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.

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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.

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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.

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.

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

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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
  • the 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, the frontal, occipital, ethmoid, and vomer.

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

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

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The alignment of this joint is important. William Sutherland, DO, father of cranial osteopathy, believed that the rest of the skeletal system moves to accommodate the SBJ. If the two bones of the joint are not aligned well, it can affect the endocrine, nervous, and cardiovascular systems.

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

When the SBJ is misaligned, it affects the jaw. (Remember, your internal jaw muscles attach to it.)

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

This is how the sphenoid bone can affect the structure of the body. Craniosacral therapists pay a lot of attention to the sphenoid and can gently move it into better alignment.

Treating TMJ issues: what various professions do to help

I’m going to write about what various healing professions do to treat TMJ issues to help you be good consumers and know what to expect in terms of results. I am a massage therapist who specializes in TMJ work, including intra-oral (inside the mouth) work, in which I’ve had special training.

I want to say up front that most massage therapists do not work inside the mouth, which is where the jaw muscles most likely to be causing TMJ pain are located. Most massage therapists have the skills to release tension in the external jaw and neck muscles. Maybe that’s all you need, if your jaw pain isn’t severe and it comes and goes. You will feel better after such sessions.

But if you are really suffering from chronic or severe jaw pain and dysfunction, you probably want a lot more than that. You will greatly benefit from intra-oral work, which takes special training and experience to do effectively.

Do not hesitate to ask whether a therapist you are considering working with is trained in releasing tension in the internal jaw muscles and uses gloves or finger cots.

Whole-body work can also help, when the TMJ pain is related to your posture (for instance, head forward posture).

These are the major results that help with TMJ symptoms, along with the professional training that can provide them:

  • reducing stress (massage therapist, acupuncturist, yoga teacher, meditation teacher)
  • reducing tension in your external jaw muscles (massage therapist)
  • releasing trigger points in your external jaw muscles (any kind of therapist with trigger point release training)
  • releasing your neck tension (massage therapist, physical therapist, chiropractor)
  • getting your pelvis aligned and balanced (massage therapist, physical therapist, chiropractor)
  • preventing your teeth from cracking due to bruxism (dentist)
  • reducing tension in your internal jaw muscles (massage therapist with special training, physical therapist with special training, Rolfer)
  • getting craniosacral therapy to restore alignment in the external cranial bones (craniosacral therapist)
  • getting craniosacral therapy to restore alignment in the internal cranial bones (craniosacral therapist)
  • repairing a torn or perforated articular disk (oral surgeon — get reviews first)
  • getting whole-body therapy to help with alignment and release strain patterns (craniosacral therapist, Rolfer, Zero Balancer, yoga teacher, yoga therapist)

This is a brief and imperfect overview to help you get the results you want, and there are many fine points not mentioned here.

 

Treating TMJ issues: the jaw-pelvis connection

The jaw-pelvis connection is real! When I ask my TMD (temporomandibular disorder) clients if they also have pelvic alignment issues, a lot of them say yes.

If your pelvis is out of alignment, quite often, so is your jaw.

Here’s how that relationship works: The pelvis includes the base of the spine, your sacrum. Your jaw — mandible — is near the upper end of your spine, and it has a special relationship with C1 and C2, the uppermost two vertebrae of your spine at the top of your neck.

Because the opening/closing motion of the jaw is both hinging and gliding, the axis of rotation is not in the actual jaw joints but is located between these two vertebrae (Guzay’s theorem — the images show the TMJ and the axis of rotation when with jaw closed — left — and open — right).

(Image source: The Heart of Listening Volume 2 by Hugh Milne)

When your jaw is misaligned, it affects these vertebrae, impacting spinal and head posture and neurological well-being.

When your pelvis is misaligned, especially the sacrum, it also impacts posture and neurological well-being.

How does that happen? The dura mater is a tough, inelastic membrane that lines the inside of your cranium and forms a tube containing cerebrospinal fluid that surrounds the spinal cord.

It’s the connection between the upper vertebrae and the sacrum. 

The dural tube is attached to the C1, C2, and C3 vertebrae and then descends unattached all the way down to the sacrum, where it attaches to bone again. The dura mater continues to the tip of the coccyx.

When the pelvis is not aligned, it torques the inelastic dura mater, and that torque continues all the way up to the upper neck vertebrae that affect the movement of the temporo-mandibular joints — TMJs. 

This torquing of the dura mater may be seen in abnormal spinal curves, pelvic rotation or tilt, head tilt, and cranial bone misalignment, which can affect your fluids, hormones, and nerves.

If your pelvis is giving you problems, put your fingertips in front of your ears and open and close your jaw. Notice if your left and right TMJs move differently. You may notice one side opens first or otherwise moves asymmetrically.

It seems likely to me that this contributes to nine times more women than men suffering from TMJ disorders, since women tend to have more pelvic floor issues than men.

The floor of the mouth, from underneath.
The floor of the pelvis, from above.

Other ways these two areas resonate:

  • The mandible crosses the midline and has two joints on either side, the TMJs. 
  • The sacrum also crosses the midline and has two joints on either side, the sacroiliac joints. 
  • The front of the pelvis, the pubis, also crosses the midline, and the hip joints (acetabula) lie on either side.
  • The pelvic floor and the floor of the mouth are similar in structure, as seen in the images above. The pelvic floor and the floor of the mouth are both horizontal tissues in the body, which consists primarily of vertical tissues. The places where vertical and horizontal tissues meet are more subject to holding tensions.
  • Fascia, which surrounds and permeates muscles, connects the pelvis and jaw. Restrictions in the fascia affect alignment.
  • Many people clench their jaws when stressed — and may also tighten their anal sphincters. 
  • At about day 15 in embryological development, two depressions form: one develops into the mouth and the other that develops into the urinary/digestive/reproductive openings — the openings at either end of the digestive canal.

What to do if you have a misaligned pelvis and jaw issues? An evaluation will help identify your specific issues. Any thorough evaluation for jaw pain will include an assessment of pelvic alignment. A treatment plan will include manual therapy as well as homework, including moves to avoid, to strengthen and align the pelvis and jaw.

If you suffer from TMJ issues, I host a Facebook group called Word of Mouth for people looking for information and solutions for these issues.

I offer free 30-minute consultations to evaluate TMJ issues that can be done in person in my Austin, Texas, office, or from anywhere over Zoom. Schedule your free consultation session here.

Therapy for the head, jaw, and mouth

I am back in the office after several days of serving as a teaching assistant for the training in TMJ and the cranial base. This class was taught by Christian Current, who did a great job teaching this for the first time. I’ve taken this class as a student twice from Ryan Hallford since 2013. They’ve both taught me a lot.

Christian is my officemate, along with Denise Deniger, who just completed this series as a student. It was a pleasure to be able to assist him and to share time with all of these biodynamic and classical craniosacral therapy students over the past 18 months. I’m looking forward to our study/practice group!

I’m also practicing the techniques I learned in the Upledger Institute’s classical craniosacral therapy classes and am signed up for another class in mid-August.

Between these trainings and several years of practice, I can help with many mouth and jaw issues of pain and alignment.

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I’ve become aware that a lot of folks simply live with “issues in these tissues” because they don’t know that help is available. A dentist may recommend wearing a mouth guard for TMJ problems, but this only protects the teeth from grinding away.

Real, lasting help means working with the muscles that hold the bones in place. Just as you can lengthen your hamstrings by holding a standing forward bend for a few minutes, a bodyworker trained in mouth work can guide the small but powerful muscles around your jaw to lengthen.

The work is gentle, slow, and precise. It should never hurt. You can signal me at any time to remove my gloved finger from your mouth.

This work can be helpful if you’ve had braces or a bridge that crosses the midline of your upper teeth. Dentists are not usually aware of the craniosacral rhythm, and braces and bridges can affect the alignment of your cranial bones.

Other reasons to seek out this work include having experienced facial or head injuries, including concussions. Curiosity is another good reason to come in!

I am running a special offer this summer: Come in for 60-minute craniosacral therapy sessions and pay $70 each. Just go to the home page and click the link to book your first appointment online. You’ll get an email confirmation, and you can opt for a text reminder the day before.