alignment Archives - MaryAnn Reynolds, MS, LMT, BCTMB

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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.

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.

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.

My Practice

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.

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.

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.

What to do if you have jaw issues? I offer a 30-minute in-person TMJ consultation to gather information and evaluate your issues. I teach clenchers an alternative to clenching as well as the above information to stop grinding.

These habits are major contributors to TMJ issues, and you can change them.

If you’re not in Austin, I can do the above as well as help you learn what to ask about when seeking TMJ relief near you. Just let me know if you need a phone or Zoom consultation.

I offer a combination TMJ Consultation plus TMJ Relief session in person in Austin, Texas. The consultation serves as an intake, so I have a better idea of what your issues are and how we’ll measure progress. Your consultation is free when combined with your first TMJ Relief session. This is a two-hour session.

To be fair, when you’ve had TMJ issues for a long time, or they are acute, you may need multiple sessions to retrain your system to retain the ease and alignment, along with doing your homework to stop clenching or grinding your teeth.

I offer a package of four TMJ Relief sessions for 10 percent off single sessions, best done a week or two apart. These sessions are 90 minutes and integrate various bodywork modalities — including work in your mouth — so that you feel great when you get off the table. They are best done over 4 to 6 weeks.

If you’re really adventurous, you can schedule a 75-minute Self-Treatment for TMJ Issues session on Zoom where we’ll do an intake and I will teach you how to work on releasing the tension patterns that cause problems, including working in your own mouth. You’ll need clean hands and short nails. It’s really not that hard! Learn more about it here.

My Practice

Treating TMJ issues: what various professions do to help

What do various healing professions do to treat TMJ issues?

I’m going to try to answer that, to help you be better health-care consumers and know what to expect in terms of results.

By the way, I am a massage therapist who specializes in TMJ work, including intra-oral (inside the mouth) work, in which I’ve had advanced training from three teachers and experience since 2013. I admit, I am biased!

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 do have the skills to release tension in the external jaw and neck muscles. Maybe that’s all you need, if your jaw pain is mild and intermittent. You will feel better after such sessions.

But if you are really suffering from long-term jaw pain and dysfunction, you definitely need more than that to get relief. You could 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.

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

Here’s a look at results you might expect from working with practitioners in different professions:

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 (massage therapist)
doing myofascial release on your external jaw muscles (massage therapist)
releasing neck tension (massage therapist, physical therapist, chiropractor)
getting your pelvis aligned and balanced (massage therapist, physical therapist, craniosacral therapist, chiropractor)
getting your head aligned on top of your spine (craniosacral therapist, chiropractor)
preventing your teeth from cracking due to grinding (dentist or over-the-counter night guard)
checking whether grinding in your sleep is related to airway obstruction (sleep specialist)
reducing tension in your internal jaw muscles (massage therapist with special training, physical therapist with special training, Rolfer as part of 10-series)
restoring alignment in the cranial bones (craniosacral therapist)
repairing or replacing a dysfunctional articular disk (oral surgeon)
getting whole-body therapy to help with alignment issues and release strain patterns (craniosacral therapist, Rolfer, Zero Balancer, yoga teacher, yoga therapist)

There is one major caveat here: these are generalities based on my own knowledge and experience. Each profession has its specialties. Not all physical therapists work on the jaw or pelvis — in fact, not many do.

Do not hesitate to ask questions and do your own research.

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

These habits are major contributors to TMJ issues, and you can change them.

If you’re not in Austin, I can do the above as well as help you learn what to ask about when seeking TMJ relief near you. Just let me know if you need a phone or Zoom consultation.

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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 back of your pelvis includes the base of your spine, the triangle-shaped sacrum. Your jaw — mandible — is near the upper end of your spine, and it has a special relationship with the uppermost two vertebrae at the top of your neck, C1 and C2.

Because the opening/closing motion of the jaw is both hinging and gliding (open your mouth slowly and you can feel it hinge, then glide forward as you open wider), the axis of rotation is not in the actual jaw joints but is located between these two vertebrae, according to Guzay’s theorem (Guzay was an engineer interested in neurology).

The images below show the TMJ and the axis of rotation when with jaw closed (left) and open (right). The upper cross-hairs show the TMJ, and the lower cross-hairs show the actual axis of rotation for jaw opening and closing.

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

When your pelvis is misaligned, it affects these vertebrae, impacting neck and head posture and neurological well-being. (This is why nearly everyone I treat for TMJ issues also has neck issues, which I treat too.)

How can the pelvis affect the jaw? There is a tough, inelastic membrane surrounding your spinal cord that connects your sacrum with your cranium. The dura mater lines the inside of your neurocranium, includes membranes between the two hemispheres and between the cerebrum and cerebellum of your brain, and forms the dural tube containing cerebrospinal fluid that surrounds the spinal cord, all the way down to your sacrum.

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

When the sacrum is not aligned with the other pelvic bones — in other words, when you have sacroiliac joint problems, it torques the inelastic dura mater all the way up to the upper neck vertebrae that affect the movement of the 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 central nervous system.

Here’s a little exercise: put your fingertips in front of your ears and open and close your jaw slowly a few times. Notice if your left and right TMJs move differently. You may notice one side opens first and/or protrudes further out or forward than the other.

This shows your TMJs are unbalanced. Because the mandible is one bone with two joints, even if one joint is out of balance, the other joint is affected, though you may not feel symptoms in both.

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

The floor of the mouth, viewed from below.

The floor of the pelvis, viewed from above.

Other ways these two areas resonate:

The sacrum also crosses the midline and has two joints on either side, the sacroiliac joints.
The pelvic floor and the floor of the mouth are similar in structure, as seen in the images above. Both are horizontal tissues in the more vertical body. The places where vertical and horizontal tissues meet are generally more subject to holding strain patterns.
Fascia in muscles and bones connects the pelvis and jaw. Restrictions in the fascia affect the alignment of bones.
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 develops into the openings at the other end of the digestive canal.

These habits are major contributors to TMJ issues, and you can change them.

If you’re not in Austin, I can do the above as well as help you learn what to ask about when seeking TMJ relief near you. Just let me know if you need a phone or Zoom consultation.