMJ disorders and nerve compression.

A narrow palate can result from trauma to the face or thumb-sucking as a child, or sometimes it’s just a family trait. Whatever the cause, a qualified dentist is sometimes able to correct a narrow arch, especially early in life. This allows the mandible to shift forwards, decompressing the jaw joints and their nerves.

The long reach of a little nerve

Beyond simply pain in the jaw, the auriculotemporal nerve seems to be a factor in the development of other symptoms. This is because it connects to an area of the brain where signals can get mixed up with those of other nerves.

These nerves supply and control a wide range of functions in the neck and head. Such functions include sensation of the eye, movement of the face, neck and shoulders, hearing and interpretation of sound, and sensation of the throat and voice box.

If the brain misinterprets signals from the auriculotemporal nerve, it could trigger problems in all those other areas. The results, therefore, can be as far-ranging as spasm, wry neck (‘torticollis’), hoarseness, a sense of fullness in the throat, vocal disorders, and neck, shoulder or facial tics, and tinnitus. That’s a lot of problems for one small nerve! 

Tinnitus

Tinnitus affects around 11.5% of people who have TMJ disorders. This could be due to signals coming from the auriculotemporal nerve getting mixed up with signals from the ear. In addition to that, there are a couple of other possible explanations.

First, the proximity of the jaw muscles to the tiny muscles of the middle ear mean TMJ dysfunction could bring on or aggravate tinnitus. Second, there’s a direct ligament link from the TMJ to the malleus (a tiny bone of the middle ear). This means damage to the TMJ could inhibit correct function of the middle ear, as suggested by this study.

So what’s the answer?

As you might expect – it’s complicated! The first step is to assess the structure and function of the TMJs to ascertain how they might be contributing to symptoms.

You may want to seek advice from your doctor or dentist. Choose a dentist that understands TMJ biomechanics and has an interest in treating TMJ problems. You may be referred for dental X-rays, CT scan or MRI to get a clear understanding of structural issues in the joint.

Treatment options may include painkillers or muscle relaxants, oral splints to protect against tooth grinding, corticosteroid injections or even joint surgery.

Many osteopaths treat TMJ disorders, sometimes alongside dental treatment. Let’s take a look at how osteopathy can help.

The osteopathic approach to the TMJ

An osteopath takes an integrative approach to assessing and treating TMJ disorders. That means they look at how the TMJ functions, but also at the function of the neck (especially the upper neck), the back, shoulders, hips, legs and feet. Osteopaths are great at seeking out issues in one area that have rippling effects throughout the body.

For example, side-to-side tilts in the pelvis have a knock-on effect further up the body. Misalignment in the back and neck can then produce muscle imbalance and malalignment of the jaw. This has been noted in people with scoliosis, who have a greater incidence of TMJ symptoms.

As such, it’s wise to seek a wide-ranging biomechanical assessment. Your osteopath can treat your jaw pain directly, reducing spasm and trigger points in the muscles of the face, mouth, throat, head and neck. They can gently improve joint mobility and reduce inflammation and irritation.

But they can also work to address postural problems, muscle imbalances or joint restrictions in other areas that might contribute to your jaw dysfunction. Unless these triggers are resolved, you’re unlikely to get a long-lasting resolution.

At OCHK, we can also empower you with a corrective exercise programme. You’ll learn why certain areas of your body are connected to your symptoms and what you can do about it.

We can also offer counselling. It’s widely accepted that stress can be a significant trigger in the development of TMJ disorders. If you think this is an issue for you, get in touch, we’d be pleased to help.

Combining osteopathy and dental work

People having orthodontic treatment to correct a bite can benefit from osteopathic treatment. This is because of that close connection between posture and jaw alignment.

Even if you have no jaw pain, addressing your body’s structure to ensure the jaw joints are ideally positioned can give you the best outcome for your dental work.

Looking for TMJ treatment?

If you think you might have a TMJ disorder, or you’d like to know if your headaches, back pain or other symptoms might be connected to your TMJs, get in touch. We’d love to work with you to develop a lasting solution. Book today!

The post A Pain In The Jaw: What Is The TMJ, Anyway? appeared first on Osteopathic Centre Hong Kong.