An Overview of Physical Therapy for TMJ

If you have pain in your jaw on one or both sides, you may have a condition called temporomandibular joint disorder, or TMD. (You will also hear this referred to as TMJ.) Your jaw may hurt, the muscles of your face may feel like they are in spasm, and you may feel clicking and catching in your jaw. These symptoms may make eating and talking painful or impossible.

There are many different treatments for TMJ. You may benefit from medicine or massage, and some people even have surgery to correct the problem. Physical therapy for TMD is another option to help you relieve jaw pain. So what can you expect from PT for TMD, and how can a physical therapist help you if you have TMD?

What Is TMD?

Temporomandibular joint disorders, known as TMD, is a condition that can cause significant difficulty using your jaw. The condition is marked by pain in your jaw that limits your ability to comfortably open and close your mouth. You may also experience clicking or "catching" while chewing food, yawning, or talking.

Symptoms of TMD tend to come on gradually with no specific injury or event. You may notice the pain starts after eating hard foods. The pain typically is intermittent in nature, and it usually comes on after using your jaw to eat hard foods or opening your mouth wide, as you would during yawning.

Anatomy of the Temporomandibular Joint

Your temporomandibular joint is formed by the articulation of your mandible to the mandibular fossa of the temporal bone of your skull. There is a small piece of cartilage called an articular disc that resides between the two bones. When you open and close your mouth, the disc slides as your jaw bone rotates and glides forward and back, making movement possible.

Various muscles attach near your temporomandibular joint. These muscle help to open and close your jaw, allowing you to talk, eat, and swallow. (Your jaw is the most used joint in your body.) Several small ligaments attach the bones together, increasing the stability of the joint.

What Can Go Wrong?

What causes problems with your TMJ? How can things go wrong with the joint? There are many causes of TMD. These may include:

• Displacement of the articular disc in the joint
• Muscle spasms
• Forward head posture
• Stress
• Clenching of your teeth (known as bruxism)

Whenever the joint is over-stressed, it can cause pain and joint movement dysfunction. This may lead to inflammation of the joint or of the muscles and ligaments surrounding the temporomandibular joint.

Diagnosis

If you are experiencing joint pain in your jaw, you should visit your dentist or healthcare provider. He or she can determine the cause of your pain and can properly diagnose your condition. Diagnosis of TMD is made largely by clinical examination.

Your healthcare provider will also examine your jaw's range of motion, looking for any deviations in movement. Sometimes your jaw may open well on one side and not the other, making your jaw move to one side as you open your mouth.

Occasionally an X-ray is taken to check if your temporomandibular joint has arthritic changes, and an MRI may be taken to examine the position of the articular disc in your jaw.

If your healthcare provider rules out TMD, there may be other causes of your jaw pain. These may include:

• Tooth decay or cavities
• Facial neuralgia
• Neck arthritis

Once a diagnosis of TMD is made, you can begin treatment. Working with a physical therapist may be an option for you.

PT Evaluation

Your first visit with a physical therapist for your TMD will be an initial evaluation. Your PT will take time to discuss your condition. He or she will ask you questions about how your jaw pain started and what activities make your symptoms better or worse. He or she will also discuss eating habits and other activities that may be irritating to your jaw.

Your therapist will also ask about previous treatments you may have had for your TMD pain. A thorough review of your medical history may also be done.

During the physical therapy evaluation, several tests may be performed to get a baseline measurement of your TMD condition. Components of a PT evaluation for TMD may include:

• assessment of posture
• measurements of neck range of motion
• measurement of jaw range of motion in various directions
• palpation of structures around your jaw
• measurement of the strength of your jaw and postural muscles

Once your evaluation is complete, your physical therapist will discuss with you the findings and make a plan of care to start treating your TMD. Be sure to ask questions about your condition and what you should expect from therapy. Your PT will also work with you to develop goals for your course of therapy.

PT Treatments

Your physical therapist may use various treatments for your TMD. These treatments are designed to decrease inflammation and pain, improve posture, improve jaw mobility, and help you regain normal function of your jaw. Treatments may include many potential methods for rehabilitating your joint.

Application of Heat or Ice

Heat may be used on your jaw to relax muscles and decrease pain and muscular spasm. Ice is sometimes used for TMD to decrease inflammation and pain around your jaw.

Ultrasound

Ultrasound is a treatment used in PT to provide deep heat to tissues and improve cellular mobility. It is sometimes used in the treatment of TMD pain. One study in the Journal of Physical Therapy Science found that the addition of ultrasound in conjunction with home exercises provided greater pain relief and improved mobility when compared to exercise alone.

Caution should be used with ultrasound; many studies regarding its use in PT find that it often offers little functional improvement.

Massage

Your PT may use various massage techniques to treat your jaw pain. Massage may be applied to your jaw muscles, facial muscles, and neck and shoulder muscles. The goal of massage is to relax muscles and improve circulation to them, allowing for a normal motion to occur in your temporomandibular joint.

Temporomandibular Joint Mobilizations

Your therapist may utilize mobilizations to your jaw to help improve the mobility of the joint. Mobilizations can restore normal joint motion and may help relocate a displaced articular disc in your jaw joint. The mobilizations your therapist performs may be a bit uncomfortable; many involve your PT placing her thumb or finger in your mouth along your teeth to mobilize your jaw. (Don't worry, gloves will be worn for this procedure.)

Postural Instruction

Sitting or standing with a forward head and rounded shoulder posture may place excessive stress and strain on your jaw joint. If your PT assesses that your posture is contributing to your jaw dysfunction, he or she may instruct you in proper posture. Exercises like the slouch-overcorrect procedure may be used.

Scapular strengthening exercises may also be prescribed to improve your overall postural awareness.

Exercises

Exercise for your jaw is one of the most important components of your TMD treatment program. Your PT will likely prescribe exercises to improve that way your jaw opens and closes. He or she may have you use a mirror so you can see how your mouth and jaw are moving and so you can ensure that they remain in proper alignment while exercising. The goal of exercise for TMD is to restore normal, pain-free jaw motion.

If you have any questions about your rehab program for TMD, ask your therapist. He or she will likely be happy to help you understand your therapy program and make adjustments so you can get the most out of PT.

What to Avoid

If you have TMD, there are certain things you should avoid as part of your treatment program. These things—often referred to as parafunctional activities—are things that you may be doing that are not necessary for function but are placing undue stress on your TMJ. Parafunctional activities may include:

• chewing gum
• biting pens or pencils
• leaning your chin in your hand
• eating hard foods

Avoiding these things can help take pressure and stress off your jaw joint and muscles and allow things to heal.

Timeline for Healing

Most cases of temporomandibular joint pain get better within six to eight weeks. Working with your PT and performing regular exercises can help in your recovery. Some cases may take longer, and some people continue with symptoms after treatment.

If this is the case, you should return to your healthcare provider for follow up care. Some patients benefit from other treatments such as wearing a mouthguard while sleeping or surgery for their TMD.

A Word From Verywell

If you have pain in your jaw, you may have temporomandibular joint disorder or TMD. Physical therapy can be a help modality of care if you have jaw pain from TMD. Your PT can help determine the cause of your pain and can improve the way your jaw moves. That way, you can quickly and safely get back to your normal activities.