By: Dale J. Buchberger, PT, DC, CSCS, DACBSP
Temporomandibular joint disorder also known as TMD is a disorder of the jaw and surrounding structures where the jawbone (mandible) meets the skull (temporal bone). Between the jawbone and skull is a cushioning disk or meniscus. Stress and trauma such as working at a computer for long hours or being involved in a whiplash type accident can cause damage or misalignment of the temporomandibular joint (TMJ) leading to breakdown of the joint structure and the disk. Clenching or grinding the teeth at night during sleep is also a common pattern of stress. Over time, the muscles that control the TMJ become tighter causing the joint to compress and eventually tear the meniscus. As the meniscus tears the joint surfaces begin to grind causing further wear and breakdown. It is not uncommon for the meniscus to “slip” out of the joint. When this happens it is called a “disk-derangement”. This grinding can usually be heard as popping or snapping sounds also called crepitus. Patients who grind or clench their teeth often have symptoms of TMD. The muscles that attach the jaw to the neck and head cause a large number of TMD symptoms once they become “hypertonic” meaning that the muscles are not given the opportunity for rest and recovery.
The most common symptoms of TMD are: popping, clicking and snapping sounds with opening and/or closing the mouth. It is common for patients to complain of the jaw actually locking in place and not being able to open or close the jaw for several hours. Patients with TMD have difficulty opening the mouth wide as in yawning and find it difficult to eat hard or dense foods such as pretzels, steak or even a large sandwich. Dental examination often reveals a noticeable change in bite or uneven breakdown of the tooth surface. If the patient continues to experience chronic TMD syndrome they will begin to develop headaches, neck pain, dizziness and even tinnitus or ringing of the ears.
While this disorder is commonly associated with dental care, physical therapy can offer a large number of TMD patient’s significant relief of their pain and dysfunction. TMD has been associated with two key areas today, stress and postural dysfunction or misalignment. With today’s technology driven society stress in the neck and upper back is increasing. This can result in grinding of the teeth in an attempt to relieve stress. This is why patients are prescribed a mouth guard for sleep or even daytime hours to help cushion the grinding effect. However the mouth guard by itself is limited and will not strengthen or correct the postural dysfunction that may have started the disorder in the first place. The keystone to physical therapy treatment for TMD is postural retraining and improved endurance in the muscles of the neck, upper back and jaw. The Rocabado 6×6 is an established program of postural and jaw exercises developed specifically for TMD. When performed as prescribed by your dentist, oral surgeon, physical therapist or chiropractor they can significantly reduce your TMD symptoms. Physical therapists may also apply additional treatment methods when exercise alone is not resolving the TMD symptoms. Manual therapy techniques such as joint mobilization may be applied in order to improve the mobility and range of motion of the temporomandibular joint itself. Advanced soft tissue techniques such as Active Release Techniques® (ART®) can be used to correct joint and muscular misalignments. You can find a certified ART® provider by going to www.activerelease.com. Modalities such as ultrasound and electrical stimulation can be used to reduce inflammation of the joint and the surrounding tissues. Combining a program of postural exercises with manual joint mobilization and advanced soft tissue techniques provides a comprehensive approach in the physical therapy management of TMD.
If you believe that you display symptoms of TMD you should make an appointment with your dentist or oral surgeon for a complete dental evaluation to be sure that there is not an underlying dental cause of the TMD. Once a dental cause has been ruled out you can request a physical therapy order from your dentist or oral surgeon for treatment of TMD. Physical therapy treatment can be safely rendered in conjunction with dental management strategies. In the end the best chance for resolving TMD pain and symptoms is a medical-dental team approach that includes physical therapy treatment and rehabilitation.