Choose a practitioner for intra-oral TMJ therapy that works on the lateral pterygoids

So far I’ve had two clients come in for TMJ relief sessions who have previously seen multiple practitioners who worked inside their mouths.

They’ve 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 pterygoids.

These are small and hard to access muscles, and in my opinion (and my main TMJ teacher’s opinion), they are most often the key muscles to address to release 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 TMD cases I’ve worked on so far, 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 never (that I’ve seen in 5 years) the biggest cause.

In other words, 90% of the time when people have jaw pain from muscle tension, the lateral pterygoids are the biggest culprit.

It’s not that these other intra-oral practitioners have nothing to offer. I’m not familiar with all of them, but chiropractors, Rolfers, and massage therapists have definitely helped me.

But if jaw tension and pain resulting from jaw tension is your major complaint, and you’d like a sense of spaciousness in your TMJs (if you can even imagine how great that would feel), go to a practitioner that works on the lateral pterygoids.

Click here to book a free 30-minute consultation.

Other things that distinguish my work:

  • I work as gently as possible.
  • I never make any sudden moves.
  • My sessions start with full body alignment to get you relaxed and progress toward the intra-oral work at the end.
  • I offer you legal hemp oil to relieve anxiety, pain, and inflammation before working in your mouth. It’s not required, but some clients really like it.
  • I offer single TMJ Relief sessions as well as a TMJ Relief Program consisting of 5 sessions in 4 weeks for lasting change, along with education and support for habit change and self-care.
  • I created a Facebook group, Word of Mouth: Resources for Jaw Pain/Dysfunction, for people who want to work on their jaw issues.

I hope this information helps you at least ask informed questions when choosing a practitioner to relieve your jaw tension and pain.

Massage therapy for jaw pain

The January/February 2019 issue of Massage & Bodywork (magazine for massage therapists) includes the article “Temporomandibular Joint Disorders: Biting Off More Than We Can Chew”. It’s full of information about the anatomy, pathology, demographics, contributing factors, symptoms, and treatment options for TMJD. The author is Ruth Werner, who wrote A Massage Therapist’s Guide to Pathology.

The article mentions that many dental professionals enthusiastically recommend massage therapy as an early intervention for TMJ disorders, which are often accompanied by dysfunction elsewhere in the body — the shoulder girdle, pelvis, and feet, for example.   Regular massage therapy sessions can also help relieve pain and tension in the external jaw muscles.

The author states, “The [internal] pterygoid muscles require more specialized skill… Work inside the mouth carries some serious responsibilities… It’s not for beginners, and it’s not for dabbling. When things go wrong in this joint, problems can reverberate through the whole body… [Massage therapists working inside the mouth should] get advanced training…

“Intraoral massage may trigger unintended responses… Emotional release in response to work in and around the mouth is also a strong possibility. It is critical that massage therapists be mindful of their scope of practice and respectful of their clients’ processes if this happens. Massage therapists must be prepared to be present, nonjudgmental, and appropriately supportive for this kind of event. Once again, it’s not for dabblers. If you want to do this work, get appropriate training.”

After reading this, I feel good about what I do. Massage therapists trained to work inside the mouth mostly follow three paths of advanced training: craniosacral therapy (like me), neuromuscular therapy, and structural integration (aka Rolfing).

Also, not all craniosacral therapists or neuromuscular therapists work with the internal pterygoid muscles, so be sure to ask beforehand if that’s what you expect. That was part of my training with Ryan Hallford, not (so far) with the Upledger Institute.

Also, I’m thanking the Upledger Institute for my training in SomatoEmotional Release as well as past experience and research in trauma recovery.

I’m grateful to see that treatment for TMJ disorders by licensed massage therapists is getting media attention, and that TMJD itself is getting more recognition. The TMJ Association recently announced that the National Institutes of Health have agreed to do more research. It’s very much needed — practitioners know what we don’t know, and it’s a lot.

Who doesn’t love a head massage? Check it out and help me name it!

After spending 4 days recently taking a class called “Addressing the Skull,” I want to get you onto my massage table so I can practice, practice, practice! It’s the best way I know to integrate training into, well, my advanced integrative bodywork practice.

I also need your help naming this new addition to my repertoire. I want to describe it separately from a Zero Balancing session. In my view, a ZB session addresses the whole body, including the head, whereas a skull/cranium/crown session spends most of a 45-minute session on the head.

This was a class in Zero Balancing, which aligns your structure and frees your energy, but most of the session will be spent addressing your skull. I learned lots of secrets of the skull, including that working on the outside of the skull affects the inside, i.e., the brain. And it’s not exactly a massage. It uses artful touch and knowledge of anatomy to find those places that release tension you may not have even known you had.

For instance, there is a place behind your ears that is similar to that place where dogs love to be petted, behaving as if they could never get enough, leg twitching and groaning with pleasure.

There are several special places on your skull where two or three or four bones come together that just love to be touched.

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I imagine that everyone in the class experienced several releases of tension in their skulls that they were not aware of before. We can get so habituated to stress that it gets normalized. Guess what? Normal can be better. (Thanks to San Antonio ZBer Jamie Carmody for making “Make normal better” her tagline.)

I suspect this work may prevent headaches and migraines.

After four days of training, which included many trades, my friend and I noticed that we could see better. When looking into our training room, the 3D-ness of everything was in sharper relief, and everything had more clarity. Working on the head affects all the senses.

This is your brain, on ZB.

I plan to run this special for a couple of weeks, and may consider extending it after that. I’ve lowered my price by $25 for a 45-minute Zero Balancing session. Go here to book yours.

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.

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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.