Treating TMJ issues: asymmetries in the rest of the body

Jaw pain is rarely entirely in the jaw!

If you were building a tower, and one of the floors wasn’t level, it would affect the floors above it — unless you somehow compensated.

The Leaning Tower of Pisa is kind of like that, only it’s because it settled unevenly on the ground beneath it. As they built it over the years, it would sink, stabilize, sink more…

The structure of the body is like that too — even when standing on level solid ground.

Because the jaw is near the top of the skeleton, imbalances below can affect the alignment and functionality of the temporomandibular joints (TMJs).

The primary cause of most jaw pain is asymmetrical hypertonicity. Thanks, TMJ Mastery teacher John Corry! That means that some of the muscles that affect the jaw are tighter than others.

I include a basic structural evaluation in my free TMJ consultations. It’s pretty cursory. I’m just looking for asymmetries. Here’s how I do it.

The patient stands with their shoes off.

I feel the space under theIr arches and check whether their feet (or one foot) are pronating or supinating.

Checking the points on the tops of the hips to see if they’re level comes next.

I ask about scoliosis if it’s not already apparent. Same with pelvic floor issues.

Then I check their shoulders to see if they’re level.

I look at the patient from each side to see if they have a pelvic tilt toward the front or the back and view their spinal curves.

When they are lying on my massage table, I can check for a leg length discrepancy with their legs flat, and then with feet flat/knees bent. I can also see whether their feet point up symmetrically.

I place the pads of my fingers over their TMJs right in front of their ears and ask them to open and close repeatedly.

Usually one side moves first.

Often one side feels closer to the ear than the other.

Sometimes one side sticks out more than the other.

Try it yourself. What do you notice?

None of this is super precise. I’m just getting a basic read on asymmetries in the structure of the patient that may affect the jaw.

Have you noticed that you have a dominant side? A side that feels stronger than the other?

Have you ever had a foot, ankle, leg, or hip injury? Can you still tell the difference between the injured side and the uninjured one?

Does your physical activity work your body evenly, left and right sides, front and back, upper, lower?

Do you have a full range of movement in your joints?

How’s your posture?

How about your sleep posture?

It’s not my main business to start correcting these asymmetries (except in the upper body/jaw when I can). Becoming more symmetrical can take a while, years in some cases, so I consider it a long-term project for people with jaw pain to find relief, as well as more ease and functionality in their bodies.

Symmetry is also an ideal, like perfection. Most of us are doing the best we can. There’s probably always going to be some asymmetry in the body, but we can definitely address the most dysfunctional areas.

The functional movement screen is a set of 7 movements you do with a trainer, who scores you and can prescribe workouts that strengthen your weaknesses. FMS was developed to identify athletes who were prone to injury before they got injured. It can work for ordinary people too.

Here’s a link to view the screening movements. Find a trainer on your own.

Practices of non-linear movement can help if done regularly over a long period. These movements work both sides of the body. They increase flexibility and balance and fluidity. And they are fun! Examples:

  • yoga, especially if it’s alignment-oriented like Iyengar and Anusara
  • qi gong
  • tai chi
  • Gyrokinesis
  • martial arts
  • dance, especially free-form dancing like ecstatic dance

The type of bodywork that addresses asymmetries is called structural bodywork. There are two main schools of training: Rolfing Structural Integration and Anatomy Trains Structural Integration. Neuromuscular therapy also assesses posture and gait pattern and can address imbalances.

There are a lot of tools that you can use on yourself to improve posture and sleep posture, release muscle tension, help remove strain from the neck and the sacrum. Some of them are included in this post on self-care tools.

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, seen in the images below).

(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. The same when your pelvis is misaligned. 

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.

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 dura mater, and that torque continues all the way up to these upper neck vertebrae that affect the temporo-mandibular joints.

This torquing of the dura mater may be seen in abnormal spinal curves, pelvic rotation, 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 feel different or the same. You may notice one side opens first or is more restricted 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 (jaw bone) 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 a body that consists primarily of longitudinal tissues. The places where these 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 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.

This post in particular has been shared widely on the internet, separated from the rest of my website. 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 also have a private bodywork practice in Austin, Texas, where I offer TMJ Relief sessions. I offer free 30-minute consultations to evaluate TMJ issues.