Tag: muscles

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Treating TMJ Issues: choose a practitioner who works on your 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 clients both told me, “No one has ever touched me there,” after I worked on releasing tension in 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 lateral pterygoid muscle) and not directly accessible on everyone, being overlaid by the temporalis tendon and the medial pterygoid.

You can get close enough to influence it, however.

In my opinion, the lateral pterygoids are often the keys for releasing jaw tension and also for relieving clicking and popping noises. Notice that the upper head is attached to the articular disc that separates the temporal bone and the mandible —the two bones of the TMJs (acronym for temporomandibular joints).

When this disc does not move smoothly with the mandible when the jaw opens and closes, clicking, popping, and sometimes a crunching noise can occur.

anatomy of the jaw muscles

It’s not that the other jaw muscles don’t contribute. They do. I’ve found tension in the temporalises, trigger points in the masseters, and taut bands in the medial pterygoids.

I usually save the lateral pterygoids for last when working on someone’s internal jaw muscles, because they are harder to access and can also be sensitive.

It helps to have tiny pinky fingers, and even then sometimes I need to ask a client to shift their jaw to one side to get near the muscle and joint.

Most of my TMJ clients are not aware when they come in that there are even jaw muscles here! The masseters usually get all the glory, and I’m touching a place that never gets touched. No wonder this area can be sensitive.

When I get near a lateral pterygoid, it can be a revelation. “That’s the place!” clients exclaim when I remove my finger.

Once I get there, I don’t need to stay long to make a difference. I invite my TMJ clients to move their jaws after I work on each muscle. Releasing tension in this muscle creates a sense of spaciousness around the joint.

If jaw pain and tension are your major complaint, and you’d like a sense of spaciousness in your jaws (if you can even imagine how great that would feel), find a practitioner that works on the lateral pterygoids, or come see me.

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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. It definitely has wings! 

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

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
  • your 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, and the frontal, occipital, ethmoid, and vomer.

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

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

The alignment of this joint is important. William Sutherland, DO, father of cranial osteopathy, believed that the alignment of the entire skeletal system is influenced by the SBJ.

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

If the SBJ is out of alignment, it affects the temporal bones, the upper bones of the temporomandibular joints (TMJs), colored reddish-pink in the image above.

Your internal jaw muscles attach to your sphenoid. In my TMJ Relief sessions, the clinical intraoral work relieves tension in these muscles, helping to release tension affecting the sphenoid and SBJ.

If the bones of the joints are not aligned well, it can also affect the endocrine, nervous, and cardiovascular systems.

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

Craniosacral therapists pay a lot of attention to it and can gently help it find better alignment.

Getting this bone and joint properly aligned creates an often-subtle shift that ripples out into more ease and better health.

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Treating TMJ issues: what various professions do to help

What do various healing professions do to treat TMJ issues?

I’m going to try to answer that, to help you be better health-care consumers and know what to expect in terms of results.

By the way, I am a massage therapist who specializes in TMJ work, including intra-oral (inside the mouth) work, in which I’ve had advanced training from three teachers and experience since 2013. I admit, I am biased!

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 do have the skills to release tension in the external jaw and neck muscles. Maybe that’s all you need, if your jaw pain is mild and intermittent. You will feel better after such sessions.

But if you are really suffering from long-term jaw pain and dysfunction, you definitely need more than that to get relief. You could 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.

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

Here’s a look at results you might expect from working with practitioners in different professions:

  • 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 (massage therapist)
  • doing myofascial release on your external jaw muscles (massage therapist)
  • releasing neck tension (massage therapist, physical therapist, chiropractor)
  • getting your pelvis aligned and balanced (massage therapist, physical therapist, craniosacral therapist, chiropractor)
  • getting your head aligned on top of your spine (craniosacral therapist, chiropractor)
  • preventing your teeth from cracking due to grinding (dentist or over-the-counter night guard)
  • checking whether grinding in your sleep is related to airway obstruction (sleep specialist)
  • reducing tension in your internal jaw muscles (massage therapist with special training, physical therapist with special training, Rolfer as part of 10-series)
  • restoring alignment in the cranial bones (craniosacral therapist)
  • repairing or replacing a dysfunctional articular disk (oral surgeon)
  • getting whole-body therapy to help with alignment issues and release strain patterns (craniosacral therapist, Rolfer, Zero Balancer, yoga teacher, yoga therapist)

There is one major caveat here: these are generalities based on my own knowledge and experience. Each profession has its specialties. Not all physical therapists work on the jaw or pelvis — in fact, not many do.

Do not hesitate to ask questions and do your own research.

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

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.

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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.