Trigger-Point Dry Needling in the Treatment of TMJ

Dry needling can greatly reduce your jaw pain and can assist in improving your jaw's range of motion and restoring your jaw function.

Treating TMD with Physical Therapy

If you have pain in your jaw on one or both sides, you may have a condition called temporomandibular joint disorder, or TMD (you may also hear this referred to as TMJ). This is a common condition that limits the natural functions of the jaw, such as opening the mouth and chewing.

TMD currently affects more than 10 million people in the United States. It affects more women than men and is most often diagnosed in individuals 20 to 40 years old. TMD causes a range of problems from poor posture, chronic jaw clenching, and poor teeth alignment, to fractures or conditions such as lockjaw, where the muscles around the jaw spasm and reduce the ability of the mouth to open.

Physical therapy can help ease the pain of TMD, regain normal jaw movement, and lessen daily stress on the jaw. Therapy may also improve quality of life through hands-on care, patient education, and prescribed movement.

What Is Temporomandibular Joint Disorder?

Temporomandibular joint disorder, known as TMD, is a condition that can cause significant difficulty using your jaw marked by pain that limits your ability to comfortably open and close your mouth. The temporomandibular joint, or TMJ, is a hinge joint that connects your jaw to your skull in front of your ear. The TMJ guides jaw movement and allows you to open and close your mouth and move it from side to side to talk, yawn, or chew. Various muscles attach near your temporomandibular joint. These muscles 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.

Symptoms of TMD tend to come on gradually with no specific injury or event. 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 when yawning. 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.

What Causes TMD?

Bad posture habits. One of the reasons TMD is so common is because many of us spend a great deal of time sitting at a desk, where we often hold our heads too far forward as we work. The forward head position puts a strain on the muscles, disk, and ligaments of the TMJ. The jaw is forced to "rest" in an open position, and the chewing muscles become overused. But there are many other kinds of bad posture. Sitting in the car for a long commute, working at a checkout station, always carrying your child on the same hip—all can place the head in an awkward position and cause jaw problems.

Chronic jaw clenching (bruxism). Many people clench their jaws throughout the day or at night while they sleep—usually due to stress. This puts a strain on the TMJ and its surrounding muscles.

Problems with teeth alignment (malocclusion). If your teeth are misaligned, greater stress is placed on the TMJ when performing everyday jaw motions, such as chewing.

Fracture. In a traumatic accident involving the face or head, a fracture to the lower jaw may result and cause TMD. Even when the fracture is fully healed, TMJ stiffness and pain may remain.

Surgery. Individuals may experience a loss of TMJ mobility and function following certain kinds of surgery to the face and jaw.

Trismus (lockjaw). This occurs when the jaw muscles spasm and the jaw cannot be fully opened. This can be both a cause and a symptom of TMD. Other causes of trismus include trauma to the jaw, tetanus, and radiation therapy to the face and neck.

Displacement of the disc or soft-tissue cushion located between the ball and socket of the TMJ. This causes popping or clicking of the jaw and, frequently, pain.

Over-stressed joints. This can cause pain and joint movement dysfunction. It may also lead to inflammation of the joint or of the muscles and ligaments surrounding the temporomandibular joint.

What are the Symptoms of TMD?

The symptoms of TMD can be temporary or last for years. Jaw pain is the most common symptom.

CAUTION: Jaw pain also can be a symptom of a heart attack. Seek medical care immediately if jaw pain is
accompanied by:

  • Chest pain
  • Shortness of breath
  • Dizziness
  • Left arm pain
  • Numbness in the left arm
  • Nausea

TMD symptoms include:

  • Jaw pain
  • Jaw fatigue
  • Difficulty opening your mouth to eat or talk
  • Ringing in your ears
  • Dizziness
  • Headache
  • Popping sounds in your jaw
  • Neck pain
  • Locking jaw


How Is TMD Diagnosed?

If you are experiencing joint pain in your jaw, you should visit your dentist or healthcare provider. They 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 may:

  • Review your medical history and discuss any previous surgery, fractures, or other injuries to your head, neck, or jaw.
  • Ask you to describe your pain, including headaches, and observe any pain patterns in the neck and TMJ.
  • Palpate, or touch, your jaw joint and the muscles around it, feeling for tenderness or clicking while you open and close your mouth.
  • 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.
  • Evaluate your posture and observe how your cervical spine—the upper portion of your spine situated in your neck—moves. They may examine your TMJ to find out how well it functions and whether there are any abnormalities in your jaw motion.
  • Take an X-ray to check if your temporomandibular joint has arthritic changes. 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

  • 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.

How can Physical Therapy help?

Your physical therapist can help you restore the natural movement of your jaw and decrease your pain. Your first visit with a physical therapist will be an initial evaluation. They will ask you questions about how your jaw pain started and what activities make your symptoms better or worse. They 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 an 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 the findings with you and select treatments that will work best for you. Be sure to ask questions about your condition and what you should expect. Your physical therapist will also work with you to develop goals for your course of therapy.

Can TMD Be Prevented?

Maintaining good sitting posture is key to preventing TMJ problems. Your physical therapist will show you how to maintain better posture to prevent future episodes of TMD.
General tips include:

  • Place any work you are focusing on (written documents, computer screens) directly in front of you and not off to the side where you are forced to look in one direction for long periods of time.
  • Place your computer monitor at eye level so you don’t have to look up, down, or to the side throughout your day.
  • If you are on the phone at work for long periods of time, use a headset that allows the neck and jaw to remain in a restful ("neutral") position.
  • Maintain good oral hygiene and tooth health.
  • Avoid repetitive chewing, such as chewing gum.
  • Avoid biting pens or pencils.
  • Avoid leaning your chin in your hand.
  • Avoid smoking.
  • Avoid opening the jaw too wide.
  • Avoid eating hard or chewy foods.
  • Avoid sleeping on your stomach, which forces the neck to rotate to one direction in order to maintain an open airway, increasing stress on the TMJ.

What are you waiting for?

Pain Relief Starts Here and Now!

By working at the causes of pain rather than putting out the fire, you can find relief, become more comfortable, and be freed from the pain cycle. Learn more about how our team of highly qualified therapists with their assessment tools will help you manage your pain – so you can get back to doing what you love.