A Guide to Physical Therapy for Temporomandibular Joint Disorder (TMD)
Millions of people suffer from TMD (Temporomandibular Joint Disorder) each year in the U.S. TMD can put a major damper on daily life due to changes in sleep, eating, and even cognition. Working with a CityPT clinician can help.
Temporomandibular joint dysfunction is the second most commonly occurring musculoskeletal condition (after chronic low back pain), affecting approximately 5 to 12% of the population.1
In many cases, TMD can be treated effectively with physical therapy. In this article, we will discuss the symptoms, causes, diagnosis, and treatment of TMD. We will also explore prevention strategies that can help you avoid this condition altogether.
- Understanding Temporomandibular Joint Disorder
- Symptoms of TMD
- What are the Most Common Causes of Tempormandicular Joint Disorder?
- Diagnosing Temporomandibular Joint Disorder
- What to Expect from Physical Therapy for TMD
- What If Conservative Treatment Doesn't Work?
- Preventing Temporomandibular Pain
- Is It Time to Seek Treatment?
Did you know? TMD is often mistakenly referred to as TMJ, which is an abbreviation for the jaw joint itself.
Temporomandibular joint disorder (TMD or TMJD) is a condition that causes pain in the jaw joint and/or muscles that control jaw movement. When pain occurs in the TMJ, there are a variety of potential underlying causes and affected tissues.
Jaw Anatomy Review
The temporomandibular joint (TMJ) is the joint that connects your lower jaw (mandible) to your skull. It’s a unique compound joint that allows your jaw to move in two different directions — up and down, and side to side.
The TMJ complex is an inherently unstable joint due to the nature of the surfaces (two convex surfaces). It requires a significant amount of stability from the ligaments and the disc as well as appropriate neuromuscular control to allow normal function.
The TMJ is a synovial joint that has smooth cartilage and a thick viscous fluid (synovial fluid) to aid in movement — just like all of your other moveable joints, such as the knees, shoulders, and hips. Plus, it has a disc similar to your spine vertebra. The disc is the primary stabilizer of the jaw. When dysfunction of the normal movement occurs the disc can translate forward causing a host of mechanical issues.
TMD can cause a wide variety of symptoms. The most common symptom is pain in the jaw joint and/or muscles that control jaw movement. This pain can be sharp, dull, or achy, and it can radiate from the jaw to other areas of the face, head, neck, or even shoulders.
Other symptoms of TMD include:
- Clicking, popping, or grating sounds when you move your jaw
- Limited ability to open or close your mouth
- Locking of the jaw in an open or closed position
- Difficulty chewing or pain while chewing
- Swelling on the side of your face
- Earache, ringing, or a feeling of fullness
- Difficulty sleeping
- Changes in balance
- Difficulty focusing or a sense of "brain fog"
Warning: Jaw pain can be a sign of a heart attack. If it is accompanied by other symptoms like chest pain, dizziness, shortness of breath, nausea, or numbness in the left arm — seek medical care immediately.
There are a variety of potential causes of TMD that affect different tissues of the jaw joint complex. Let's review:2
- Clenching or grinding your teeth (bruxism)
- Muscles spasms
- Joint inflammation
- Chewing gum excessively
- Biting your nails
- Eating hard foods
- Poor posture that puts strain on the jaw, neck, and/or shoulder
- Stress and anxiety (typically due to teeth clenching)
- Trauma to the jaw or face, such as whiplash or a fall
- Mental health changes
- Changes in tooth alignment (tooth loss, braces, movement, etc.)
- Prolonged mouth opening (dental procedures or general anesthesia)
- Seasonal allergies
- Sinus conditions
- Connective tissue disorders associated with conditions like Marfan's Syndrome, Cerebral Palsy, and Down Syndrome
- Inflammatory diseases such as rheumatoid arthritis, gout, and ankylosing spondylitis
If you think you may be suffering from TMD, the first step is to visit your doctor, physical therapist, or dentist for a comprehensive evaluation. They will take a complete medical history and ask about your symptoms. They will also conduct a physical examination of your face, neck, and jaw to look at:3
- Posture of the jaw, tongue, and neck
- Range of motion of the jaw
- Mobility of the neck (cervical spine) and upper back (thoracic spine)
- Tenderness in the muscles or joints
- Clicking or popping sounds when you move your jaw
- Any visible changes to the structure of your face, jaw, or teeth
If needed, your doctor may order imaging tests, such as x-rays, MRIs, or CT scans to get a better look at the structures of your jaw or rule out other causes of jaw pain. They may also refer you to a specialist, such as an oral surgeon or dentist that specializes in jaw pain.
Physical therapy is one of the most effective ways to treat TMD because it can target all of the potential underlying causes, such as joint mobility restrictions, muscle length deficits, and neuromuscular coordination dysfunction. A CityPT physical therapist will develop a customized treatment plan to address your specific needs.
Treatment may include:
- Joint mobilizations or soft tissue massage to reduce pain and tension, and improve range of motion4
- Modalities for short term pain relief, such as heat or ice
- Exercises to improve range of motion, strength, and coordination — of the jaw and entire upper body
- Education on optimal posture (for sitting, sleeping, etc.), ergonomic modifications, and body mechanics with daily activities to promote local tissue health
- Relaxation techniques to reduce stress and muscle tension
- Education to understand your pain, triggers, and learn how to protect your jaw from further injury
If your physical therapist notices that your jaw pain is linked to changes in your teeth or they believe you may be grinding your teeth (known as bruxism), they will likely refer you to your dentist for a night splint to promote jaw relaxation. Your dentist can also help with underlying causes related to tooth alignment.
Conservative care will be effective for the majority of people to get pain relief. With severe cases of joint damage, injections or surgery may be recommended. Talk to your physician about your options.
There are a few things you can do to help prevent TMD or keep it from getting worse:
- Eat softer foods and avoid chewing gum and/or candy
- Practice good posture by setting up your work space and other frequent positions for optimal tissue balance
- Build awareness around potentially aggravating activities, such as clenching your teeth or biting your nails
- Relax your jaw muscles by placing your tongue on the roof of your mouth (when appropriate)
- Do not open your mouth unnecessarily wide, such as with yawning or eating foods like hamburgers
- Manage stressful situations when possible
- Practice regular stress management with regular self-care, exercise, socializing, etc.
- Manage any underlying mental health disorders
- Stretch and strengthen your jaw and neck muscles regularly
- Talk to your dentist or physical therapist about concerns
- Make healthy lifestyle choices, such as adequate sleep, hydration, a nutrient dense diet, and avoiding smoking to promote optimal tissue health and reduce overall body inflammation
TMD can make it hard to do what you love, from eating to sleeping well or talking with a friend. Rather than hoping the pain will go way or just dealing with it, get the care you need.
With the help of a CityPT specialist, you can book an appointment and starting getting relief as soon as possible.
This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.
NIDCR. Prevalence of TMJD and Its Signs and Symptoms. National Institute of Dental and Craniofacial Research. Accessed November 19, 2022. https://www.nidcr.nih.gov/research/data-statistics/facial-pain/prevalence ↩
Physiopedia. Temporomandibular Joint Disorders. Physiopedia.com. Accessed November 2, 2022. https://www.physio-pedia.com/Temporomandibular_Disorder ↩
Fernandes G, Franco AL, Gonçalves DA, Speciali JG, Bigal ME, Camparis CM. Temporomandibular disorders, sleep bruxism, and primary headaches are mutually associated. J Orofac Pain. 2013 Winter;27(1):14-20. doi: 10.11607/jop.921. PMID: 23424716. https://pubmed.ncbi.nlm.nih.gov/23424716/ ↩
Calixtre LB, Moreira RF, Franchini GH, Alburquerque-Sendín F, Oliveira AB. 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 randomised controlled trials. J Oral Rehabil. 2015 Nov;42(11):847-61. doi: 10.1111/joor.12321. Epub 2015 Jun 7. PMID: 26059857. https://pubmed.ncbi.nlm.nih.gov/26059857/ ↩