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Jaw Pain & Injuries (TMJ)

Are you suffering from jaw pain? Do you have discomfort or pain when chewing, experience difficulty speaking, a swollen face or headache pain around your temples?

Jaw Physiotherapy can help you relieve your jaw pain at Pivotal Motion Physiotherapy 07 3352 5116 .

The jaw is a complex structure which allows us to eat and talk, and is often used when breathing as well. With all this responsibility, the jaw or temporomandibular joint (TMJ) is often the most used joint in the body, and so there are a range of issues which can arise from overuse, misuse or abnormal scenarios.

Made up of two main bones, the TMJ is the only movable joint of the skull and allows chewing (mastication) and formation of words. The upper aspect of the jaw is fixed, immovable and is called the maxilla. The maxilla holds our upper row of teeth and provides attachment for a range of facial muscles. The lower part of the jaw (commonly referred to as the ‘jaw bone’) is the mandible and is the strongest bone in the body. The muscles and ligaments of the TMJ allow the mandible to move up and down as we chew or talk. TMJ injuries are a special passion of Pivotal Motion founder and principle physiotherapist Bobbie-Jo Strong.

Primary Function of the TMJ

The key functions of the temporomandibular joint (TMJ) is to enable us to speak and chew, and it can also be active when breathing. Pivoting at the joint (found just in front of and slightly below our ear lobes), the muscles of the jaw pull the mandible upwards and cause slight movement from side to side to allow the teeth to properly break down food and begin digestion. Both sides of the jaw contain similar muscles, which keep the jawline and chewing motion even. If you are experiencing jaw pain or discomfort this can signifcantly impact on your daily activities and life.

If you are experiencing jaw pain contact Pivotal Motion today – 07 3352 5116 !

Anatomical structures of the TMJ

The TMJ is made up of six main components:

  • Mandibular head
  • Articular surface of the temporal bone
  • Articular disc
  • Joint Capsule
  • Ligaments
  • Lateral pterygoid

Normal full jaw opening is between 40-50mm. The first 20mm is pure rotation of the mandibular head within the articular surface. At this point, if the mouth continues to open, not only is the mandibular head rotating within the TMJ, but the entire mandibular head and articular disc has to translate forward as wellThe forward translation of the disc and mandibular head is purpose designed to allow further rotation (opening) of the jaw which would otherwise be restricted by the articular surface of the temporal bone.

  • The disc and mandibular head fit into the socket when the jaw is closed
  • The disc and mandibular head slide forward to allow the jaw to fully open

Normal movements of the mandible during function, such as or chewing, are known as excursions. There are two lateral excursions (left and right), forward excursion, known as protrusion and backward excursion being retrusion.

The mandible is primary moved by four predominant muscles:

  • Masseter
  • Medial pterygoid
  • Lateral pterygoid
  • Temporalis

All four muscles work together to achieve each direction of excursion of the jaw. The lateral pterygoid muscle acts to protrude the jaw (translate forward) to allow full opening while the other three muscles all work to close the jaw.

Jaw Injuries & Symptoms

Whilst the strongest bone in the body, the jaw can often be a hot point for injury as it is the only moving part in the skull. Dislocated or broken jaw bones are the most common jaw injury and can cause severe jaw pain. Jaw injuries are often a result of either accidents, or from trauma in contact or combative sports. When dealing with a broken or dislocated, time is hugely important. It is vital to consult the appropriate health professionals as soon as possible, as an increased period before treatment can mean greater risk of re-injuring the body part in future and can complicate recovery.

Dislocation of Temporomandibular Joint (TMJ)

Dislocation of the jaw can occur due to trauma though is more commonly due to a wide opening followed by biting pressure or a dental procedure. General laxity of ligaments or hypermobility may contribute to increased likelihood of TMJ dislocation.

Symptoms of a TMJ dislocation include: pain which is made worse when moving the jaw, abnormal protrusion or misalignment of jaw (teeth don’t line up properly), an inability to completely close mouth, drooling, and difficulty and pain when speaking. When a dislocated TMJ is suspected it is important to attend a doctor’s surgery or hospital as soon as possible as the longer the joint is out of alignment, the more likely the injury is to reoccur.

Break/Fracture of the Mandible

Fracture of the mandible is often caused due to significant trauma to the bone. This generally occurs from a direct blow, whether from physical contact/assault or some form of accident (motor vehicle or such) a broken jaw will present with significant pain, swelling, and pain or difficulty when trying to move the jaw (e.g. speak or chew), bleeding in the mouth and bruising around or under the tongue. Once again it is important to get to a hospital or doctor’s quickly in order to correctly set the jaw and allow complete recovery.

Joint or Muscular Strain around the Jaw

Joint or muscle strains can also occur at the TMJ. The usual mechanism of injury will be hyperextension of the joint. Hyperextension can occur from extending the jaw too far whilst yawning, with problems after lengthy dental procedures being common as well. The most common disorder, known as TMJ Disorder, is often identified be muscle stiffness, joint pain or the constant grinding of teeth, the result of the dysfunction of the joint.

TMJ Disorder can be caused by a range of issues, which are generally broken down into intra-articular or extra-articular. Intra-articular (inside the joint) issues can be caused by; inflammation, structural changes or articular degeneration. Extra-articular TMJ disorders will be caused by muscular imbalances or over-activity in the muscle of mastication (chewing) or neck (cervical spine).

TMJ Disorder will present with a range of symptoms, including acute or aching pain and tenderness in the jaw or temporomandibular joints, minor swelling, pain transferral through the face, difficulty chewing and speaking and locking or grating of the joint.

Physiotherapy can help TMJ or jaw pain.

Physiotherapy is incredibly important for jaw pain to ensure proper and complete recovery. Though each injury will differ slightly, physio can aid in making sure that there is a correct process of healing and to work on a rehabilitation program that will allow you to execute full recovery goals in a timely manner to get you back to health as soon as possible. The treatment of exercises may include:

  • Manual therapy (soft tissue massage and trigger pointing).
  • Joint mobilisation.
  • Education and advice regarding reasonable expectations
  • Exercise programs for rehabilitation.
  • Ice or heat treatment.
  • Work or activity modification advice and referral.

Physiotherapy will be important in treating all TMJ conditions as there will be muscular changes when recovering from either a dislocation or fracture, especially if the joint is immobilised. Our physios can work to release joints and muscles to allow proper function and aid in realignment of the jaw. It will also be important in the treatment of TMJ Disorder as there can be a range of muscular and further joint issues that will arise and be contributing to any pain present.

TMJ Dysfunction and its treatment is of special interest to our principle Physiotherapist Bobbie-Jo Strong and she will be eager to help with your recovery.

How to help avoid TMJ & jaw pain?

Avoiding jaw injuries, which leads to jaw pain, as with avoiding most injuries, involves paying attention to your movements and avoiding situations which could cause issues. As fracture of the mandible usually occurs in accidents, it can be difficult to actively avoid the injury, suggestions would be to limit participation in sports and games where there is a significant possibility of fracture, such as contact or combat sports. Dislocation can be avoided by ensuring that you do not open your mouth excessively wide, as it often occurs due to hyperextension. Similarly stopping yourself from hyperextending can limit the possibility of TMJ Disorder or dysfunction. It can be helpful to also avoid very hard foods, especially if they are large (e.g. large gum balls).

Recovery can be take a long time for mandible fractures or TMJ dislocation. This will be directed by a doctor or surgeon, however physiotherapy will aid in full recovery of the muscles and correct alignment of the jaw. TMJ Disorder can take a long time to recover as well, however our physios will help relieve pressure and tight muscles to help you make a full recovery as soon as possible.