The temporomandibular joint (or TMJ) is a hinge joint, located right in front of your ear, that connects your jaw bone (also known as the mandible) to your skull. Calling it a hinge joint, actually, is a bit of an oversimplification – there is a substantial piece of cartilage in between the bones which slides back and fourth as the mouth opens and closes, and a complex system of ligaments and muscles that control the movement of this cartilage and the bones.
This joint works hard for you every day – each time you chew, talk, or yawn, your TMJ is involved. Problems in this joint – which usually present as pain felt just in front of the ear, clicking or popping in the joint or in the ear itself, difficulty chewing, or the mouth getting “locked” in the open or closed position – often result from poor joint alignment. The muscles, ligaments and cartilage of this joint must all maintain a balance between mobility and stability in order for smooth, controlled opening and closing of the mouth to be possible. Further, the TMJ on the right side of the mouth must work in a coordinated way with the TMJ on the left side of the mouth.
Various factors can influence the alignment of this joint. Poor posture of the neck or back, jaw clenching, tooth grinding, extended dental work, the use of oral appliances like braces, or asymmetrical chewing (as in habitual gum chewing, or chewing on one side of the mouth to avoid pain from a cavity) are some of the most common. If the joint is not aligned properly, even if it is off by a couple of millimeters, the delicate length-tension balance of the muscles and ligaments around this joint can be lost, leading to pinching of tissues that normally have no problem getting out of the way as the jaw opens and closes. This can cause inflammation and pain. Further, the cartilage disc that typically slides forward and back as the jaw opens and closes can become “stuck” in the forward position, which can also cause pain, and in some cases prevent the mouth from closing.
Treatment of TMJ pain usually involves physical therapy, rest, some behavioral training (to break the habit of gum chewing or tooth grinding), use of a night splint, and anti-inflammatory medicine as recommended by a doctor. The goals of treatment are to improve alignment of the joint, decrease joint inflammation, and train the joint to work in a balanced way again.
In all of these traditional treatment approaches, a great deal of attention is given to the position and motion of the mandible (the white bone in the photo below). While this bone is obviously of critical importance in the context of treating TMJ pain, we should not overlook the other bone that makes up this joint – the temporal bone (the pink bone in the photo below). There are of course two of these in your skull, one on either side of your head. This bone is easy to recognize in any skull model, as it has a hole going through it to accommodate your ear canal. This is the bone that the mandible connects to at the temporo-mandibular joint, and as such, any treatment approach that does not include at least an assessment of this bone should not be considered comprehensive.
This is where Craniosacral Therapy can be helpful. As you can see from the photo above, the cranium is not one solid head-shaped piece of bone. Rather, it is made of 8 bones, the differentiation of which you can see as each colored piece of the model is a separate bone. (Actually, the skull itself is made up of 20 bones; for our purposes I am just focusing on the 8 bones of the cranial dome.) Though there has been a great deal of debate and discussion, some research* shows that movement of the bones of the cranium is possible at the places where they join (called sutures). Because of this small degree of motion, membrane tensions within the cranium, postural imbalances, or head trauma can cause the temporal bone(s) to be slightly moved out of proper alignment. As a result, the position and motion of the TMJ can become dysfunctional as well. A therapist trained in the use of Craniosacral techniques can assess the position and motion of the temporal bones, as well as the alignment of the mandible, and can work to bring all of these bones toward more optimal positions. This is an important component in comprehensive treatment of TMJ, for if the membranes within the cranium are pulling the temporal bone in to a dysfunctional position, no postural re-education program, anti-inflammatory, or night splint will completely correct the problem at the joint. Further, the deep relaxation that is experienced during a Craniosacral session can go a long way to counteract the effects of stress – translated as jaw clenching and tooth grinding in the TMJ – that can fuel chronic TMJ pain.
To review – integrating Craniosacral therapy as part of a comprehensive TMJ pain treatment plan is a good idea. Other components that should be part of TMJ dysfunction treatment include exercises for muscle re-education, rest via temporary diet modifications that allow for decreased chewing, and postural changes to allow for continued optimal joint alignment. Visiting a Physical Therapist that is trained in the use of Craniosacral techniques would allow you to address all of these needs with one practitioner.
Debbie Turczan is a Physical Therapist specializing in Craniosacral Therapy, with offices in New York City and Long Island.