Temporomandibular Disorder

The hinge joint between the jaw and head is unique, allowing the hinge opening action to be combined with sliding in any direction. This is because the Temporomandibular Joint (TMJ) has a tiny disc inside the hinge. The jaw rotates on the disc (hinge action) and the disc slides the jaw forward or sideward (glide action). Try chewing something to understand this. It is a fascinating part of the body. Here is a picture.

This part of your body is important for eating, breathing, talking and social expression. Problems occur with limited opening, painful clicking on opening or difficulty to chew food. Have you or are you suffering from pain and stiffness in your face, jaw, temple or in front of your ear in the last month? Or your hearing feels odd or echo-like? You probably have a problem with this area of your face. We call these Temporomandibular Disorders (TMD).

TMDs are very common, with estimates of anywhere from 40-75% of the population suffering at some time, of which only about 10% of sufferers seek help. About 40% will resolve over time. The remainder need help.

Physiotherapy is key to many in recovery. The neck is intimately related biomechanically to the jaw. To understand this, think of the head and neck as an upside down pendulum. A complex neural network of muscles and control systems guide head, neck and jaw rest position.(1)(2)(3) Head neck position can even alter elevation of the larynx and can influence voice.(4)
Research demonstrates that TMD sufferers are more likely to have altered neck/jaw posture, restricted neck movement, as well as altered TMJ motion.(5)(6)
Physiotherapy treatment focuses on manual treatment to eliminate painful clicks, restore joint gliding and muscle memory (jaw and neck muscle motor control and strength). Education on the condition, self-care, lifestyle and ergonomic factors are important. Every patient journey is different as TMD is a broad term which covers problems of muscles, or joints, the joint disc or a combination of all three. There are always simple self-care solutions we ask people to follow, particularly regarding jaw and mouth bracing, tightening or chewing during the day. We call these parafunctions, increased mouth activity when nothing is in the mouth. The muscles work too much and the TMJ is repetitively and needlessly compressed, which can cause issues.
Physiotherapy treatments are shown to improve mouth opening and reduce pain in several research trials.(7)(8)(9)
​Time to smile!
  1. Flores. 2017. Cranio: 79-85
  2. Malfosky.  1991. Cranio: 316-321
  3. Rocabado. 1983. Cranio: 61-66
  4. Honda. 1999. Lang Speech 42: 401-411
  5. Grondin F. 2015. Cranio: 91–99
  6. Greenbaum. 2017 Msk Sci Pract: 7-13
  7. La touch 2009. J Oral Rehab: 36:644-652
  8. Calixtre 2016, J Oral Rehabil 42: 847-861
  9. Martins 2016 Man Ther 21: 10-17
  10. Grondin 2017 Phys Th Theory Prac 33 52-61
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* Conferred by Fellowship of the Australian College of Physiotherapists in 2010