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: restless legs and sleep bruxism

A new clue about bruxism.

A neurology practice noted that of its patients who had restless legs syndrome (RLS), 60% also had bruxism (grinding teeth during sleep). They found that 52% had RLS, bruxism, and migraines.

Do you relate?

The lead neurologist for this study speculated there is a gene that links these conditions.

It gets more interesting. Both restless legs syndrome and bruxism are involuntary movements occurring during sleep. Is bruxism “restless jaw syndrome?”

I’m always happy to see more research about TMJ-related issues, especially because there are so many factors that play a role in jaw dysfunction and pain.

More about bruxism.

Bruxism includes clenching and grinding the teeth. Some distinguish these as “waking bruxism” and “sleep bruxism”.

They may have different causes, in my opinion.

Sleep bruxism, in contrast to daytime clenching, is hard to treat because it occurs when unaware of your behavior and unable to change it.

Waking bruxism is a habit that can change with awareness and practice. I’ve helped many clenchers learn how to relax their mouth position.

Some things I’ve noted about bruxism in my manual therapy practice:

  • Many people don’t know they grind during sleep until a dentist tells them they have damaged teeth.
  • Bruxism often requires expensive dental work: mouthguards or splints to prevent further damage, and crowns to fortify cracked or broken teeth.
  • Sometimes the noise of grinding during sleep is loud enough to wake up family members, and that’s how people learn they have sleep bruxism.
  • People who grind at night often wake up with jaw, face, or neck pain, earaches, and/or headaches.
  • Over time, bruxism can damage the temporomandibular joints, possibly requiring surgery.

Dentists and jaw issues.

Many people expect dentists to be experts on jaw issues, yet their domain is treating the teeth and gums.

Learning about TMJ disorders is not required in dental school.

General practice dentists can prevent further tooth damage with appliances like mouthguards and splints. They can repair existing tooth damage.

Some dentists may try to adjust the positioning of the TMJs, and a few dentists also address airway issues (like sleep apnea, which also may accompany sleep bruxism) in their work.

Dentists do not address stress or tension in the jaw muscles, which contribute so much to jaw pain.

Some dentists and hygienists in the Austin area refer people with jaw pain or issues opening wide to me. (New alternative to manual therapy during the COVID pandemic: my upcoming online course, Self-Help for Jaw Pain.)

Solutions to try.

If you grind your teeth during sleep, it is possible to stop by using hypnotherapy and EFT.

I often recommend a recorded hypnotherapy session for bruxism that’s available on YouTube to listen to before sleep.

I don’t know if it works for everyone, but it’s soothing — I always fall asleep before it ends. Less stress is always desirable.

As mentioned above, dopamine agonists are prescribed for low dopamine levels.

Dopamine is released when your brain is expecting a reward — when you anticipate a pleasurable activity such as eating a delicious meal, spending time with someone you love, or receiving a big check.

It’s sometimes called “the happy hormone” because it affects your enthusiasm, motivation, and focus.

If you suffer from bruxism, before going the pharmaceutical route with dopamine agonist drugs, you may want to consider nutrition — consuming foods or taking supplements that raise your dopamine levels.

In particular the amino acid tyrosine increases dopamine.

I found a few links that may be helpful:

Treating TMJ issues: portrait of a typical patient

Based on patients I’ve seen for jaw pain since 2013, I created this portrait of a typical patient.

She’s female and first experienced jaw pain in her teen years.

She’s suffered for at least a decade.

She clenches and/or grinds her teeth.

A dentist has prescribed an appliance to prevent damage to her teeth. The chances are 50/50 that she uses it as prescribed.

Woman with jaw pain

Her pain level fluctuates, increasing with stress, and she hasn’t gone more than 6 months free from jaw pain since onset.

Her neck and shoulders are tight. Sometimes she has headaches.

She has sought help from physical therapy, chiropractic, acupuncture, and/or massage therapy, and it helped some, but the results didn’t last.

She wonders if over time, it will get worse.

She is mostly resigned to suffering from jaw pain.

Still, she keeps hoping and searching.

If you can relate to at least some of this, please consider joining my Facebook group, Word of Mouth: Resources for Relieving Jaw Pain/Dysfunction and taking my Self-Help for Jaw Pain course (soon to be announced).

You have better things to do than suffer.

Speaking about my work…

Today I have the good fortune to be interviewed on Mind Body Radio at 10-10:15 am CST. You can listen on the Internet live or find my interview afterwards. Here’s the link: https://mindbodyradio.com.

Sunday I hosted a brown bag education session on craniosacral therapy for 10 of my fellow members of the Austin Wellness Collaborative. I spoke for about an hour about how I got into CST, its evolution and branches, and answered questions. Then I did a demo, talking about what I was doing and sensing, on a fellow AWC member, who also commented on what she was noticing. Success!

Coming up, on January 29 I will be talking to the staff at the office of Dr. Elizabeth Raine, DDS (my own dentist) about what I do and asking questions about what they notice and how they work with TMJ issues. This will be my first talk with a dental office.

It feels good to be doing more educational work, continuing to get the word out that skilled manual therapy can relieve TMJ symptoms.

If you know of an opportunity to educate, please keep me in mind.

TMJ Relief: Some medications cause jaw clenching

I have recently become aware that some widely used pharmaceutical medications 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. I’m sure you’ve heard of Prozac (fluoxetine). Here are some other SSRIs:

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

In addition, antipsychotics like Haldol are said to cause bruxism. Symbyax, which is Prozac plus the antipsychotic Zyprexa (fluoxetine + olanzapine), is also on the list.

In general, if you take any medications in these categories and you are clenching or grinding your teeth, talk to your doctor about alternatives: psychotropics, dopamine agonists, antihistaminergics, and psychostimulants.

Cigarette smoking, caffeine, alcohol, and recreational drugs all may increase the risk of bruxism, studies have found. 

I recently learned that there’s an alternative to pharmaceuticals for treating depression and other mental disorders. It’s called TMS (transcranial magnetic stimulation) and it works with your brain waves (rather than the chemical approach using particles).

I know one integrative MD in Austin who offers it, and your insurance may cover it for depression. To learn more, please connect with Oak Hill Wellness Center. They even offer a free TMS consultation.

It’s been approved by the FDA to treat depression and migraines, and it’s also being used to treat anxiety, OCD, PTSD, Asperger syndrome, TBI, ADHD, and more.

One more bit of info: I had a new TMJ Relief patient who was taking an SSRI for depression. I treated her and gave her the info above, but unlike others I’ve treated, she didn’t notice a difference at the end of the 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 an SSRI and have jaw pain, one of my TMJ Relief sessions (or even better, the 5-sessions-in-4-weeks program) can help, and meanwhile you can be investigating alternatives.