How Physiotherapy Can Help with Temporomandibular Dysfunction (TMD)
April 1, 2016
Leanne Loranger, PT
More commonly known as the jaw joint, your temporomandibular joint (TMJ) is a hinge joint found on either side of your head, just in front of your ears.1 It is the joint between your skull and the lower part of your jaw. In fact, it takes two joints working together to create the motions needed for speaking, eating and yawning. If the TMJ on one side is not moving properly, it can cause changes to the movement patterns and function of the joint on the other side as well.
As the image below shows, the joint is made up of two bones, the mandible (lower jaw), and the temporal bone (side of the skull). Inside the joint there is a disk found between the two bones, which enables the gliding movement of the joint. Several deceptively small, but remarkably strong muscles around the joint control its movement.
Source: The Canadian Dental Association1
What is temporomandibular dysfunction (TMD)?
TMD is a broad term used to describe a group of problems including pain in the jaw muscles or joint, decreased movement (limited mouth opening), catching or locking of the jaw,2,4 and joint noises.4 TMD can also be associated with headaches and pain with chewing.3 Occasionally, people also notice changes in their bite related to TMD. Though jaw noises are often associated with TMD, joint noises themselves do not typically cause pain or limited movement and do not require treatment unless accompanied by other problems like pain or loss of movement.2
TMD can also be associated with other head and neck problems such as headache, ear pain or neck problems.4 It’s also been noted that TMD occurs at a higher frequency among patients who have experienced a whiplash injury.5
Why does TMD occur?
TMD can have many contributing causes and the reasons why people develop TMD aren’t entirely clear. Among proposed underlying causes, a history of injury or trauma is often present (such as a direct injury to the jaw or even a motor vehicle accident). Emotional stress may also play an important role, as can neck problems and chronic pain conditions. Non-traumatic TMD may relate to a repetitive movement disorder2 or arthritis in the joint.1 Other contributing factors include habits such as teeth clenching and grinding and gum chewing.2 Bite issues have been suggested as another potential cause of TMD, however the research to date is not conclusive, and treating tooth and bite alignment may be ineffective or cause other problems.8,9,10
What treatments are offered?
The goals of physiotherapy treatment in TMD are to reduce pain and inflammation of the TMJ, and to improve TMJ movement and function. Treatment focuses on both the TMJ and other body parts that are contributing to the problem. Physiotherapists treat TMD using exercises including:
• Jaw movements2,7 and posture correction4,7
• Manual therapy including soft tissue release (massage), joint mobilizations and stretching2,4,7
• Modalities such as laser and ultrasound4
• Other treatments such as relaxation training and biofeedback6
Patient education focuses on changing habits such as altering the resting position of the jaw, avoiding daytime teeth clenching and gum chewing, and modifying food textures to avoid eating hard or chewy food.2,3 Some physiotherapists also use acupuncture or other dry needling techniques to treat TMJ pain.4
Dental splints, most commonly used while sleeping, may also be prescribed by dentists to help prevent the negative side effects of clenching and grinding of the teeth.1
A systematic review of the research on TMD treatment found that the best evidence supported the use of tailored exercise programs and manual therapy to reduce pain and increase range of movement.4 Limited evidence supports the use of modalities to increase range of movement.4 However, there isn’t a great deal of research into physiotherapy treatment of TMD and what research exists isn’t considered by experts to be of very high quality due to challenges in identifying research participants and a lack of detail in many published reports.4 One finding that appears consistent is that the use of a conservative, non-invasive approach is recommended, providing equivalent results at lower cost and with lower risk for many patient groups.7
Treatment decisions should, therefore, be guided by patient preferences and clinician experience in addition to the research evidence.
Who’s on the team to manage TMJ?
A multidisciplinary team of physiotherapists, dentists, psychologists, and physicians (and occasionally orthodontists) may be involved to help manage TMD symptoms.4 If you have TMD, it is recommended that you look for physiotherapists and dentists with experience and a special interest in treating this problem.
Where can you find a PT who treats TMJ?
You can find a physiotherapist to treat your temperomandibular joint pain or disease, by visiting our physiotherapist directory.
Canadian Dental Association. TMD (Temporomandibular joint disorder). Available at: https://www.cda-adc.ca/en/oral_health/talk/complications/temporomandibular_disorder/ Accessed March 16, 2016.
Wright EF, North SL. Management and treatment of temporomandibular disorders: A clinical perspective. The Journal of Manual & Manipulative Therapy year; 17(4):247-254.
Oh JS, Kim SH, Park KN. Effects of controlled condylar rotation exercise on symmetrical mouth opening in patients with temporomandibular disorder. Journal of Physical Therapy Science 2015; 27: 1319-1321.
McNeely ML, Armijo-Olivo S, Magee DJ. A systematic review of the effectiveness of physical therapy interventions for temporomandibular disorders. Physical Therapy 2006; 86(5):710.
Haggman-Henrikson B, List T, Westergren H, Axelsson S. Temporomandibular disorder pain after whiplash trauma: A systematic review. Journal of Orofacial Pain 2013; 27(3):217-226.
Medlicott MS, Harris SR. A systematic review of the effectiveness of exercise, manual therapy, electrotherapy, relaxation training, and biofeedback in the management of temporomandibular disorder. Physical Therapy 2006; 86(7):955-973.
Armijo-Olivo S, Pitance L, Singh V, Neto F, Thie N, Michelotti A. Effectiveness of manual therapy and therapeutic exercise for temporomandibular disorders: Systematic review and meta-analysis. Physical Therapy 2016; 96(1):9-25.
Okeson J. Management of temporomandibular joint disorders and occlusion (7th ed.), St. Louis: Elsevier Mosby, 2013.
The American Academy of Orofacial Pain. Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management, (5th ed.) de Leeuw, Reny and Klasser, Gary D Editors. Chicago: Quintessence Publishing Co. ISBN 978-0-86715-610-2, 9780867156102
Romero-Reyes M, Uyanik JM. Orofacial pain management: Current perspectives. Journal of Pain Research 2014; 7:99-115.