TJM Dysfunction Thoughts 1 ~The Big Picture Model

TMJ can be a really painful and chronic condition involving the jaw and even the whole side of your head. In this short article, we will look at potential causes and zoom out a little to look at whole body considerations. I like to create therapeutic models and then test my ideas through soft tissue work. Here is a model I’ve used successfully in the past:

TMJ Model

The Big Picture:

I like to think of the front of the body as starting at the jaw, and working down to the top of the toes. I see the back of the body functionally from the the roof of the mouth up the head and into the back. With this model, the front and back of the body essentially meet at the jaw. This can make sense for folks who have jaw pain as it really feels like there is a fight for totally world dominion at the tempromandibular joint. The jaw itself is a pretty clever bit of technology, allowing us to chew and speak and mostly by lowering the mandible (jaw bone). The maxilla (roof of the mouth) is the stable part oft he equation.

When the front and back of the body and not happy or balanced, sometimes the weak link is at the jaw. The anatomical outline is the very basics, but feel free to skip it if it’s not for you. Hopefully this will still make sense either way.

Anatomical outline:

I like to think of the mandible (jaw bone) ans structurally part of the neck and chest. The chest and rib cage are a unit and the rectus abdominal  (abs) are the string to that bow. Have you ever done a sit up and felt the front of your neck muscles really engage? This is a function front line that runs clear down to your pubic bone. Going even further,  and associate your hip flexors (your lap) as the next step but that may be another article.

The sternocleidomastoid muscle (SCM) connects just under your ear and jaw into your sternum. This is a pretty important muscle to this equation and I’ll reference it in the future. If you look in the area I’ve circled you’ll also see the jaw muscle or massater, it’s said that massater is the strongest muscle of it’s size. If you’ve ever bit down on something unexpected you know how much power is in the jaw. This is the muscle that gets pretty tight and can cause some real pain. it’s not the enemy, but it’ll need attention.

Moving deeper we have the temporomandibular joint itself. This is where the jaw and skull meet up. It’s a joint but I like to think of it as an articulation of two bones. Two friends who need each other and communicate about it. It’s capable of great delicacy and tremendous power. It’s also capable of going wrong.

TMJ Dysfnction: The tight front

Think of the jaw as part of the front and think of that front being way to short. Slouching while at a computer  or driving can easily cause a short front. I’ve also seen lots of exercise, especially abdominal strengthening cause tons of problems at the jaw.  We can almost imagine (and I’ve dissceted in real life) fascial connections from the abs clear to the jaw. because the SCM goes from being a front muscle to esentially a back one it bulls the back of the head down, thus shortening the distance from the back of the skull to the sternum. This tends to make one of the cervical vertebra run deep. The only place that isn’t held snugly in place in the jaw, and in the case the jaw yields to stronger actors.

deep jaw

TMJ Dysfunction: The left-right asymmetric model

In the model we’ve got a rotation of the head from left to right. This may be coming from the spine, the hips, the result of an injury or repetitious patters like holding a phone receiver between an ear and shoulder. In this case one side typically hurts much more than the other. Often the dominate side can cause ringing and clenching, and the weak side can be very inflamed and irritated, and feel exhausted. If there is a left-right asymmetry we often need to look to the rotation of the neck. Typically the first cervical vertebrae is burying itself in the cranium on one side, and way out in the breeze on the other.

TMJ Dysfunction: Stress

Another potential for TMJ is stress. Stress is almost always associated with either of the conditions above, but I’d like to take it further and give it it’s own category. The neck is a very common place to heap your stress. A tight back is going to breed a tight or weak front. I’ve heard discussions about TMJ and feeling like your not being heard, or holding back what you need to say. When I even pretend to be angry the first thing I do is clench my jaw. Fear is another common clencher, and can be thought of as an underlying narrative, for example: “I don’t know whats coming next for me”, “I’m afraid I’ll loose my job, spouse, or child”, “I don’t feel safe or secure”.  These are not one time messages but can been constantly running in the background. It’s these chronic conditions that we are interested as a cause for TMJ.

Treatment Ideas:

When working with someone with TJM, I’d like to think of one or all of these as factors to base a session on. There are many opinions and approaches to treating TMJ, and this article for me was a way of sharing something I’ve been seeing in my practice in the last few weeks. While meant to inform this is by no means a definitive guide to TMJ.

Observation

When observing someone with TMJ, I first look at the rotation of the arms and shoulders relationship to the trunk. The shoulders rounded forward my tell us about the tight front model. Next, I’ll look at the heads relationship to the shoulders and center line of the body. If the head is forward it supports the tight front, if they are different from side to side its supports lateral asymmetry. Next I look for the SCM, if it’s visible and pronounced I know it’s working hard and may be contributing. If one shoulder is lower than the other or if the head is rotated to one direction those are indicators of lateral asymmetry.

Treatment (next blog post)

I’d begin a session at the hands or rib cage and work up to the neck. The costal arch may be very sore and if it’s feels tight, it’s pretty straight forward: open up the whole front of the body. I’d work the neck muscles in side lying, and under the jaw line in the prone position. (Continued in TMJ 2 ~Treatment)