Excerpt from an article written by Tracey first published in Today's Therapist in 2009
Figures from the British Dental Health Foundation estimate that one in four people suffer from TMJ (temporomanibular joint disorder) - a debilitating condition that can cause intense symptoms in the face and jaw and completely affect the quality of a person's life.
While teaching a course in massage for the treatment of TMJ I asked students how many thought they had TMJ. In a room of 30 people, five people raised their hand. By the end of the morning, after a palpation assessment exercise and discussion around signs and symptoms I asked the question again and this time over half the class raised their hand.
This came as no surprise to me. In my 16+ years' experience as a dental nurse I saw many patients pass through the surgery with TMJ dysfunction.
Conventional treatments on offer had mixed success and included wearing splints at night, taking muscle relaxant drugs, adjusting high fillings and replacing worn fillings.
When these measures failed, patients would be referred to a specialist for extensive tests including panoramic x-rays and even MRI. Surgery was an option but was very rarely considered as a last resort.
So what is TMJ? Why is it so difficult to diagnose and treat? More importantly what can we as massage therapists do about it?
TMJ stands for TemporoMandibular Joint
The TMJ is the hinge joint that connects the lower jaw (mandible) to the temporal bone of the skull. The joints move up and down and side to side and enable you to talk, chew, and yawn. Muscles attached to and surrounding the joint control its position and movement.
Because it combines a hinge action with sliding motions, the TMJ is one of the most complex joints in your body. The parts of the bones that interact in the joint are covered with
cartilage and are separated by a small shock-absorbing disc, which keeps the movement smooth. TMJ is also used to describe a number of diseases and disorders associated with the joint. What are TMJ diseases/disorders?
TMJ diseases and disorders are a complex set of conditions that can cause issues in the area of the joint and associated muscles and/or problems using the jaw. Both or just one of the joints may be affected. TMJ diseases and disorders can affect a person's ability to speak, eat, chew, swallow, and even breathe.
TMJ diseases and disorders fall mainly into three categories. A person may have one or more of these conditions at the same time.
Myofascial. This refers to discomfort or restrictions in the muscles that control jaw function and can also extend to the muscles in the neck and shoulders.
Internal derangement of the joint. This involves displacement of the disc that acts as a cushion between the skull and lower jaw.
Inflammatory joint disease, including arthritis, an inflammatory condition that affects a joint; and synovitis, an inflammatory condition of the synovial membrane. The synovial membrane lines the joint and produces a fluid that lubricates the joint.
How do we know if a client has TMJ?
First and foremost, as massage therapists it is NOT our job to diagnose.
Even for the dental surgeon diagnosing TMJ diseases and disorders can be difficult and confusing. Apart from the three main categories stated above, facial symptoms can be a symptom of many conditions, such as sinus or ear infections, decayed or abscessed teeth, various types of headache, and facial neuralgia
Massage can bring about huge relief for TMJ sufferers where the soft tissues are involved. However, there is always the possibility of another problem that needs intervention by a dental professional.
If a client is describing symptoms that make you suspect TMJ there is a simple palpation assessment you can perform to help determine if there is a problem with the joint and soft tissues. You should then refer your client to their dentist for a full assessment and diagnosis and then bring them back to you for treatment to complement the work their dentist is doing.
So what can WE do?
The good news is that appropriately trained massage therapists are in a unique position to help sufferers of this condition improve their quality of life. Disorders of the muscles of the TMJ are the most common complaints by TMJ patients.
Simple cases of this type of TMJ are caused by overuse of the muscles. Problems in the joint will often be coming from the soft tissues surrounding it. Even if there is a physical problem with the disc or the joint itself the muscles will often be involved and a significant reduction in symptoms and improved function can be achieved with trigger point work.
© Tracey Kiernan 2009