muscle Archives - MaryAnn Reynolds, MS, LMT, BCTMB

Treating TMJ issues: types, causes, and exercises

I have discovered an excellent source of information about TMJ pain and dysfunction. It’s a 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. 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.

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Treating TMJ issues: de-stress quickly with these breathing techniques

Learning how to de-stress yourself is huge. Everyone experiences stress. It’s just part of life.

Stress becomes an issue when there’s too much of it, and your system has trouble rebounding resiliently to a calm, alert state.

How is this relevant to TMJ issues? So much TMJ misery is related to chronic and acute stress. It’s one of the major contributors to TMJ issues. People clench and grind due to stress, and stress is always accompanied by muscle tension, which causes a lot of jaw issues.

Staying stressed for too long is bad for your well-being. It affects your digestion (including absorption of nutrients and detoxification) and creates unnecessary wear and tear on your vital organs.

I’m talking about bad stress as opposed to good stress, such as the anxiety before a performance that makes you a better performer, or the adrenaline you feel when a bad driver nearly hits you that helps you react quickly and successfully avoid being hit.

In my opinion, bad stress includes most news about politics (just donate money and volunteer for candidates you like) and traumatic events (there’s always something awful happening in the world).

Also, the desire to control others’ behavior can bring about bad stress. Better to focus on accepting them as they are and work on a healthy path for yourself.

Maybe they’ll witness you and want to change themselves.

You can still care and have a constructive strategy to manage stressors.

You can do these things from a calm, alert state. Imagine that.

The beauty of using a little breathwork to get yourself out of an unhelpful state of stress (any stressor that does not require immediate action) is that breathwork bypasses your mind.

Has “you need to calm down” ever helped anyone to actually calm down, whether it’s yourself or someone else telling you this?

Breathwork is also quick. You can simply do a little breathwork when stressed, and your system starts shifting into parasympathetic mode.

A note to the chronically stressed: here’s how to tell when you’re in a parasympathetic state. Your whole body starts to feel a softness and relaxation because you have let your guard down. You notice your that breathing has changed, to becoming slower, deeper, with longer pauses.

If this is hard, because maybe you’ve been carrying the guarding that often occurs after a trauma, try this: Imagine yourself in a completely safe environment where you don’t have to be guarded against anything. Maybe you are surrounded by softness, or floating in body-temperature water. You may have any objects (real or imaginary) that bring you comfort.

Let go of your thoughts and just be.

The more you practice breathwork and conscious relaxation, even when not stressed, the more it gets wired into your neurology.

The physiological sigh

The physiological sigh is breathwork technique that’s getting a lot of attention now. It’s been recognized for 80 years as a behavior people do automatically when claustrophobic and in other stressful situations.

Now you can put it to work for yourself when you need to de-stress yourself.

I learned about it from Dr. Andrew Huberman, a Stanford University professor who runs a neurobiology lab and has a podcast.

In brief, it’s two inhalations through the nose, and one longer exhalation through the mouth. (I think of it as the “sniff sniff ahhhhh” breath.)

Here’s a video demonstrating technique.

Dr. Huberman says sometimes people fall asleep if they do it 15 times in a row, but just three of these physiological sighs are enough to start slowing your heartbeat down in 20-30 seconds.

I nearly always yawn when I start doing physiological sighs.

4-7-8 breathing

Another fairly quick breathwork technique for reducing stress is the 4-7-8 breathing (the Relaxing Breath). Dr. Andrew Weil, who has been practicing and writing about holistic health and integrative medicine for 30 years, came up with it.

Dr. Weil recommends doing four of these breath cycles at least twice a day for two months to get the benefits. This wires it into your neurology.

He recommends slowing the cycle down, with the limiting factor being how long you can comfortably hold your breath.

It can also help with cravings and falling asleep.

In essense, you are retraining your nervous system to be more relaxed.

You may become less stressed from using either or both of these techniques and still benefit from receiving a TMJ Relief session to retrain your jaw muscles into relaxation. The breathwork will help your body retrain itself more quickly and prevent relapses.

If you’re ready to have that conversation with me, please connect. I’d love to hear from you.

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.

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Treating TMJ issues: the effects of stress

For decades, the news has cautioned us about the ill effects of stress on our health, longevity, and happiness. But what is stress and how do you know when you are experiencing it? What does it have to do with jaw pain and dysfunction? Most of all, what can you do about it?

Stress is your body’s response to threats, real or imagined. You become alert, focused, and energized, ready for action. It is a physiological response designed to protect you in dangerous situations, to get you away from the danger or to confront it. Something in us is always scanning for danger and ready to respond.

It also gives you the energy to meet life’s challenges, for example, taking a test, interviewing for a job, making an important presentation, having a difficult conversation, scoring a point, winning a game, driving safely. Doing anything difficult where you care about the outcome requires some extra energy and focus.

So stress isn’t inherently bad — but too much stress can damage your health and quality of life. In the fight-or-flight response (sympathetic dominance of the autonomic nervous system), your body releases stress hormones. Your heart rate goes up, your blood pressure rises, your muscles tense, your breathing quickens, and your senses become sharper, all so you can respond to the situation.

We’re designed to respond this way in extraordinary situations, and the rest of the time (which ideally would be most of the time), to live peacefully, nourishing ourselves, cooperating with the group, resting, relaxing, having fun, and enjoying our lives (parasympathetic dominance, or rest-and-digest mode).

Physiologically, the heart rate slows, breathing slows, blood pressure goes down, muscles relax, and attention becomes broader. In this state, your system has more resources for digesting and assimilating your food and repairing damage.

The switch from rest-and-digest to fight-or-flight occurs quickly and automatically, bypassing your conscious mind. You become aware afterwards that your state has changed.

This is a good exercise: How do you know you are experiencing stress? What tips you off? Do you notice a sudden sharp inhalation and muscle tension? (That’s what I notice.) Do you feel your heart pounding? Do you notice that your mind suddenly becomes focused and alert?

Another good exercise: How do you know you’re okay? Is there a kinesthetic signature that lets you know you are relaxed? I feel a peaceful, happy feeling in my chest. What do you notice?

What does stress have to do with jaw pain and dysfunction? Almost every bit of information available about the causes of TMD connects it to stress. Muscle tension is a universal response to stress. The jaw muscles tighten.

Most everyone experiences stress, but not everyone experiences jaw symptoms. No one seems to know why this is. Here are some of my observations and hypotheses.

I’ve observed that most people carry way more muscle tension from stress in their upper bodies, in the upper back, shoulders, neck, jaw, and/or face. For some, all of those places get tense. For others, only one or two get tense.
The jaw is the only part involved in chewing and talking. Chewing doesn’t have any associations with threats or danger that I can think of. If the food tastes good and is safe and your teeth and jaws are healthy, chewing is a pleasure.
Talking can be dangerous. Some clients have directly related the onset of their jaw symptoms with feeling unsafe about freely expressing themselves about a difficult situation they had with another human being. This could have happened long, long ago, with the unpleasant memory being repressed.
Some people have had so much stress and/or trauma in their lives, it’s become chronic. They don’t know how to deeply relax.

Maybe some people are predisposed to have jaw issues. It could be from the strains of their birth and an attempt to reshape the head. It could be a learned strain pattern that runs in their family. It could be from a lack of nutrients that help form healthy jaws (read more about the work of Weston A. Price, DDS, on this topic). I’m sure there are many other possibilities.

I do know that for everyone, help is available. You can release (or get help releasing) the tension in your jaw muscles. You can examine your past, with psychotherapeutic help or by journaling or talking to a trusted friend. You can learn to deeply relax, and it’s a pleasure. And that’s a good topic for tomorrow.

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Treating TMJ issues: releasing trigger points in your jaw muscles

You have nine jaw muscles: two pairs of large ones on the outside of your head (the masseters and temporalises), four small ones inside your mouth (two medial pterygoids and two lateral pterygoids), and one in the floor of your mouth (digastric).

Any of them can get trigger points.

What is a trigger point? It’s unhealthy muscle tissue that causes pain that can occur locally to the trigger point or at some distance — referred pain.

Healthy muscle tissue is made of bundles of fibers that run in the same direction. This tissue is pliable. It contains fluid. It stretches or contracts when you move.

A trigger point is a spot where the muscle tissue has lost its pliability. A massage therapist may feel that some tissue in a particular spot feels hard, creating a small nodule that’s hard and stiff. The tissue feels dense and often rolls under the fingers when compared to healthy muscle tissue.

Trigger points cause that band of muscle fibers within a muscle to shorten and tighten, restricting full range of movement of the entire muscle.

Trigger points feel tender when you apply pressure to them.

Where several of them occur in an area, they form “constellations.” If one of those trigger points in the constellation is the primary one and the rest are satellites, it takes trial and error to locate and treat the primary one — and until that happens, the satellites keep reoccurring.

This makes them the tricksters of the nervous system, and it’s why specialists in trigger point therapy are rare and sought after.

You can work on your own trigger points to release them. It helps if you’ve received trigger point work from an experienced massage therapist, but you can learn to do it yourself. Even then, you may prefer to have a massage therapist work on them, especially if you have a lot of them.

Even with an experienced therapist working on your trigger points, sometimes the body clearly says “no more today,” a signal to move on to another technique and schedule another session.

My favorite reference book for working with trigger points is The Trigger Point Therapy Workbook, third edition, by Clair Davies and Amber Davies.

It is written for laypeople to release their own trigger points, but many massage therapists use it as a reference book in their offices. I got my copy spiral-bound for ease of use.

When I am working on TMJ issues, I sometimes notice that people have trigger points in their masseters, the big external jaw muscles on the sides of your face that run from your cheekbone to the bottom of your jawbone.

Here’s how to find trigger points in your own jaw: using a bit of pressure, drag your fingers slowly down the masseter muscle on both sides of your face. Do this several times, experimenting with adding pressure, and notice if there are tender spots or small dense spots that roll under your fingers. Repeat on the other masseter.

If you don’t have masseter trigger points, this usually feels pretty good.

Screen Shot 2018-07-12 at 8.41.19 AM — Left: trigger point locations in the left masseter. Right: areas of associated pain. Source: The Trigger Point Therapy Workbook.

If you find trigger points in your masseters (and you can have other TMJ issues without them), there are several ways of treating them.

Some therapists apply a huge amount of pressure. I don’t recommend this because if you have TMJ issues, your jaw is probably already out of alignment, and applying lots of pressure could make it worse.

A better way, in my opinion, is to use less pressure. Yes, you can gently release trigger points!

I learned to do this from a local (Austin) massage therapist, Rose of Sharon, who is very experienced with trigger point release. She’s worked on me and released many trigger points, teaching me how to do this in the process.

If you have a lot of trigger points, I highly recommend seeing her. She’s amazing at discovering patterns if you have “constellations” of trigger points.

If you are interested in having her work on you, you can reach her by phone or text at 512-282-1672. Please leave a message with your name and number so she can contact you.

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.