How can a Physical Therapist Help with Jaw Pain?

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How can a Physical Therapist Help with Jaw Pain?

Most people have heard of TMJ or TMD. What a lot of people don’t know is that a physical therapist can help people who are having symptoms of TMD or TMJ pain.

TMD, or tempormandibular dysfunction, is a relatively common problem that is most often associated with pain in the jaw, but has other symptoms as well, including jaw popping/locking, difficulty chewing, and even headaches, ear aches, and neck aches. There are two general categories of TMD.

  • Myogenous or Myalgia – meaning the problem is coming mostly from the muscles around the temporomandibular joint, simply means muscle pain.
  • Arthrogenous – meaning the problem is coming from structures inside the joint itself.

Myalgia is characterized by having a history of pain located in the jaw, temple, and/or ear area AND that pain is changed by jaw movement or function. That means you tend to notice your pain more when you do things like talk or chew. Additionally, the pain can be reproduced by pressing on the muscles on the side of your jaw (A, masseter) and/or on the side of your head (B, temporalis). Opening your mouth may or may not be painful and your mouth range of motion may or may not be limited.

So, if this sounds like you, then there is a good chance you have myalgia.  Now, what can you do about it? We will go through three strategies of self care that attempt to address myalgia: 1) activity modification, 2) soft diet, and 3) jaw exercise and awareness.

Activity modification:

Most of the time people develop myalgia because they do activities that cause excessive or repetitive stress through the muscles of the jaw, so in order to eliminate your symptoms you need to figure out how to reduce or eliminate these activities. This seems simple, but it’s harder than it sounds. There are at least 21 of these activities or habits people often do that can be lessened or eliminated. A few of these activities include things like:

  • chewing gum
  • singing or sustained talking
  • holding a phone between your ear and shoulder
  • resting your chin on your hands
  • sleeping on your stomach
  • clenching/grinding your teeth
  • biting/holding objects such as pens

If you can identify these types of activities and take them out of your daily routine, there is a good chance your jaw pain may begin to decrease.

Soft diet:

Going on a soft diet for a while can decrease the amount of work your jaw muscles have to do and over time can decrease the tension and pain in your jaw muscles. A soft diet can be more than just jello, applesauce, and smoothies. It can include things like:

  • eggs – scrambled, fried, soft, or hard boiled
  • cooked cereals like grits or oatmeal
  • pudding
  • cooked vegetables
  • pasta
  • ground meat
  • cheese, cottage cheese
  • soft rolls, bread, or pastries

In general, while on a soft diet you should avoid taking large bites, foods that require prolonged chewing even if they are soft, forceful biting, and any food that causes jaw pain. Foods to specifically avoid are hard or chewy foods like:

  • chewing gum
  • popcorn
  • hard or chewy candy
  • steak or any tough meat
  • pizza
  • pizza, bagels, or other tough breads
  • chips
  • nuts
  • ice cubes
  • apples, carrots, celery sticks
  • corn on the cob
  • granola, cold breakfast cereal

Jaw exercises and stress awareness:

A big reason people get myalgia is because of teeth grinding or clenching, which causes increased tension in the jaw muscles. Teeth clenching generally happens during periods of stress. Screaming kids, pressure at work, sitting in traffic, can all cause stress and result in clenching and contribute to myalgia. Teeth clenching can also happen during other times as well, such as when intensely focusing or during strenuous activity like working out or doing heavy yard work. It is important to become aware of your jaw, if you are clenching it, and what situations cause you to clench. There are exercises you can do during these times to make sure you aren’t clenching your teeth and to make sure you are maintaining a relaxed jaw posture. These exercises include:

  • finding your jaw resting position – This is an important one! This should actually be how your jaw is positioned ALL of the time, or as much as possible. To get in to your jaw resting position, gently place your tongue behind your top front teeth where your teeth and gums come together. Your lips could be closed and your back teeth should NOT be touching. In fact, unless your are swallowing or chewing, your back teeth should not touch. Remember tongue up teeth apart!
  • controlled opening/closing – from the jaw resting position with your tongue touching behind your front teeth, open your mouth but keep your tongue touching the back of your front teeth. This will give the muscles that close your jaw a bit of a break, a gentle stretch, and will keep your mouth from opening too wide. This is also a good trick to use when you yawn. If you keep your tongue against the back of your top teeth when you yawn, you won’t yawn too wide.
  • jaw wiggle – this one takes just a little coordination, but you’ll get it. With your teeth apart, gently move your jaw side to side. Don’t go too far. it’s not about how far you go and it’s not a stretch, it’s just an exercise to get the jaw muscles to relax a bit. It’s kind of like “shaking out” your arms or legs after a workout.

Hopefully making some of these changes in behavior, diet, and jaw posture can reduce or eliminate your jaw pain. If they don’t, then don’t panic. There are lots of other ways to address myaglia, but you’ll need a physical therapist to help. There are several massage techniques for the muscles of the jaw that a physical therapist can perform to help decrease tension and pain. Dry needling (*link text to dry needling page/blog*) can be particularly helpful for trigger points in the jaw muscles. There is also a close relationship between the jaw and the neck, and performing manual therapy and stretching to the neck can help reduce muscle tension in both the neck and the jaw.

*NOTE: this post is about myalgia, which is a specific type of TMD. The points above are specific to myalgia and are not necessarily applicable to other types of TMD. A physical therapist can help if you have other types of TMD, too. If you are experiencing painful jaw popping, jaw locked closed or open, or significantly limited jaw opening, then you should make an appointment with a physical therapist specializing in TMJ such as Back in Action’s very own Sean Nixon, DPT, or a dentist or other oral health care provider who specializes in TMJ.

Image: http://www.aasmnet.org/jcsm/ArticleImages/jcsm.10.3.291a.jpg

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