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.

Treating TMJ issues: what would you like to learn more about?

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.

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.

Treating TMJ issues: videos of self-care techniques

If you suffer from jaw pain, you may want to try some of these jaw exercises and self-massage techniques.

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TMJ Exercises & Stretches to Relieve Jaw Pain — Ask Dr. Jo. 3:03. Dr. Jo is a physical therapist who demonstrates four simple exercises.

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.

Absolute Best TMJ Treatment You Can Do Yourself for Quick Relief. 5:48. “Bob and Brad, the two most famous physical therapists on the internet” (as their theme song goes) show you how to massage your external jaw muscles.

10 Best TMJ Exercises to Stop Pain in Your Jaw. 11:57. Bob and Brad show you the standard relaxed position for your jaw along with several exercises. They cite the American Academy of Family Physicians as the source for these exercises. Start saving popsicle sticks!

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.

Yoga to Release Jaw Tension from Grinding Teeth, Clenching, TMJ. 10:26. Karuna demonstrates self-massage to release jaw tension, including a technique you can do right before you go to sleep that may prevent clenching and grinding while asleep.

I’m interested in hearing back from you about which exercises help you the most. If you’ve found other helpful videos about TMJ self-care, please let me know.