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:

Coming attraction: yoga for the jaw

I’m announcing now that I intend to create a “yoga for the jaw” class by the end of this year. There’s a sweet overlap of demographics: women of child-bearing age are nine times more likely than men to have severe or chronic TMJ issues, and this group also tends to take yoga (and Pilates) classes.

My plan is in the seedling stage right now. I have so much to learn and discern.

It feels good to get back into teaching yoga. I completed teacher training 10 years ago and taught restorative classes for a while. I’ve been practicing since 1982 and have been especially devoted since 1996 after a car wreck. I’m drawn to alignment-oriented classes and teachers, both for my own issues and as a bodyworker.

To this end, I will be taking a workshop from a highly-regarded yoga teacher in Dallas in late September. Embodied Dharma: Yoga, Connective Tissue, and Inter-Being is being offered at the Dallas Yoga Center by Tias Little, who created and teaches Prajna yoga.

Learning from Tias has been on my bucket list for a decade, and I’m finally doing it! Prajna means wisdom in Sanskrit, and Prajna yoga is more comprehensive than most yoga, including more of the eight limbs of Patanjali’s yoga into practice, as well as anatomy and somatic awareness. Tias includes aspects of Buddhism and craniosacral therapy — interests we share — into his teachings.

I am especially looking forward to learning more about yoga for the cranium, jaw, and ear from him.

Thank you, Anna Gieselman, a Prajna teacher at Castle Hill Fitness in Austin, for letting me know about this workshop!

If you’re interested, Anna is teaching a free Prajna yoga class on Labor Day, Free Day of Yoga, at Castle Hill’s downtown location. You can reserve your spot here.

Choose a practitioner for intra-oral TMJ therapy that works on the 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.

These two clients both told me, “No one has ever touched me there,” after I worked on their lateral pterygoid muscles. That surprised me.

These small muscles are hard to access, being nearly surrounded by bones (cut away in the image below so you can see the two-headed muscle), and in my opinion, they are often the keys for releasing jaw tension.

anatomy of the jaw muscles

It’s not that the other jaw muscles don’t contribute. They do, and in roughly 10% of the jaw pain cases I’ve worked on, one of the medial pterygoids is the problem child.

The external jaw muscles — the masseters and temporalises — also play a role in jaw tension but are usually not the biggest cause. Sometimes it’s all of them.

I usually save the lateral pterygoids for last when working on someone’s internal jaw muscles, because they are so hard to access. It helps to have tiny pinky fingers.

It can take time to reach them, and sometimes I can’t reach them on the first couple of visits because all the muscles affecting the TMJs are so tight. Any release of tension in this area near the joint is therapeutic.

Keep in mind that I’m touching where people never get touched. This area can be sensitive. This is why I offered CBD oil to my TMJ clients.

When I get near or on them, it can be a revelation. “That’s the place!” When they are tight, getting some release of tension can profoundly affect the TMJs. Once there, I don’t need to stay long.

It’s not that these other intra-oral practitioners (at least in these two clients’ experiences) have nothing to offer. I’m not familiar with all of them, but chiropractors, Rolfers, and massage therapists have all helped me.

But if jaw pain and tension are your major complaint, and you’d like a sense of spaciousness in your jaws (if you can imagine how great that would feel), go to a practitioner that works on the lateral pterygoids.

I hope this information helps you ask informed questions when choosing a practitioner to relieve your jaw tension and pain.

Free consultation for TMJ issues

I’m please to announce I’ve added a new service. If you have jaw pain or dysfunction and are wondering if I can do anything for you, please schedule a free 30-minute consultation.

A lot of people, including dentists, are not aware that appropriately trained massage therapists can work on relieving your TMJ issues that are due to muscle tension or trauma. 

Screen Shot 2018-05-30 at 8.44.49 PMI’ll ask about your symptoms and your history. I’ll also evaluate your body, including your neck and jaw.

Then we can talk about treatment options. If you’ve never had manual therapy for jaw pain and dysfunction, or if you’ve received it previously from a different practitioner, I’ll be happy to tell you what a typical session is like and the typical progression if you are curious about buying a series of sessions.

Please note: What I find once I start working and how well your system responds are variable with bodywork.

I’ve been doing TMJ Relief sessions since 2013. My teacher was Ryan Hallford of the Craniosacral Resource Center in Southlake, TX. I’ve taken his cranial base/TMJ class twice and been a teaching assistant for it when Christian Current taught. In addition, I’ve studied craniosacral therapy with the Upledger Institute.

Most recently, I studied TMJ Mastery in London, Ontario, with John Corry, a massage therapist and teacher with 26 years of experience working with TMJ issues.

Please let me know if you have any questions, and don’t hesitate to read the testimonials on my What People Are Saying page.

Treating TMJ issues: types, causes, and exercises

I just discovered an excellent new source of information about TMJ pain and dysfunction. It’s a really 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. (If you have other issues, please look around. 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.