Tag: advanced integrative bodywork

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Treating TMJ Issues: some medications cause jaw clenching

I’ve learned that some widely used medications can cause jaw clenching and grinding as side effects.

The best known are in a class called SSRIs, selective serotonin reuptake inhibitors, commonly prescribed for depression and/or anxiety.

I’m sure you’ve heard of Prozac (generic name fluoxetine). Here are some other SSRIs that can cause bruxism. There may be others:

  • Zoloft (sertraline)
  • Celexa (citalopram)
  • Lexapro (escitalopram)
  • Paxil and Pexeva (paroxetine and paroxetine CR)
  • Viibryd (vilazodone)
  • Luvox (fluvoxamine and fluvoxamine CR)

Do not stop taking them without a doctor’s supervision, as you may have withdrawal symptoms, possibly dangerous.

This is a known problem. This link to an abstract of a 2017 journal article for psychiatrists has more. I don’t have access without paying a lot of money, but you can share this link with your psychiatrist if this applies to you, and there may be updates on this topic.

https://pubmed.ncbi.nlm.nih.gov/28492455/

In general, if you take any of these medications and you are clenching or grinding your teeth, talk to your doctor about alternatives. From the abstract: “Alternative classes of antidepressants reviewed include serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, atypical antidepressants, and monoamine oxidase inhibitors. Findings indicate that dopamine agonists and buspirone are currently the most effective medications to treat the side effects of SSRI-induced bruxism, but results regarding the effectiveness of specific antidepressants that avoid bruxism altogether remain inconclusive.” (My italics.)

One more bit of info: I had a new TMJ Relief patient who was taking an SSRI. I treated her and gave her the info above.

Unlike others I’ve treated, she didn’t notice a difference in how her jaws felt and moved at the end of her first session.

However, she emailed me the next day to tell me that for the first time in a while, she woke up without severe jaw pain and headache.

So even if you are taking one of these SSRIs and have jaw pain, one of my TMJ Relief sessions can help.

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Treating TMJ Issues: choose a practitioner who works on your lateral pterygoids

Recently I’ve had two clients come in for TMJ relief sessions who have previously seen multiple practitioners who worked inside their mouths. Between them, they have seen chiropractors, chiropractic neurologists, Rolfers, dentists trained by the Las Vegas Institute (LVI), and/or other massage therapists.

Each of these clients told me “No one has ever touched me there” after I worked on releasing tension in their lateral pterygoid muscles.

These small muscles are hard to access, being nearly surrounded by bones and tendons (cut away in the image below so you can see the upper and lower branches of the lateral pterygoid).

They are not easily accessible on everyone, being overlaid by the coronoid process of the mandible and the temporalis tendon, but they can definitely be influenced.

In my experience of giving over a thousand TMJ Relief sessions, many TMJ issues are due to an imbalance in muscle tension among the nine muscles that are directly involved in moving the mandible and numerous others that connect to the bones of the mouth and jaw.

The lateral pterygoids are often the muscles most responsible for releasing jaw tension and relieving clicking and popping noises on opening and/or closing.

Notice that the upper head of the lateral pterygoid is attached to the articular disc that separates the temporal bone and the mandible —the two bones of the temporomandibular joints.

When this disc does not move smoothly with the mandible when the jaw opens and closes in a hinge-and-glide motion, a clicking, popping, or crunching noise often occurs.

anatomy of the jaw muscles

It’s not that the other jaw muscles don’t contribute. They do. I’ve found tension in the temporalises, trigger points and taut bands in the masseters, and taut bands in the medial pterygoids, not to mention strain patterns from lower in the body.

In sessions, I work on the lateral pterygoids after working on the medial pterygoids. They can take time to access and can be sensitive, because most new TMJ Relief clients have never been touched there.

It helps to have small pinky fingers, and even then the area is so tight that sometimes I need to ask a client to shift their jaw to one side to get my finger near the muscle and joint.

Most of my TMJ clients are not aware when they come in that there are even jaw muscles there!

When I massage a lateral pterygoid, it can be a revelation. “That’s the place!” clients exclaim when I remove my finger.

Once I get there, I don’t need to stay long to make a difference. I invite my TMJ clients to move their jaws after I work on each muscle pair. Releasing tension here helps create a sense of spaciousness and ease around the joint.

To feel it for yourself, retract your mandible backward as far as you can. In other words, pull your chin in. You should feel some muscle activation in front of your ears and even in your ears. Kd

If jaw pain and tension (and clicking or popping) are your major complaint, and you’d like a sense of ease and spaciousness in your jaws, schedule a free 15-minute Discovery Call or a TMJ Relief session on my online scheduler. (I live and work in the Austin, Texas, area.)

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Treating TMJ issues: types, causes, and exercises

I have discovered an excellent source of information about TMJ pain and dysfunction. It’s a great website called Be My Healer offered by a doctor of physical therapy, Sophie Xie.

She’s got a couple of posts about TMJ issues. I am impressed with the quality of her posts in terms of credible information, writing to a lay audience, and her images. You go, Dr. Sophie Xie!

First, this article helps distinguish between types and causes of TMJ dysfunction. In short:

  • Type 1 is arthrogenous TMJ, meaning the problem is related to the functioning of the bony temporomandibular joint. There are two causes: arthritis and disc displacement. She recommends the best treatments for each cause. (Exercises* can help .)
  • Type 2 is myogenous, meaning muscle-related. Causes include bruxism (clenching and/or grinding), muscle imbalance (such as forward head posture, chewing on the same side, playing the violin), and systemic influence causing muscle tension (such as chronic stress, fibromyalgia, PMS).

Dr. Sophie Xie writes, “TMJ massage therapy can help by releasing the tense mastication muscle and provide pain and stress relief. However, you will need to call around to find a massage therapist who is specialized in intraoral release to receive the most targeted treatment.”

Here’s me raising my hand, signaling “Pick me!” I can help with all of the muscle-related types of TMD. I offer intra-oral work, help relieve forward-head posture, and help you relax from stress.

Again, exercises* can also help.

  • Type 3 is idiopathic, referring to a single cause: trauma impacting the joint  from accidents, injuries, dental treatments, even violent laughing or yawning.

Dr. Sophie Xie writes, “Post-traumatic TMJ pain is highly preventable. Early intervention such as physical therapy and massage therapy are excellent in preventing scar formation and muscle stiffness​. Gentle and progressive jaw stretching and exercises* will build a strong muscle function to keep chronic and repetitive TMJ pain away.”

Again, I can help.

*In her post Say goodbye to TMJ pain with these 5 convenient jaw exercises, Dr. Sophie Xie describes and shows (with delightful illustrations) exercises to strengthen and balance your jaw muscles.

She writes, “Most people experience significant TMJ pain reduction with daily exercises after 5-6 weeks. You should experience even faster results if you are also combining TMJ massage therapy with a nightly mouth guard.”

Her website has a contact page if you want to work with her. (I believe she’s practicing in Washington state.)

If you are in Austin, Texas, I’m happy to help.

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Treating TMJ issues: de-stress quickly with these breathing techniques

Learning how to de-stress yourself is huge. Everyone experiences stress. It’s just part of life.

Stress becomes an issue when there’s too much of it, and your system has trouble rebounding resiliently to a calm, alert state.

How is this relevant to TMJ issues? So much TMJ misery is related to chronic and acute stress. It’s one of the major contributors to TMJ issues. People clench and grind due to stress, and stress is always accompanied by muscle tension, which causes a lot of jaw issues. 

Staying stressed for too long is bad for your well-being. It affects your digestion (including absorption of nutrients and detoxification) and creates unnecessary wear and tear on your vital organs.

I’m talking about bad stress as opposed to good stress, such as the anxiety before a performance that makes you a better performer, or the adrenaline you feel when a bad driver nearly hits you that helps you react quickly and successfully avoid being hit.

In my opinion, bad stress includes most news about politics (just donate money and volunteer for candidates you like) and traumatic events (there’s always something awful happening in the world).

Also, the desire to control others’ behavior can bring about bad stress. Better to focus on accepting them as they are and work on a healthy path for yourself.

Maybe they’ll witness you and want to change themselves.

You can still care and have a constructive strategy to manage stressors.

You can do these things from a calm, alert state. Imagine that.

The beauty of using a little breathwork to get yourself out of an unhelpful state of stress (any stressor that does not require immediate action) is that breathwork bypasses your mind.

Has “you need to calm down” ever helped anyone to actually calm down, whether it’s yourself or someone else telling you this?

Breathwork is also quick. You can simply do a little breathwork when stressed, and your system starts shifting into parasympathetic mode.

A note to the chronically stressed: here’s how to tell when you’re in a parasympathetic state. Your whole body starts to feel a softness and relaxation because you have let your guard down. You notice your that breathing has changed, to becoming slower, deeper, with longer pauses. 

If this is hard, because maybe you’ve been carrying the guarding that often occurs after a trauma, try this: Imagine yourself in a completely safe environment where you don’t have to be guarded against anything. Maybe you are surrounded by softness, or floating in body-temperature water. You may have any objects (real or imaginary) that bring you comfort. 

Let go of your thoughts and just be. 

The more you practice breathwork and conscious relaxation, even when not stressed, the more it gets wired into your neurology.

The physiological sigh

The physiological sigh is breathwork technique that’s getting a lot of attention now. It’s been recognized for 80 years as a behavior people do automatically when claustrophobic and in other stressful situations.

Now you can put it to work for yourself when you need to de-stress yourself.

I learned about it from Dr. Andrew Huberman, a Stanford University professor who runs a neurobiology lab and has a podcast.

In brief, it’s two inhalations through the nose, and one longer exhalation through the mouth. (I think of it as the “sniff sniff ahhhhh” breath.)

Here’s a video demonstrating technique.

Dr. Huberman says sometimes people fall asleep if they do it 15 times in a row, but just three of these physiological sighs are enough to start slowing your heartbeat down in 20-30 seconds.

I nearly always yawn when I start doing physiological sighs.

4-7-8 breathing

Another fairly quick breathwork technique for reducing stress is the 4-7-8 breathing (the Relaxing Breath). Dr. Andrew Weil, who has been practicing and writing about holistic health and integrative medicine for 30 years, came up with it.

Dr. Weil recommends doing four of these breath cycles at least twice a day for two months to get the benefits. This wires it into your neurology.

He recommends slowing the cycle down, with the limiting factor being how long you can comfortably hold your breath.

It can also help with cravings and falling asleep.

In essense, you are retraining your nervous system to be more relaxed.

You may become less stressed from using either or both of these techniques and still benefit from receiving a TMJ Relief session to retrain your jaw muscles into relaxation. The breathwork will help your body retrain itself more quickly and prevent relapses.

If you’re ready to have that conversation with me, please connect. I’d love to hear from you.

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Treating TMJ issues: the effects of stress

For decades, the news has cautioned us about the ill effects of stress on our health, longevity, and happiness. But what is stress and how do you know when you are experiencing it? What does it have to do with jaw pain and dysfunction? Most of all, what can you do about it?

Stress is your body’s response to threats, real or imagined. You become alert, focused, and energized, ready for action. It is a physiological response designed to protect you in dangerous situations, to get you away from the danger or to confront it. Something in us is always scanning for danger and ready to respond.

It also gives you the energy to meet life’s challenges, for example, taking a test, interviewing for a job, making an important presentation, having a difficult conversation, scoring a point, winning a game, driving safely. Doing anything difficult where you care about the outcome requires some extra energy and focus.

So stress isn’t inherently bad — but too much stress can damage your health and quality of life. In the fight-or-flight response (sympathetic dominance of the autonomic nervous system), your body releases stress hormones. Your heart rate goes up, your blood pressure rises, your muscles tense, your breathing quickens, and your senses become sharper, all so you can respond to the situation.

We’re designed to respond this way in extraordinary situations, and the rest of the time (which ideally would be most of the time), to live peacefully, nourishing ourselves, cooperating with the group, resting, relaxing, having fun, and enjoying our lives (parasympathetic dominance, or rest-and-digest mode).

Physiologically, the heart rate slows, breathing slows, blood pressure goes down, muscles relax, and attention becomes broader. In this state, your system has more resources for digesting and assimilating your food and repairing damage.

The switch from rest-and-digest to fight-or-flight occurs quickly and automatically, bypassing your conscious mind. You become aware afterwards that your state has changed.

This is a good exercise: How do you know you are experiencing stress? What tips you off? Do you notice a sudden sharp inhalation and muscle tension? (That’s what I notice.) Do you feel your heart pounding? Do you notice that your mind suddenly becomes focused and alert?

Another good exercise: How do you know you’re okay? Is there a kinesthetic signature that lets you know you are relaxed? I feel a peaceful, happy feeling in my chest. What do you notice?

What does stress have to do with jaw pain and dysfunction? Almost every bit of information available about the causes of TMD connects it to stress. Muscle tension is a universal response to stress. The jaw muscles tighten.

Most everyone experiences stress, but not everyone experiences jaw symptoms. No one seems to know why this is. Here are some of my observations and hypotheses.

  • I’ve observed that most people carry way more muscle tension from stress in their upper bodies, in the upper back, shoulders, neck, jaw, and/or face. For some, all of those places get tense. For others, only one or two get tense.
  • The jaw is the only part involved in chewing and talking. Chewing doesn’t have any associations with threats or danger that I can think of. If the food tastes good and is safe and your teeth and jaws are healthy, chewing is a pleasure.
  • Talking can be dangerous. Some clients have directly related the onset of their jaw symptoms with feeling unsafe about freely expressing themselves about a difficult situation they had with another human being. This could have happened long, long ago, with the unpleasant memory being repressed.
  • Some people have had so much stress and/or trauma in their lives, it’s become chronic. They don’t know how to deeply relax.

Maybe some people are predisposed to have jaw issues. It could be from the strains of their birth and an attempt to reshape the head. It could be a learned strain pattern that runs in their family. It could be from a lack of nutrients that help form healthy jaws (read more about the work of Weston A. Price, DDS, on this topic). I’m sure there are many other possibilities.

I do know that for everyone, help is available. You can release (or get help releasing) the tension in your jaw muscles. You can examine your past, with psychotherapeutic help or by journaling or talking to a trusted friend. You can learn to deeply relax, and it’s a pleasure. And that’s a good topic for tomorrow.

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Treating TMJ issues: sleep posture

Are you aware that there is a pillow specially designed for people with TMJ and neck issues? I’ve had one for several years, and I love it. I take it with me when I travel and when I camp. Since I started using it, I’ve never woken up with neck or jaw pain.

It’s the Therapeutica Sleeping pillow, designed by a chiropractor and an ergonomic designer. It’s…different-looking.

Screen Shot 2018-07-13 at 6.51.17 PM

It’s designed for people who sleep on their sides or their back.

I don’t believe there are any pillows designed for stomach sleepers, which is hard on the neck and not great for your organs either.

This pillow comes in five sizes, and you order the size that fits your shoulder width. The proper-sized pillow keeps your head and neck aligned with your spine. Since we spend a third of our lives sleeping, this is important! Good sleep posture makes a difference over time, resulting in fewer neck and jaw issues.

Screen Shot 2018-07-13 at 6.55.05 PM

The indentations on the “wings” relieve pressure on your jaw when side-sleeping. Some users also find it helps with shoulder issues.

The pillow comes with a 5-year warranty not to lose its shape or resilience, and many users have used it long beyond 5 years. I put a king-size pillowcase on my average size pillow, which comes with a zippered case.

At $86.99 for an average size, the Therapeutica Sleeping Pillow is expensive for a pillow. If you average it out over 5 years, though, you pay less than $20 per year for child, petite, average, and large adult sizes, and about $22 for extra large. When you look at it that way, it seems totally reasonable to spend this much on a pillow.

Note the link above is for the average size. Be sure to measure and get the size that’s designed for your shoulder width.

Are you a back sleeper? It’s the recommended sleep position for people with TMD. The back-sleeping-only pillow is called the Travel Pillow, and it comes in three sizes.

On Amazon, read the reviews and the Q&A. Note that not everyone likes this pillow. I believe you should try it for a week before deciding, because it may be very different from what you’ve been sleeping on, and therefore it will take time for your body to adjust. You can and will adjust if you give yourself time.

Your flexible spending account may cover the cost, so check on that if you have one. With Amazon, you can use an app like Honey that watches for price changes and notifies you via email if the price drops within 60 days.

For more on TMD and sleep, check out these sites:

If you’ve found relief from TMJ pain using this or a different pillow, please share in the comments.

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Treating TMJ issues: releasing trigger points in your jaw muscles

You have nine jaw muscles: two pairs of large ones on the outside of your head (the masseters and temporalises), four small ones inside your mouth (two medial pterygoids and two lateral pterygoids), and one in the floor of your mouth (digastric).

Any of them can get trigger points.

What is a trigger point? It’s unhealthy muscle tissue that causes pain that can occur locally to the trigger point or at some distance — referred pain.

Healthy muscle tissue is made of bundles of fibers that run in the same direction. This tissue is pliable. It contains fluid. It stretches or contracts when you move.

Screen Shot 2018-07-12 at 8.36.04 AMA trigger point is a spot where the muscle tissue has lost its pliability. A massage therapist may feel that some tissue in a particular spot feels hard, creating a small nodule that’s hard and stiff. The tissue feels dense and often rolls under the fingers when compared to healthy muscle tissue.

Trigger points cause that band of muscle fibers within a muscle to shorten and tighten, restricting full range of movement of the entire muscle.

Trigger points feel tender when you apply pressure to them.

Where several of them occur in an area, they form “constellations.” If one of those trigger points in the constellation is the primary one and the rest are satellites, it takes trial and error to locate and treat the primary one — and until that happens, the satellites keep reoccurring.

This makes them the tricksters of the nervous system, and it’s why specialists in trigger point therapy are rare and sought after.

You can work on your own trigger points to release them. It helps if you’ve received trigger point work from an experienced massage therapist, but you can learn to do it yourself. Even then, you may prefer to have a massage therapist work on them, especially if you have a lot of them.

Even with an experienced therapist working on your trigger points, sometimes the body clearly says “no more today,” a signal to move on to another technique and schedule another session.

Screen Shot 2018-07-12 at 8.08.14 AMMy favorite reference book for working with trigger points is The Trigger Point Therapy Workbook, third edition, by Clair Davies and Amber Davies.

It is written for laypeople to release their own trigger points, but many massage therapists use it as a reference book in their offices. I got my copy spiral-bound for ease of use.

When I am working on TMJ issues, I sometimes notice that people have trigger points in their masseters, the big external jaw muscles on the sides of your face that run from your cheekbone to the bottom of your jawbone.

Here’s how to find trigger points in your own jaw: using a bit of pressure, drag your fingers slowly down the masseter muscle on both sides of your face. Do this several times, experimenting with adding pressure, and notice if there are tender spots or small dense spots that roll under your fingers. Repeat on the other masseter.

If you don’t have masseter trigger points, this usually feels pretty good.

Screen Shot 2018-07-12 at 8.41.19 AM
Left: trigger point locations in the left masseter. Right: areas of associated pain. Source: The Trigger Point Therapy Workbook. 

If you find trigger points in your masseters (and you can have other TMJ issues without them), there are several ways of treating them.

Some therapists apply a huge amount of pressure. I don’t recommend this because if you have TMJ issues, your jaw is probably already out of alignment, and applying lots of pressure could make it worse.

A better way, in my opinion, is to use less pressure. Yes, you can gently release trigger points!

I learned to do this from a local (Austin) massage therapist, Rose of Sharon, who is very experienced with trigger point release. She’s worked on me and released many trigger points, teaching me how to do this in the process.

If you have a lot of trigger points, I highly recommend seeing her. She’s amazing at discovering patterns if you have “constellations” of trigger points.

If you are interested in having her work on you, you can reach her by phone or text at 512-282-1672. Please leave a message with your name and number so she can contact you.

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Treating TMJ issues: the role of the sphenoid bone

The sphenoid bone is one of the most fascinating bones in the body. If you were looking at someone and could see their bones, the sphenoid would be behind their eyes and in front of their ears, with the outermost parts (the greater wings) accessible at the temples, and the lowermost parts (the pterygoid processes) being what your internal jaw muscles attach to behind your upper back teeth.

The word sphenoid comes from the Greek for wedge-shaped. Its shape has been likened to a moth, a bat, a butterfly, and a wasp. It definitely has wings! 

Here’s a picture of it, as viewed from the front.

Screen Shot 2018-07-10 at 8.53.53 AM

It’s a central cranial bone that does many important things:

  • it connects to your internal jaw muscles
  • muscles involved in swallowing are attached to it
  • it helps form the orbits of your eyes
  • your optic nerves meet, cross, and pass through it
  • your pituitary (master gland) sits on top of it (in the “sella Turcica” — Turkish saddle!)
  • it contains two air sinuses, the sphenoidal sinuses, which open into the nasal cavity through the ethmoid bone
  • it has openings for major blood vessels and nerves of the head and neck
  • the tentorium cerebelli, part of the membranous system surrounding the central nervous system, attaches to it

The sphenoid has been called the keystone bone of the skull. It touches 12 other cranial bones: the two parietals, two temporals, two zygomas, two palatines, and the frontal, occipital, ethmoid, and vomer.

The occiput is considered the base of the cranium. The place where the sphenoid and occiput meet is called the sphenobasilar joint (SBJ).

You can see the SBJ in the middle of the image below where the orange and yellow bones meet.

Screen Shot 2018-07-10 at 8.58.35 AM

The alignment of this joint is important. William Sutherland, DO, father of cranial osteopathy, believed that the alignment of the entire skeletal system is influenced by the SBJ.

Misalignment of the SBJ obviously affects other cranial bones, which fit closely together, something like a spherical jigsaw puzzle.

If the SBJ is out of alignment, it affects the temporal bones, the upper bones of the temporomandibular joints (TMJs), colored reddish-pink in the image above.

Your internal jaw muscles attach to your sphenoid. In my TMJ Relief sessions, the clinical intraoral work relieves tension in these muscles, helping to release tension affecting the sphenoid and SBJ.

If the bones of the joints are not aligned well, it can also affect the endocrine, nervous, and cardiovascular systems.

Alignment of the SBJ is also a consideration in migraines, headaches, sinus problems, head/neck/back pain, scoliosis, eye movement, and problems with behavior, personality, learning, coordination, hormones, and emotions.

Craniosacral therapists pay a lot of attention to it and can gently help it find better alignment.

Getting this bone and joint properly aligned creates an often-subtle shift that ripples out into more ease and better health.

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Treating TMJ issues: what would you like to learn more about?

I’m two-thirds of the way through writing daily posts about living with, treating, and resolving TMJ disorder issues.

I’ve posted on who tends to get it, linked to videos of self-care techniques, written about reducing night grinding and daytime clenching, explored the connection between the jaw and the pelvis (and the jaw and the endocrine system), shared recommendations about essential oils for relief, discussed the throat chakra, shared an upper body yoga sequence, listed nutrients that can make a difference, described acupressure points, posted on what massage therapists can do to help (includes what I do), what acupuncturists do, and what chiropractors do. And more.

If you’ve tried any techniques that are new to you after reading these posts, what’s helped?

What would you like to learn that I haven’t covered yet? Here are some possibilities. If you have others in mind, please comment.

  • releasing trigger points in your jaw muscles
  • the role of the sphenoid bone in structural health (your jaw muscles attach to it)
  • meditations and music for the throat chakra
  • calming your nervous system
  • mouthguards, night guards, and splints
  • relaxing the facial muscles
  • jade rolling and facial massage
  • what any other professions do to help with TMJ issues
  • the contributions of Weston Price, dental researcher
  • more on any topic I’ve posted on so far

If you have any other TMJ-related topics you’d like to see addressed, please comment.

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Treating TMJ issues: an upper-body yoga sequence

Often neck and shoulder tension accompanies jaw pain. I’m enjoying this seated yoga sequence for neck and shoulder tension, recommended in a FB conversation about what people with TMJ do for self-care. It’s 8:29 in length.

Yoga for Neck & Shoulder Tension

I’m a big fan of yoga, having practiced it since 1982. It’s definitely helped with stress, tension, flexibility, energy, body awareness. I’ve taken yoga teacher training and taught restorative yoga and one-on-one classes for yoga newbies.

My yoga orientation is alignment-oriented hatha yoga like Iyengar and Anusara, which I combine in my home practice with sun salutation vinyasas and balance poses to meet the needs of my body. I notice I’m becoming more and more attracted to kundalini yoga.

If you do yoga, do you have any favorite asanas or breathwork practices for jaw pain?