Assessing the TMJ
Assessing TMJ
When it comes to managing jaw pain or dysfunction, a detailed assessment is the first step. Temporomandibular dysfunction (TMD) affects many people, and getting to the root cause is essential for effective treatment. Here's a look at how we assess and treat issues with the TMJ (temporomandibular joint) and surrounding muscles.
Step 1: Identifying the Problem
Our initial focus during an assessment is determining if the issue is related to the joint itself or the surrounding soft tissue. This involves differentiating between intracapsular (joint-related) issues and extracapsular (soft tissue-related) issues.
Checking Jaw Movement and Alignment
We start by asking the patient to open their jaw as wide as possible, observing for any deviation, lateral movement, or clicking and popping sounds. These signs indicate TMD, pointing us toward a potential dysfunction within the TMJ.
Palpating the Joint for Pain
Next, we apply gentle pressure around the TMJ while the patient slightly opens their jaw. We ask if this replicates any regular symptoms. If it does, the problem may be joint-related; if not, we focus on soft tissue.
Step 2: Assessing Soft Tissue
If the joint is not the source of pain, we assess the surrounding muscles, such as the masseter and temporalis muscles. By feeling for trigger points or tender areas, we can locate muscle tightness or knots that may contribute to jaw discomfort. Often, patients are unaware of these trigger points until theyโre palpated.
Soft Tissue Release Techniques
Once trigger points are identified, we use specific soft tissue techniques, applying pressure to release muscle tension. This often involves firm pressure on the trigger points to help ease tightness, which may improve jaw movement and reduce symptoms.
Step 3: Retraining the Jaw Muscles
After soft tissue work, itโs essential to retrain the muscles involved in jaw movement to promote balanced and controlled motion. Hereโs one exercise we often recommend:
Tongue-to-Roof Exercise: The patient places their tongue on the roof of the mouth and slowly opens their jaw until the tongue begins to lift. This controlled movement helps train the jaw to open evenly, reducing strain on the TMJ.
Step 4: Addressing Joint-Related Issues
If the assessment reveals a joint issue (intracapsular problem), we move to exercises that retrain the jawโs movement patterns. One effective approach is a jaw protrusion exercise, where the patient gently extends their lower jaw forward or upward to improve joint mechanics.
Jaw Protrusion Exercise: By guiding the lower jaw in a specific direction, we can help retrain the TMJโs movement and reduce symptoms. As the patient progresses, they may increase the intensity of the movement to further restore function.
Step 5: Ongoing Rehab and Home Exercises
After assessing and treating the TMJ and muscles, we always recommend ongoing exercises to maintain improvement. This includes the tongue-to-roof-of-mouth exercise, as well as any other movement patterns that aid in restoring balance and control to the jaw.