Physical Therapy and Temporomandibular Disorders
Temporomandibular joint (TMJ) is a hinge that connects skull and jaw. One TMJ is located on each side of your jawline. Just like other joints in your body, TMJ is prone to damage, pain, and different disorders that affect its function and your quality of life. Temporomandibular disorders (TMDs) can cause pain in your jaw and muscles that control its movement. TMD causes great difficulties related to eating, speaking, chewing and even kissing for these patients which is why the treatment is of a vital importance. Many joint-related conditions are treated with physical therapy, but can it help in this case too? In today’s article, we decided to cover the basics about the temporomandibular joint disorder, only to later discuss the importance of physical therapy as a part of the treatment plan for such a joint disorder.
What is TMD?
The TMJ contains muscles, blood vessels, bones, and nerves. Muscles participate in chewing and they allow you to open and close your jaw. The jawbone is controlled directly by TMJ and it performs two motions: hinge action or rotation and gliding action. Thanks to the temporomandibular joint you can open your mouth wide enough so that you can eat, drink, speak, kiss, chew – activities without our life would be impossible to live with. In many cases, temporomandibular disorders are called TMJ just like the joint itself, but that is an inaccurate term. The proper term is either temporomandibular disorders or TMDs and temporomandibular joint syndrome. The temporomandibular joint syndrome is a term that is being used to refer to the problems with your jaw, and the muscles that control your jaw.
About 12% of Americans or 35 million people are affected by TMD at any given time[i]. Although men can develop this problem too, the majority of patients seeking treatment for TMD are women in childbearing years – from 18 to 44 whereas men are exposed to a lower risk compared to women,
Causes and symptoms of TMD
Despite wide prevalence of TMD, the underlying cause is still unknown. Painful disorders affecting TMJ can occur due to joint damage, cartilage damage, and when disk erodes out of its alignment. Factors that increase your risk of getting TMD are:
- Arthritis – rheumatoid arthritis and osteoarthritis, the two most common types of arthritis
- Jaw injury
- Chronic clenching of teeth
- Connective tissue diseases
- Stress – since it leads to teeth grinding and clenching
- Poor posture in the neck
- Genetic predisposition to pain sensitivity
- Excessive chewing of gum
- Use of orthodontic braces
In many cases, patients experience a number of symptoms including pain and tenderness in their jaw, facial pain, locking of the joint i.e. difficulty to open or close your mouth, difficulty chewing, pain in one or both TMJs, pain in and around the ear[ii]. Patients can also experience tinnitus or ringing in the ears. Characteristic clicking or popping sounds in the temporomandibular joint might also be heard. The symptoms can affect one or both temporomandibular joints at a time. The symptoms can spread far away from the joints and affect your eyes, causing blurred vision, your neck, causing stiffness to develop and your shoulders as you would experience radiating pain.
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Diagnosis and treatment
Usually, it is the dentists that notice the symptoms of the temporomandibular disorder first so they advise their patients to visit their doctor to get these symptoms checked in. In most cases, the physical exam and the anamnesis tell everything to the doctor so the diagnosis is easily set and a treatment plan is developed. Methods such as X-rays, CT scan, and ultrasound are commonly used as well. In some cases, the doctor can perform a TMJ arthroscopy to confirm the diagnosis. Temporomandibular joint disorders do not always require treatment. Some people experience symptoms relief by only applying warm compressions over the joint and jaw, using painkillers and avoiding chewing on any gum or hard food for a while. For others, a treatment plan is developed. The treatment plan can involve anything from physical therapy, medications, surgery, Botox injections etc. depending on how severe the symptoms actually are. Surgery is usually the last treatment in mind after all of the other usual treatment methods have been tried and did not show any change in symptoms.
Does physical therapy help?
Physical therapy consists of many different methods such as massage, exercise, electrotherapy, hydrotherapy, thermotherapy and many others. Up until now, physical therapy has proven its beneficial effects on many occasions, helping people all around the world dealing with different diagnosis to go back to their lives and participate as much as possible. Physical therapy is one of the most beneficial treatment options for many joint-related conditions, but it’s not the first thing we think of when TMDs come to mind. These disorders are usually treated with medications, lifestyle modifications, and surgery as last resort. Physical therapy can be a great approach, too.
A review of studies on this topic published in the Physical Therapy journal analyzed 36 papers and 12 of them met the criteria for final selection. Scientists found that postural exercise can reduce pain and improve function in the oral opening. A combination of manual therapy and active exercises can decrease pain intensity and the similar effects were accomplished through low-level laser therapy treatment, muscular awareness relaxation therapy, and biofeedback training[iii].
A growing body of evidence confirms that physical therapy may be effectively utilized as a standalone treatment for TMDs, but it’s even more successful when it is used in combination with other approaches. Physical therapy also has the potential to induce changes in stomatognathic dynamics[iv]. The stomatognathic system is defined as an anatomic system consisting of jaws, teeth, and soft tissues.
How physical therapy works?
As shown above, physical therapy can be your trusted ally in the management of TMD. To get the maximum out of this treatment approach, it is necessary to work with a physical therapist with experience in programs for patients with TMD. Physical therapy works by stretching the joint, providing relaxation, and it releases scar tissue and tight muscle.
Not only will this unlock your joint, but the added flexibility can help you chew and open your jaw without pain and discomfort. Besides acting as a valuable TMD management approach, physical therapy is also useful for patients who have undergone surgery for this disorder.
Physical therapy is a frequently used term, but it is largely misunderstood. It’s not just about exercises, but more than that. Techniques that are used to help patients with TMD include[v]:
- Massage to alleviate muscle tension
- Jaw exercises to improve flexibility, the range of motion, and muscle strength
- Ultrasound therapy i.e. the use of high-frequency sound waves to alleviate pain and swelling while improving circulation
- Heat therapy to improve blood flow to the affected joint, while at the same time reducing the pain
- Ice therapy to numb pain, improve blood flow and reduce any present swelling
- Training to correct your posture
- Movement of TMJ to release scar tissue and improve flexibility
- TENS (transcutaneous electrical nerve stimulation) to relax muscles, improve blood flow, and alleviate pain
Not only does physical therapy relieve pain and improve flexibility, but it also provides much-needed education that a patient can use in every aspect of their life to prevent symptoms of TMD and with that prevent TMD from ever happening in the future again.
The temporomandibular joint is yet another joint that is commonly affected by symptoms such as radiating pain, swelling, reduced the range of motion, stiffness, and inability to achieve the most basic movements that allow a person to eat, speak, chew, kiss etc. The temporomandibular joint is commonly affected by a range of issues known as temporomandibular disorders or temporomandibular joint syndrome. Temporomandibular disorders are common and they affect millions of people. The symptoms are a quite characteristic involving pain, swelling, clicking sounds, locking of the jaw, reduced range of motion etc. Common treatment options include intake of medications, lifestyle modifications, and surgery, but physical therapy can be effective too. A growing number of studies confirm the efficacy of physical therapy due to its ability to relieve pain, increase flexibility, provide more muscle strength, and it educates patients to improve their quality of life. All of these beneficial effects provide a chance to reduce the symptoms and improve the patient’s wellbeing so that no trace of the temporomandibular disorder is left behind. In addition, physical therapy will teach you what you should and should not do if you are interested in avoiding the temporomandibular disorder any time soon as well.
[i] TMD Basics: the basics of the jaw joint, TMJA http://www.tmj.org/Page/34/17
[ii] TMJ disorders, ;Mayo Clinic https://www.mayoclinic.org/diseases-conditions/tmj/symptoms-causes/syc-20350941
[iii] McNeely M, Olivo SA, Magee DJ. A systematic review of the effectiveness of physical therapy interventions for temporomandibular disorders. Physical Therapy 2006 May;86(5):710-25. Doi: 10.1093/ptj/86.5.710 https://academic.oup.com/ptj/article/86/5/710/2857458
[iv] Wright EF, North SL. Management and Treatment of Temporomandibular Disorders: A Clinical Perspective. The Journal of Manual & Manipulative Therapy. 2009;17(4):247-254. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813497/
[v] Physical therapy for temporomandibular disorders, WebMD https://www.webmd.com/oral-health/physical-therapy-for-tm-disorders