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.

Treating TMJ issues: the role of the sphenoid bone

The sphenoid bone is one of the most fascinating bones in the body. If you were looking at someone and could see their bones, the sphenoid would be behind their eyes and in front of their ears, with the outermost parts (the greater wings) accessible at the temples, and the lowermost parts (the pterygoid processes) being what your internal jaw muscles attach to behind your upper back teeth.

The word sphenoid comes from the Greek for wedge-shaped. Its shape has been likened to a moth, a bat, a butterfly, and a wasp.

Here’s a picture of it, as viewed from the front.

Screen Shot 2018-07-10 at 8.53.53 AM

It’s a central cranial bone that does many important things:

  • it connects to your internal jaw muscles
  • muscles involved in swallowing are attached to it
  • it helps form the orbits of your eyes
  • the optic nerves meet, cross, and pass through it
  • your pituitary (master gland) sits on top of it (in the “sella Turcica” — Turkish saddle!)
  • it contains two air sinuses, the sphenoidal sinuses, which open into the nasal cavity through the ethmoid bone
  • it has openings for major blood vessels and nerves of the head and neck
  • the tentorium cerebelli, part of the membranous system surrounding the central nervous system, attaches to it

The sphenoid has been called the keystone bone of the skull. It touches 12 other cranial bones: the two parietals, two temporals, two zygomas, two palatines, the frontal, occipital, ethmoid, and vomer.

The place where the sphenoid and occiput meet is called the sphenobasilar joint (SBJ). (The occiput is considered the base of the cranium.)

You can see the SBJ in the middle of the image below where the orange and yellow bones meet.

Screen Shot 2018-07-10 at 8.58.35 AM

The alignment of this joint is important. William Sutherland, DO, father of cranial osteopathy, believed that the rest of the skeletal system moves to accommodate the SBJ. If the two bones of the joint are not aligned well, it can affect the endocrine, nervous, and cardiovascular systems.

Misalignment of the SBJ can obviously affect other cranial bones, which fit closely together, something like a spherical jigsaw puzzle.

When the SBJ is misaligned, it affects the jaw. (Remember, your internal jaw muscles attach to it.)

It is also a consideration in migraines, headaches, sinus problems, pain in the head, neck, and back, scoliosis, eye movement, and problems with behavior, personality, learning, coordination, hormones, and emotions.

This is how the sphenoid bone can affect the structure of the body. Craniosacral therapists pay a lot of attention to the sphenoid and can gently move it into better alignment.

Treating TMJ issues: what various professions do to help

I’m going to write about what various healing professions do to treat TMJ issues to help you be good consumers and know what to expect in terms of results. I am a massage therapist who specializes in TMJ work, including intra-oral (inside the mouth) work, in which I’ve had special training.

I want to say up front that most massage therapists do not work inside the mouth, which is where the jaw muscles most likely to be causing TMJ pain are located. Most massage therapists have the skills to release tension in the external jaw and neck muscles. Maybe that’s all you need, if your jaw pain isn’t severe and it comes and goes. You will feel better after such sessions.

But if you are really suffering from chronic or severe jaw pain and dysfunction, you probably want a lot more than that. You will greatly benefit from intra-oral work, which takes special training and experience to do effectively.

Do not hesitate to ask whether a therapist you are considering working with is trained in releasing tension in the internal jaw muscles and uses gloves or finger cots.

Whole-body work can also help, when the TMJ pain is related to your posture (for instance, head forward posture).

These are the major results that help with TMJ symptoms, along with the professional training that can provide them:

  • reducing stress (massage therapist, acupuncturist, yoga teacher, meditation teacher)
  • reducing tension in your external jaw muscles (massage therapist)
  • releasing trigger points in your external jaw muscles (any kind of therapist with trigger point release training)
  • releasing your neck tension (massage therapist, physical therapist, chiropractor)
  • getting your pelvis aligned and balanced (massage therapist, physical therapist, chiropractor)
  • preventing your teeth from cracking due to bruxism (dentist)
  • reducing tension in your internal jaw muscles (massage therapist with special training, physical therapist with special training, Rolfer)
  • getting craniosacral therapy to restore alignment in the external cranial bones (craniosacral therapist)
  • getting craniosacral therapy to restore alignment in the internal cranial bones (craniosacral therapist)
  • repairing a torn or perforated articular disk (oral surgeon — get reviews first)
  • getting whole-body therapy to help with alignment and release strain patterns (craniosacral therapist, Rolfer, Zero Balancer, yoga teacher, yoga therapist)

This is a brief and imperfect overview to help you get the results you want, and there are many fine points not mentioned here.

 

Treating TMJ issues: reducing daytime clenching

A new follower of my Facebook business page is working on reducing her daytime clenching.

Along with any kind of helpful stress-reducing practice (4-7-8 breathing, yoga, meditation, epsom salt baths, etc.), you can retrain your jaw and mouth muscles to be more relaxed.

Actually, you can retrain your entire nervous system to be more relaxed — and this may take several years of dedicated effort, including finding less stressful work along with committing to yoga, breath work, and/or meditation practices and other lifestyle changes. I plan to write more about resetting your nervous system in the future.

So for today, one step at a time: how to relax your jaw and mouth muscles when you experience daytime clenching.

The first step is to notice when you are clenching or grinding and deliberately move your teeth apart.

Next, do this to relax your tight jaw muscles: Circle the tip of your tongue on the biting surfaces of your teeth (upper and lower) 5 times in each direction. Gradually add some repetitions each time, up to 15, to help release the muscle tension of clenching by exercising the jaw muscles and tongue.

Then gradually reduce the number of repetitions to whatever it takes to loosen up.

Follow this by working to develop a new habit, because that’s what clenching is, a habit: Visualize a coffee stir stick turned sideways between your upper and lower teeth in front. That’s as far as you need to move your teeth apart.

Imagine your lower jaw hanging loosely from its hinges. Close your lips. You can give your jaw muscles a massage.

Let your tongue flatten and soften so the outer edges protrude slightly into the spaces between your upper and lower molars. Let the tip of your tongue rest gently behind your upper teeth.

This is the new relaxed resting position when you are not using your mouth. If you unconsciously begin to clench again, you will bite your tongue, and that will remind you to move your teeth back apart. (This was passed on to me by a yoga student of Maria Mendola in Tucson, and I want to give her credit.)

At first you will need to practice this a LOT and it will seem tiresome. Keep doing it anyway. Some days will be easier than others.

You may become aware that your clenching is related to suppressing speech. There are so many reasons we might do this: bad boss, difficult situation, consequences you don’t want, etc. Find a way to let those words out, even if just on paper. Discover your own truths.

Seek help if this level of change seems overwhelming.

When you have practiced unclenching and relaxing your mouth enough, one day you will notice that you did it without thinking about it. The old clenching habit may return under stress, but you’ve got the resources now to put it firmly back in the past.

If you can master this one simple change in habits, you can do almost anything. I’m wishing you success.