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: the jaw-pelvis connection

The jaw-pelvis connection is real! When I ask my TMD (temporomandibular disorder) clients if they also have pelvic alignment issues, a lot of them say yes. If your pelvis is out of alignment, quite often so is your jaw.

Here’s how that relationship works: The pelvis includes the base of the spine, your sacrum. Your jaw — mandible — is near the upper end of your spine, and it has a special relationship with C1 and C2, the uppermost two vertebrae of your spine at the top of your neck.

Because the opening/closing motion of the jaw is both hinging and gliding, the axis of rotation is not in the actual jaw joints but is located between these two vertebrae (Guzay’s theorem, seen in the images below).

(Image source: The Heart of Listening Volume 2 by Hugh Milne)

When your jaw is misaligned, it affects these vertebrae, impacting spinal and head posture and neurological well-being. The same when your pelvis is misaligned. 

How does that happen? The dura mater is a tough, inelastic membrane that lines the inside of your cranium and forms a tube containing cerebrospinal fluid that surrounds the spinal cord.

The dural tube is attached to the C1, C2, and C3 vertebrae and then descends unattached all the way down to the sacrum, where it attaches to bone again. The dura mater continues to the tip of the coccyx.

When the pelvis is not aligned, it torques the dura mater, and that torque continues all the way up to these upper neck vertebrae that affect the temporo-mandibular joints.

This torquing of the dura mater may be seen in abnormal spinal curves, pelvic rotation, head tilt, and cranial bone misalignment, which can affect your fluids, hormones, and nerves.

If your pelvis is giving you problems, put your fingertips in front of your ears and open and close your jaw. Notice if your left and right TMJs feel different or the same. You may notice one side opens first or is more restricted or otherwise moves asymmetrically.

It seems likely to me that this contributes to nine times more women than men suffering from TMJ disorders, since women tend to have more pelvic floor issues than men.

The floor of the mouth, from underneath.
The floor of the pelvis, from above.

Other ways these two areas resonate:

  • The mandible (jaw bone) crosses the midline and has two joints on either side, the TMJs. 
  • The sacrum also crosses the midline and has two joints on either side, the sacroiliac joints. 
  • The front of the pelvis, the pubis, also crosses the midline, and the hip joints (acetabula) lie on either side.
  • The pelvic floor and the floor of the mouth are similar in structure, as seen in the images above. The pelvic floor and the floor of the mouth are both horizontal tissues in a body that consists primarily of longitudinal tissues. The places where these tissues meet are more subject to holding tensions.
  • Fascia, which surrounds and permeates muscles, connects the pelvis and jaw. Restrictions in the fascia affect alignment.
  • Many people clench their jaws when stressed — and may also tighten their anal sphincters. 
  • At about day 15 in embryological development, two depressions form: one develops into the mouth and the other that develops into the urinary/digestive/reproductive openings — the openings of the digestive canal.

What to do if you have a misaligned pelvis and jaw issues? An evaluation will help identify your specific issues. Any thorough evaluation for jaw pain will include an assessment of pelvic alignment. A treatment plan will include manual therapy as well as homework, including moves to avoid, to strengthen and align the pelvis and jaw.

This post in particular has been shared widely on the internet, separated from the rest of my website. If you suffer from TMJ issues, I host a Facebook group called Word of Mouth for people looking for information and solutions for these issues. I also have a private bodywork practice in Austin, Texas, where I offer TMJ Relief sessions. I offer free 30-minute consultations to evaluate TMJ issues.