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.
I’m two-thirds of the way through writing daily posts about living with, treating, and resolving TMJ disorder issues.
I’ve posted on who tends to get it, linked to videos of self-care techniques, written about reducing night grinding and daytime clenching, explored the connection between the jaw and the pelvis (and the jaw and the endocrine system), shared recommendations about essential oils for relief, discussed the throat chakra, shared an upper body yoga sequence, listed nutrients that can make a difference, described acupressure points, posted on what massage therapists can do to help (includes what I do), what acupuncturists do, and what chiropractors do. And more.
If you’ve tried any techniques that are new to you after reading these posts, what’s helped?
What would you like to learn that I haven’t covered yet? Here are some possibilities. If you have others in mind, please comment.
releasing trigger points in your jaw muscles
the role of the sphenoid bone in structural health (your jaw muscles attach to it)
meditations and music for the throat chakra
calming your nervous system
mouthguards, night guards, and splints
relaxing the facial muscles
jade rolling and facial massage
what any other professions do to help with TMJ issues
the contributions of Weston Price, dental researcher
more on any topic I’ve posted on so far
If you have any other TMJ-related topics you’d like to see addressed, please comment.
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 back of your pelvis includes the base of your spine, the triangle-shaped sacrum. Your jaw — mandible — is near the upper end of your spine, and it has a special relationship with the uppermost two vertebrae at the top of your neck, C1 and C2.
Because the opening/closing motion of the jaw is both hinging and gliding (open your mouth slowly and you can feel it hinge, then glide forward as you open wider), the axis of rotation is not in the actual jaw joints but is located between these two vertebrae, according to Guzay’s theorem (Guzay was an engineer interested in neurology).
The images below show the TMJ and the axis of rotation when with jaw closed (left) and open (right). The upper cross-hairs show the TMJ, and the lower cross-hairs show the actual axis of rotation for jaw opening and closing.
(Image source: The Heart of Listening Volume 2 by Hugh Milne)
When your pelvis is misaligned, it affects these vertebrae, impacting neck and head posture and neurological well-being. (This is why nearly everyone I treat for TMJ issues also has neck issues, which I treat too.)
How can the pelvis affect the jaw? There is a tough, inelastic membrane surrounding your spinal cord that connects your sacrum with your cranium. The dura mater lines the inside of your neurocranium, includes membranes between the two hemispheres and between the cerebrum and cerebellum of your brain, and forms the dural tube containing cerebrospinal fluid that surrounds the spinal cord, all the way down to your sacrum.
The dural tube is attached to the C1, C2, and C3 vertebrae and then descends unattached all the way down the spine to the sacrum, where it attaches to bone again. The dura mater continues to the tip of the coccyx.
When the sacrum is not aligned with the other pelvic bones — in other words, when you have sacroiliac joint problems, it torques the inelastic dura mater all the way up to the upper neck vertebrae that affect the movement of the TMJs.
This torquing of the dura mater may be seen in abnormal spinal curves, pelvic rotation or tilt, head tilt, and cranial bone misalignment, which can affect your fluids, hormones, and central nervous system.
Here’s a little exercise: put your fingertips in front of your ears and open and close your jaw slowly a few times. Notice if your left and right TMJs move differently. You may notice one side opens first and/or protrudes further out or forward than the other.
This shows your TMJs are unbalanced. Because the mandible is one bone with two joints, even if one joint is out of balance, the other joint is affected, though you may not feel symptoms in both.
It seems likely to me that this contributes to nine times more women than men suffering from TMJ disorders, since women have more pelvic floor issues than men. (Also more stress.)
Other ways these two areas resonate:
The sacrum also crosses the midline and has two joints on either side, the sacroiliac joints.
The pelvic floor and the floor of the mouth are similar in structure, as seen in the images above. Both are horizontal tissues in the more vertical body. The places where vertical and horizontal tissues meet are generally more subject to holding strain patterns.
Fascia in muscles and bones connects the pelvis and jaw. Restrictions in the fascia affect the alignment of bones.
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 develops into the openings at the other end of the digestive canal.
What to do if you have a misaligned pelvis and jaw issues? I offer a 30-minute TMJ consultation to gather information and evaluate your issues, in person, by phone, or on Zoom.
If you’re not in Austin, I can help you learn what to ask about when seeking TMJ relief nearer you. I also teach clenchers an alternative to clenching, and give grinders my best advice on how to stop grinding. These behaviors are major contributors to TMJ issues.
I offer a combination TMJ Consultation plus TMJ Relief session at my offices in Austin and West Lake Hills, Texas (as well as Taos, NM, in the summers — details to come). 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.
Also, to be fair, most of the time TMJ issues require multiple sessions to retrain the tissues to retain the changes. 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.
I invite you to work with me!
MaryAnn Reynolds, MS, LMT, BCTMB Austin, Texas Biodynamic Craniosacral Therapy • TMJ Relief online scheduler: maryannreynolds.as.me text or voicemail: 512-507-4184
TMJ Massage: Pressure Points for Relief by MassageByHeather.com. 3:43. Massage therapist Heather Wibbels shows you four acupressure points for jaw pain. You hold them bilaterally for 30 seconds up to 2 minutes. If you’re looking for something you can do on an airplane without attracting too much attention, do these.
TMJ Exercises #1, 11:25. Chiropractor Adam Fields demonstrates exercises for the back of the neck, which is often tight when you have TMD, tongue exercises, and massage, ending with a relaxation exercise. In TMJ Exercises #2, 10:07, he focuses on massaging the muscles that open and close your jaw. He helps you tie the jaw exercises and massage into really good posture — a good habit that will help relieve jaw tension.