What is TMJ Disorder?

The temporomandibular joint is the joint that allows you to open and close the jaw. The joint connects the mandible or lower jaw to the upper jaw and face. This joint is known as the TMJ and is the only connection of the mandible to the rest of the body. The joint is a smooth “ball-in-socket” joint that is flexible enough to open and close the jaw, move the jaw from side to side and be able to accurately chew food. The muscles around the TMJ support the joint and control its movement and function.

TMJ disorders can cause significant pain and dysfunction of the jaw joint. The muscles that control jaw movement can be too tight and this can cause stiffness of the joint. More than 20 million people in the US are believed to be affected by TMJ disorders. More women seem to have the problem when compared to men.
Most people have no pain or problems with the TMJ; however some will have cyclical pain in the joint that goes away without any treatment. Some people, on the other hand, will have long term symptoms associated with the joint and will become debilitated by the pain and inability to chew affectively.

People with poor posture can get TMJ syndrome. If you are one who sits forward all day staring at a computer screen or television, you can be at risk for TMJ disorder. Lack of sleep can play a role in the disease. If you have a muscular “trigger point” or tender spot located in the muscle of the facial area, this can cause you to have problems with your TMJ.

Arthritis of the TMJ, fractures of the face or mandible or frequent dislocation of the joint can trigger TMJ symptoms. There are basically three types of pain associated with TMJ syndrome and they need to be approached differently from one another. These include:

• Internal derangement of the TMJ, such as a disc that has become displaced, an injury to the condyle or dislocation of the TMJ.
• Myofascial pain, which is pain to the muscles surrounding and controlling the joint (this is the most common source of TMJ pain).
• Arthritis in the joint itself, which can be degenerative in nature or inflammatory in nature.
• You can have any combination of these types of pain together, for example, inflammatory arthritis that is also associated with myofascial pain.

EXERCISES FOR TEMPOROMANDIBULAR JOINT DYSFUNCTION

● Perform each of the following exercises three times each day.

● For each of the exercises, do the following:

1. Perform the movement for 10 repetitions and then rest for 30 to 60 seconds.
2. Repeat step 1 two more times, thereby doing 3 sets of 10 repetitions for each exercise.

Exercise for an Inability to Fully Open the Jaw
● The exercise is performed as follows:

1. Open your mouth as wide as you can, doing this gently until you begin to feel your jaw muscles stretch.
2. Place your fingers on the top of your chin.
3. Close your mouth while you gently resist this movement with your fingers.
4. Hold this position for 3 to 5 seconds.
5. Relax your jaw.
6. Keep your fingers on your chin and open your jaw a little further until you feel your jaw muscles begin to stretch again.
7. Repeat steps 1 through 6 until you have performed 3 sets of 10 repetitions.

Exercise for Increasing Side-to-Side Movement of the Jaw
The exercise is performed as follows:

1. With your mouth slightly open, move your jaw to the left as far as you can comfortably.
2. Place the fingers of your right hand on your right lower jaw.
3. Move your jaw to the right while you gently resist this movement with your fingers.
4. Hold this position for 3 to 5 seconds.
5. Relax your jaw.
6. Keep your fingers on your chin, and move your jaw a little further to the right without forcing it.
7. Repeat steps 1 through 6 until you have performed 3 sets of 10 repetitions.
8. Repeat the entire exercise in the opposite direction.

Exercise for Increasing the Forward and Backward Movement of the Jaw
● The exercise is performed as follows:

1. With your mouth slightly open, push your jaw forward as far as you can comfortably.
2. Hold your jaw in this position for 3 to 5 seconds.
3. Relax your jaw.
4. Repeat steps 1 through 3 until you have performed 3 sets of 10 repetitions.

TMJ PHYSIOTHERAPY

Hot compresses will sooth the jaw before or after exercises. The exercises alone will be able to take care of your TMJ pain if you practice them daily for several days or weeks, depending on how severe the problem is. Everyone has different degrees of TMJ pain and it may take longer if you have severe pain. Some people actually have pain relief after just one day’s therapy. Be sure to be consistent in
doing your TMJ exercises as skipping a day or two can throw off the TMJ completely so you will have to start all over again.
There are tracking improvement exercises that are supposed to eliminate popping, clicking and abnormal movement of the TMJ. You start by placing your tongue on the roof of the mouth. Put your index finger on your chin and the other at the area where the TMJ is located (in front of your ear). Open the jaw gradually and push it down and back toward your neck. Do this five times over for five sets a day each
day. This helps stretch the muscles between your jawbone and your temporal bone.
You also need to strengthen the jaw. You start by sitting straight up on a bed or chair and release the tension from your body. Place a bent index finger inside your mouth, slightly opening the teeth. Keep your mouth open but remove your finger.
Put your tongue on the roof of your mouth and use your index finger to put pressure on your jaw upward. Then apply pressure to the lower left side of the chin for two seconds and then repeat on the right side, keeping your jaw held tight in a neutral position. Repeat each exercise five times and then do five additional sets at various intervals throughout the day.
Jaw relaxation exercises are important, too. They reduce pain and keep the tension off the joints themselves. In one exercise, pain is reduced when you open your mouth slightly and then place two fingers on the middle of your bottom teeth. Press down to open the jaw to a comfortable position. Then release and repeat ten times, holding the position for 1-2 seconds at a time.
Next, put your tong onto the roof of your mouth and open your mouth widely while your tongue is still in the same position. Count a deep breath in for two seconds and a deep breath out for two seconds. Release the position and repeat this 10 times.
The next is an isotonic exercise. Put hour fist against the underside of your closed jaw. Try to open your jaw against the pressure being placed on it. Hold the tension for ten seconds. Repeat this exercise about 10 times in one day.
Next, press your fist against the right side of your jaw below the TMJ. Try to maintain steady pressure. This isometric pressure against the muscles of the TMJ and will allow these muscles to relax if you hold pressure for ten seconds, repeating it ten times. Do the same thing on the left side of your jaw.
Next, press the jaw on either side with one finger. Apply pressure evenly on both sides of the jaw. Open the jaw slowly, watching for clicking sounds. If the TMJ actually clicks, you must release the jaw and start over again, opening the jaw more slowly the next time. The alignment of the jaw must be perfect when you apply pressure to it with your fingers.
Once your jaw has become relaxed and is perfectly aligned, hold your chin between your thumb and index finger. Loosely and slowly, shake your chin back and forth so that your jaw releases itself and relaxes. Do this for about ten seconds and repeat as often as you need to during the day to feel less pain in your TMJ. Eventually, the jaw will learn to relax itself as it develops memory of being relaxed.
Exercise to the TMJ is perhaps the best way to get relief within just a few days. You can do them for a while and quit in order to see if the problem is resolved. TMJ syndrome, however, is usually long lasting so you need to expect to do these exercises for as long as it takes to get better and remain pain free

Each requirement for successful occlusal therapy (circles) is dependent upon the others.