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. (I can’t help with these, but exercises* can help. If you’re in Austin and have disc displacement, I can refer you to a couple of oral surgeons who are getting great results.)
  • 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.

Treating TMJ issues: the relaxing breath

Today I want to complete something I promised, sharing a quick way to relieve stress. This is important since so much TMJ misery is related to stress. Either the pain causes you to feel stressed, or your stress from other reasons creates muscle tension, which creates pain. It can be hard to break that cycle.

Some people have a hard time relaxing. The pressure to perform, to get things done, is on. Maybe they have a lot of energy but haven’t learned or had a chance yet to create time for themselves yet. (Yep, in my 30s.)

Or they’ve gone through a stressful period and it feels like their body forgot how to unwind. (Been there multiple times.)

Perhaps they’ve suffered a trauma that keeps them hypervigilant. (I know that one too well.)

Some psychotherapists specialize in helping trauma victims rebalance their autonomic nervous systems, so they can pendulate between fight-or-flight only when a true threat is present and rest-and-digest when they’re safe (and enjoy its benefits of better digestion, better healing, and inner peace). If this is the case with you, check out Somatic Experiencing therapy.

Others just need a little help to get started relaxing. Massage can help tremendously.

A meditation practice is a commitment to relax while sitting upright every day, with attention on your breath and sensations, observing the activity of your monkey mind with some detachment and humor (or horror!).

In fact, I have been curious for years about how relaxed I can become without falling asleep! It’s what drives me to meditate daily, do 10-day vipassana meditations, float in floatation tanks, and get esoteric acupuncture.

If you’d like to start rebalancing from stress into relaxation on your own, there’s an exercise I recommend called 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, although its roots are in yoga.

Screen Shot 2018-07-18 at 8.45.34 AM

The video is 3:18 long. Dr. Weil recommends doing 4 breath cycles at least twice a day for two months to get the benefits.

After a month, you can increase to 8 breath cycles, the maximum.

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

After practicing this for 4-6 weeks, you can begin to use it when something stressful happens. It’s a great resource for me when another driver does something alarming, but there’s no accident and I am left with the residue of stress in my body. A few of these breaths rebalance me. It can help with cravings and falling asleep.

After 2-3 months, it changes your physiology. It lowers heart rate and blood pressure, improves digestion, and is much more powerful than anti-anxiety drugs.

In essense, you are retraining your nervous system to be more relaxed. In my 7 years of doing bodywork, one day I realized this is what we bodyworkers are doing: retraining your body to be more relaxed and functional.

You may become less stressed from using this technique (yay!) and still benefit from receiving a TMJ Relief session to retrain your jaw muscles into relaxation.

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

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.

Treating TMJ issues: releasing trigger points in your jaw muscles

You have four jaw muscles: the two large ones on the outside of your head (the masseter and temporalis) and the four small ones inside your mouth (two medial pterygoids and two lateral pterygoids).

Any of them can get trigger points.

What is a trigger point? Healthy muscle tissue is made of bundles of fibers that run in the same direction. This tissue is pliable. It stretches or contracts when you move.

Screen Shot 2018-07-12 at 8.36.04 AMA trigger point is a spot where the muscle tissue has lost its pliability. A massage therapist may feel that the fibers in a particular spot have become glued together and hard, creating a small nodule. The tissue feels denser and often rolls under the fingers, compared to healthy muscle tissue.

This causes that band of muscle fibers to become shorter and tighter, restricting full range of movement of the entire muscle.

If you can’t open your mouth wide, or move your jaw easily left and right, forward and back, you may very well have trigger points in your jaw muscles.

Trigger points usually feel tender when you apply pressure to them, and they may also refer pain elsewhere. They may also form “constellations.” This makes them the tricksters of the nervous system.

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 someone else work on them, especially if you have a lot of them in multiple jaw muscles.

Screen Shot 2018-07-12 at 8.08.14 AMMy 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 I know many massage therapists who use it as a reference book in their offices.

When I am working on TMJ issues, I notice that many 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 pressure, drag your fingers slowly down the masseter muscle on one side of your face. Do this several times, experimenting with adding pressure, and notice if there are tender spots or “roll-y” spots. Repeat on the other masseter.

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

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Source: The Trigger Point Therapy Workbook

If you find trigger points in your masseters (and you can still have 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 this 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 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 works intra-orally, as do I, but her experience is greater than mine, and she’s amazing at discovering patterns if you have “constellations” of trigger points. She’s going to be more efficient than I can possibly be. She is the queen!

If you are interested in having her work on you, her name is Rose of Sharon, and 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.