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What Causes TMJ Dysfunction & Best Exercises To Treat Jaw Pain

Written by: Nick Jack
Category: 2014
on 05 April 2021
Hits: 254

If you have ever suffered with jaw pain which is more commonly known as TMJD (temporomandibular joint disorder) you will know exactly how painful and disruptive to your daily life it can be. You will also know how frustratingly difficult it is to treat. It is one of the most confusing joints to understand and is often misdiagnosed and mistreated as the symptoms can mimic other problems. Even the cause of the pain can differ greatly from one person to the next. Like all injuries, finding the “true” cause of the problem is critical for getting on top of this. The underlying cause is what drives the constant pain and dysfunction and until this is identified and changed you will not find any long term relief. Having suffered with this condition myself recently I came to realize just how complex it can be, and it led me on the search for more answers as I struggled to find any treatment that could help. In this article I will explain the various solutions I discovered, and provide you with some unique tips and exercises to get your jaw back to normal.

What Is The TMJ?

If you have never suffered with TMJD before and not sure where this tiny muscle is located the picture below shows you exactly where it is.

 

The TMJs are the two joints in front of each ear. The joints connect the lower jaw bone (the mandible) to the temporal bones of the skull on each side of the head. The muscles controlling the joints are attached to the mandible and allow the jaw to move in three directions: up and down, side to side, and forward and back. When intact, they are the only joints in the human body that work together as a unit.

When you open your mouth, the rounded upper ends of the mandible on each side of the jaw (the condyles) glide along the joint socket at the base of the skull. They slide back to their original position when you close your mouth. To keep this motion working smoothly, a soft tissue disc lies between the condyle and the socket. The disc absorbs the shock to the joint from chewing and other movements.

"This combination of complex synchronized and three-dimensional movements of the TMJ, makes it arguably the most complicated joint in the body."

There is no denying this, is one of the most used, most necessary, and perhaps most misunderstood set of joints in the body. The health of this joint is critical to the vital work of human life, including eating, talking, kissing, yawning, and even breathing.

If you have trouble opening or closing your mouth, hear clicking or grinding when you open your jaw, difficulty chewing food, or have chronic neck pain and headaches there is a good chance you have TMJD. It is wise to go and see a qualified therapist or doctor to be diagnosed correctly. Please do not self-diagnose.

How Common Is TMJ Dysfunction?

One thing that really surprised me about this disorder is how common it is. I had heard of friends and family suffering with some type of jaw pain in the past but I assumed this was a very rare injury for someone to sustain. How surprised I was to find out during my research that it is one of the most common injuries in the modern world today! It is second only to back pain in terms of musculoskeletal disorders.

In the book “The TMJ Healing Plan” by Cynthia Paterson she quotes a study by the New England Journal of Medicine that 40-75% of adults in the US report at least one sign of TMJ disorder! They also found it is 3-9 times more common in females than males.

Here are some other interesting facts relating to the jaw and TMJ.

  • Your teeth should never be touching
  • Teeth should never come into contact during normal chewing
  • Teeth grinding is the most common source of TMJ pain and responsible for most sleep disorders
  • Only 1% of TMJ patients require surgery
  • Stability of the TMJ comes from the neck as well as the teeth
  • TMJs are the only two joints that function together as a single unit which is unlike any other joint in the body
  • Tooth enamel is the hardest substance in the body
  • The clencher/masseter also known as the cheek muscle is the second strongest muscle in the body. The tongue is the strongest.

The big question to ask is what causes TMJD? Unfortunately, this is not a simple question to answer as there are a lot of factors to consider. Finding this answer is very important if you want to find a long term solution.

Finding The Cause of TMJD is the Key

Most of the time the cause of TMJD is a combination of muscle tension and anatomic problems with the joints and supporting structures of the neck and shoulders. However, what cannot be ignored is a strong psychological component that could be behind all the structural problems.

Some people can have TMJD for years before it gets to a point where pain sets in. Whereas others it happens almost instantly which is what happened to me last year. At first I thought I had a tooth problem but I quickly realised it was something else as my teeth did not hurt and my jaw felt like it was locked. I also quickly developed severe neck and shoulder pain on the same side as the jaw. None of the exercises I used for the neck and shoulder worked at all at first and the jaw continued to worsen. I knew there was something else I had to do but I needed to be sure of what I was dealing with. Once I was able to finally see a dentist and a Chiropractor they both confirmed for me it was TMJD.

There are many potential factors that can trigger the onset of jaw pain which I will cover shortly. However, by far the biggest cause of all is repetitive HURTFUL HABITS.

These are all the little things we think nothing about and over the course of the day they begin to take a toll on the joints of our body. For me, I came to realize how often I was using so many destructive habits to my jaw, and combined with the overwhelming stress created by the Covid-19 lock-downs and, then the sudden illness of my dad was enough to push me over edge. My dad died of cancer on March 19th 2021.

It took me quite a while to pay attention to all these little habits, and even longer to change them. But once I did, I began to see rapid improvement with my jaw opening and reduction in pain. My neck and shoulder exercises finally began to work and the pain almost instantly subsided once I implemented these changes.

These are some of the things you need to consider with TMJD.

Forward Head Posture

Posture is everything to the body, in particular the head and the neck. Poor posture not only takes away from looking good, it compromises how we were designed to function, eventually leading to pain and/or injury.

Posture is defined as: "The position from which movement begins and ends."

It is only during a state of ideal posture that the muscles will function most efficiently. In ideal posture, a line extending down the side of the body should run through the ear lobe, transect the shoulder, hip and knee joints and fall just in front of the ankle bone.

We use an IPAD assessment tool called Posture Screen Pro to assess our clients and you can see an example of this below. This picture provides before and after photos over a 9 month period of postural correction. Make sure you check out how much the head weighs in a forward head posture versus good posture.

Click here to see a video of how to complete your own postural assessment,

The forward head posture is a massive problem to our neck and jaw.

Researchers have found that there is a 70% correlation between forward head posture and a jaw that is pushed back. This can lead to the development of TMJD as this position pinches the pad behind the disc, reduces TMJ blood supply, stretches out the ligaments, and strains the lateral pterygoid muscle that leads to spasms.

One of the most common causes of this problem is sitting, and making sure you address your sitting position is vital. It is easy to fall into the trap of slouching and as it becomes a permanent habit it begins the slow process of destroying our joints. Many people are familiar with the damage to their spine from sitting but not many pay attention to the damage it does to their jaw and neck. The Covid-19 lockdowns saw many people forced to work from home and as a result there was a rapid rise in muscular injuries from poor workstation set-up. I worked with many people late in 2020 to address problems caused specifically from this.

You will find a great article about how I addressed this in the article – How to stay healthy when working from home

However, the forward head posture is not limited to sitting, as this can be due to several things we do during the day such as:

  • Our posture during walking
  • Our posture standing
  • Our sleeping position
  • Occupations
  • Hobbies (eg musical instruments)
  • Postures used in various sports
  • Poor gym exercises (eg ab exercises)
  • Poor exercise technique

Anything that places us in a forward leaning position with our head looking down for hours on end is enough to create this posture.

I know for myself that cycling is a problem to my jaw and neck as it forces my head into a horrible position for long periods of time. I have worked with many musicians who also suffer with neck related problems caused by their instrument. This does not mean you need to give up these hobbies, but you do need to spend time working on your posture and improving your position as much as possible to counter the damage they can create. Normally my head and neck are fine after cycling when I complete my exercises and stretches. Unfortunately, there were a lot of other factors at play combined with this that ended up working against me. I had to stop cycling for a while as my jaw and neck were too sore.

You will find great ideas of how to do this in the articles provided below

Sleeping Position

I tended to sleep on my stomach a lot and I knew it was not good for me but I had never had any trouble before so I did not worry about it too much. How wrong I was for it was after a night of sleeping like this that my jaw was locked. This position forces your neck into extreme rotation and places extreme pressure on the jaw and neck easily irritating the joints and muscles. This is an absolute no-no for anyone with jaw or neck pain right now.

Getting a good night’s sleep is vital to the health of the body but especially the neck and jaw. We need quality sleep to repair all the damaged tissue and is also the time the body completes the digestive process. Without a good night sleep we have little chance of improving overall health.

The best position to sleep is actually on your back.

I always thought it was on your side, but this can also create problems for people by twisting their spine and hips and even force their neck out of alignment. If you do like to sleep on your side make sure you place a pillow between your legs and try to switch sides to avoid repetitive stress.

Sleeping on your back allows your spine and muscles to lengthen and prevent these problems. You will need to use a small pillow or even a specific pillow to support the neck as a large pillow will force you into forward head posture again. While this is definitely the best position to sleep it can be very difficult for some people to adopt so keep trying and use a combination of side and back sleeping where you can.

You can read more about sleeping in this article – Why sleeping is vital to our health

Stress & Clenching

This is a massive topic in its own right and one that is even harder to find an answer to. Most of us are very aware of the damage constant stress can have on our body as it wrecks everything from our immune system to our muscles and joints.

Stress is not necessarily a bad thing as it is needed to prepare us for survival and this is called the "fight of flight" response. In a stressful situation the body secretes stress hormones adrenaline and cortisol to our arms and legs in order to help us either run away fast, or, stay and fight. This is good in life and death situations as these hormones will possibly save your life. But it is not good if this system is turned on all the time.

When this stress response is turned on is also when the body begins to clench our teeth together.

Clenching is a disaster to the TMJ.

When the body is stressed our muscles tense up to get ready to fight or run away. Clenching and grinding can exert up to 300 pounds of force per square inch to your teeth, cranium, ligaments, cartilage, and disc within the TMJ. This is why clenching is often referred to as the leading cause of jaw problems. However, I would say it is not the cause as it is a psychological reason for doing this that is, and until that is resolved you will only ever be treating your symptoms.

The other disastrous thing that happens when we are stressed is that we tend to breathe much faster and open our mouth. This poor breathing reaction sets off a chain reaction of other problems that will wreak havoc on the body and the jaw.  

For people suffering from chronic stress thoughts will manifest in their subconscious mind which will lead to them grinding their teeth together while they sleep. This is exactly what happened to me last year and it is very difficult to stop doing something when you are not even awake. This is where I had to practice several relaxation techniques like meditation and tai-chi, and avoid watching the news or anything that could set off my stress.

Exercise is very beneficial for combatting this problem but you must be careful of over-doing it. I also had to be very careful of clenching in the gym when lifting weights. This took considerable time to avoid doing this as it was something I had developed for a long time and felt normal to do this. Unfortunately, if I started clenching while doing a deadlift my jaw would instantly hurt and be sore for hours afterwards.

Some great articles are shown below with a ton of ideas to help you control your stress levels.

Nose Breathing

For a long time I was aware of the importance of nose breathing and keeping the tongue on the roof of the mouth to your health. I thought I was good at doing this, and to some extent I am, however I found out I was terrible at keeping my tongue in the correct resting place. I also did not realize how much I was tensing my jaw and neck all day long. Even now while typing this article I have to keep reminding myself to relax my face muscles as they subconsciously contract. I also have to constantly remind myself to keep my tongue on the roof of the mouth.

Firstly let’s discuss the role of breathing and how intimately linked your breath and posture are.

Good posture creates the best body mechanics for optimal breathing. Conversely, poor posture will lead to inefficient and laboured breathing that creates tension in your shoulder muscles (secondary respiratory muscles). Poor posture will change ALL movements and eventually lead to chronic tension, pain & fatigue! Often in the neck and shoulders first before changing other parts of the body. It is not just the posture that is affected by mouth breathing, for your PH balance can be easily disrupted.

In the book “Close your Mouth” by Patrick McKewon he discusses the value of the Buteyko Breathing method which requires the application of nose breathing.

Breathing provides oxygen for cellular metabolism & removes the waste product carbon dioxide. When we are under stress and open our mouth to get more air due to hyperventilation it creates a chain reaction of events that leads to PH imbalance a lack of Nitric Oxide. Nitric oxide is found in your nose, so when you breathe through your nose, you carry a small portion of the gas into your lungs. Your nostrils have a smaller entry than your mouth which creates resistance resulting in smaller breathing volume along with calm and quieter breathing and ensures you maintain perfect balance with your PH levels. Whereas mouth breathing creates a dry mouth and bacteria and leads to a host of postural problems.

If your motor nerves in your face become stressed it will force you to clench and grind your teeth again.

Meditation, Yoga and cardiovascular exercise are all great ways to improve your breathing and lung capacity, however you may still need to learn how to breathe through your nose while at rest. I suggest to read this article with tons of ideas of how to do this - How to breathe correctly when you exercise

Keep the Tongue on the Roof of the Mouth and Teeth Apart to Relax the Jaw

Out of all the exercises and habits for me to address my own TMJD this was the hardest. I had to retrain my tongue to sit in the right place and keep my teeth apart while at the same time relaxing my jaw muscles.

It is extremely important to keep your teeth apart and your lips closed when practicing the tongue position. It is hard to imagine that you used to do this without even thinking prior to the jaw problem. Once you become aware of it you notice how often your tongue moves away from this position.

The place where the tongue is correctly positions is easily found when you say the letters N, T, D or L. This is where children are sometimes taught tongue exercises to pronounce words correctly as seen in the picture below.

If the tip of your tongue touches the front teeth at all then have what is called tongue thrust and you will need to retrain your tongue. Tongue thrust can actually move your teeth and have a huge impact on the joints of the jaw. The best way to get rid of tongue thrust is to train it to sit there. Just like you use bicep curls to make your arms stronger you need to do tongue exercises to make your tongue stronger. This was my biggest problem and it took me a lot of awareness and training to fix it. You must not let the tongue push towards the back of the teeth as it must sit a bit further back on the palate, known as the palatal rugae.

What keeps the tongue on the roof of the mouth is gentle suction that is maintained by keeping your mouth closed. If you open your mouth at any point, you will you lose the suction. You can see why it is so important to learn how to breathe correctly.

The only time your teeth should touch is when you swallow. In order to swallow correctly you need your tongue to be in good shape and function the way it is designed. If the tongue is not strong enough or sitting in the right place you will never get on top of your problem.

Wearing Retainers to Prevent Clenching

This is one of the most common forms of treatment and this is where a dentist prescribes a retainer to wear at night to prevent you from wearing away the tooth enamel. Most people pin their hopes on this being the answer and getting rid of the problem. It was thought that this would also prevent people from clenching and resolve the TMJD, however recent research shows that 50% of these devices make the condition worse! Only 25% cases seemed to improve from applying this strategy and when you think about it makes sense. (Source: TMJ Therapy by Dr Kimberly Bensen)

While the retainer can stop you from grinding the teeth enamel away, it does not stop your muscles from constantly biting down on the retainer itself. I know for a fact that it did not help me much at all, if anything it made my jaw pain worse as I kept on chewing on it and finding it difficult to relax my jaw.

The retainer does not address the REASON you are clenching your teeth in the first place. You must find why you are clenching and get rid of this instead of relying on a retainer to do it for you.

What Exercises Can You Use?

Well, this is not a simple answer as there is no definitive solution for everyone. You will need to apply the various things we have already discussed and put a plan in place to assess each factor and improve it if it is not functioning correctly.

Seeking help from a health therapist like a Chiropractor or Osteopath can help release tight spasms and muscular tension. I saw a Chiropractor who helped me mobilize my neck and cervical spine but he was not able to help too much with the jaw problem. It was only when I started completing my jaw exercises in combination with daily habit changes that I noticed a big improvement.

With regards to correcting forward head posture I would suggest to download the PDF book I created for shoulder pain shown below. This book features all of my assessments, over 70 exercises, and step by step programs to restore the shoulder and neck joints back to normal. Everything I use for shoulder and neck pain will be useful for the person suffering with jaw pain. I used this resource myself when my pain was at its worst and it helped me to quickly get on top of things. The functional training free report to the right also includes many great ways to improve your posture.

  

In addition to this you will need to use specific exercises for the tongue and jaw. These are a bit weird and hard to use pictures and videos to explain as you cannot see what happens with the tongue. Something I did not know until I looked this up is just how many exercises for the tongue and jaw there are! The exercises I have listed below are the ones that worked for me but do your own investigation and see what works for you.

Many of the following exercises I found from in the books “TMJ Healing plan” by Cynthia Peterson and “The TMJ Therapy” by Dr Kimberly Bensen.

Training the Teeth to Stay Apart with Tongue on the Roof of the Mouth

Before doing any exercises I always find it useful to have some kind of assessment to determine if the exercises are working. My biggest problem was opening my mouth wide enough and a simple test to determine what width you should have is to use your fingers.

Normal width is to be able to place three fingers between your top and bottom teeth without pain or straining. For a long I could barely fit two fingers, let alone three! I regularly completed this test as I felt I was improving to see how much more mobile my jaw was becoming.

This first exercise was a game-changer for me and is something I still do every day. It was very frustrating at first for my jaw kept on tensing up and I found it very difficult to relax. With practice it became easier and my jaw started to relax for long periods. Best of all the pain started to subside.

How to do it.

  1. Sit or lie in a good posture.
  2. Let your jaw completely relax and allow your mouth to hang open.
  3. With all the tension gone, place the tongue on the roof of the mouth.
  4. Try to make sure it sits in the “N” position and does not touch the teeth.
  5. Now try to close the mouth keeping your teeth slightly apart.
  6. Lastly breathe through your nose and try to keep your jaw relaxed.

Control Motion of Jaw Opening

This exercise allows you to control how the jaw joints open and close. I found this to be very helpful in preventing me from aggravating my jaw.

  1. Sit in perfect posture
  2. Place the tongue in the “N” position
  3. Open and close your mouth 10-15 times making sure you keep the tongue on the roof of the mouth

Tongue Position Exercises

The best way to learn how to keep the tongue in perfect position is to make a “clucking sound”. This requires suction of the tongue against the roof of the mouth and then releasing it. The louder the cluck the better. Perform this exercise repeatedly during the day to strengthen the tongue and help it feel that this is the preferred place to rest.

Tongue Push-ups

This is quite a simple exercise but can be very effective at strengthening the tongue.

  1. Press your tongue on the roof of the mouth.
  2. Hold it for 10-20 seconds and relax.
  3. Repeat this 5-10 times
  4. You can do this with mouth closed or mouth open which will stretch the tongue.

Learn to Swallow Correctly

This is something very similar to breathing as it is an automatic movement we do all day. If you are swallowing incorrectly you will be creating all types of problems with the jaw. Instead of your tongue being on the roof of the mouth it will be pushing against the teeth and this constant pressure pulls your jaw joints and ligaments over 2000 times per day!

Any poor posture in the neck and head will create problems with how you swallow, affecting the tongue position that keeps the vicious cycle of jaw pain continuing.

Have a sip of water and notice how you swallow. Did your tongue touch the back of your front teeth? Did your teeth clench? Did your neck or head move when you swallow? If you answered yes to any of these then you will need to learn how to swallow correctly.

How to learn how to swallow correctly.

  1. Place the tongue in the “N” position
  2. Take a cup and place it next to your mouth. Your tongue should not push against the cup
  3. As water enters your mouth let your tongue drop down to collect the fluid
  4. Swallowing starts when you close your lips and the tongue goes back to its resting position.
  5. The tongue squeezes and waves the fluid along the roof of the mouth to the back of the mouth
  6. Your tongue then returns to its resting position.
  7. Your lips, head, and neck muscles should not move or contract when you swallow.

Nutrition

Last but not least we cannot ignore the role of eating food. When your jaw is sore you will need to eat softer foods and avoid hard foods like nuts and seeds or chewy foods like a steak that can really aggravate your jaw pain. Also we cannot ignore that blood sugar crashing from food cravings can make people agitated and angry leading to clenching of the teeth. It is very important you address any nutritional problems that can exacerbate your condition. The Keto diet is a perfect way to control blood sugars and avoid falling into the trap of being "hangry".

Addressing your nutrition requirements is another factor to consider for if you are eating a diet deficient in vitamins and minerals it will speed up the rate of your decline. This becomes even more important as you age as older people do not absorb vitamins as easily as younger people and will different requirements to ensure they meet their body’s needs.

We all know calcium is important for young children to build strong bones but it is just as valuable to adults and those who suffer with joint related pain. Calcium is needed to regulate heart rate and maintain bone mass, but unlike children where they soak it up like a sponge, absorption declines with age.

Foods like sardines, Greek yoghurt, ricotta cheese & sardines have been shown to have higher levels of calcium than milk.

Read this article for more detail on this - How to adjust your nutritional requirements as you age

Summary

Jaw pain can be very debilitating and affect every part of your daily life. Just like walking we tend to take granted the ability to use our jaw to do simple activities like eat, drink, talk, and yawn and it is only when something goes wrong do we appreciate how much we need our TMJ to be in good shape. Finding the trigger and cause of your pain is absolutely critical if you want to get rid of this pain for good. There are so many potential factors at play and it can be very frustrating trying to restore things back to normal.

I hope this article gives you a stack of ideas to help you get rid of your jaw pain for good. I know exactly how you feel, but I also know it can be done. It just takes patience and a consistent approach to changing the hurtful habits.

And if you do not have TMJD right now it is a good idea to do the exercises shown in this article. For like everything to do with health, it is always easier to prevent problems than find a cure.

If you live in Melbourne and would like to know more about our personal training or core strength programs click the image below to request a free consultation and I will get back to you within 24 hours to schedule time.

About The Author

Nick Jack is owner of No Regrets Personal Training and has over 16 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specialises in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.

References:

  • TMJ Healing plan by Cynthia Peterson
  • TMJ Therapy by Dr Kimberly Bensen
  • Sitting On The Job - By Scott Dunkin
  • Movement - By Gray Cook
  • Osteoporosis Australia
  • Corrective Exercise Solutions for the Hip & Shoulder - by Evan Osar
  • Back Pain Mechanic - by Dr Stuart McGill
  • Diagnosis & Treatment Of Movement Impairment Syndromes - By Shirley Sahrman
  • Low Back Disorders - by Dr Stuart McGill
  • Ultimate Back Fitness & Performance - by Dr Stuart McGill
  • Core Stability - by Peak Performance
  • Athletic Body in Balance - by Gray Cook
  • Anatomy Trains - by Thomas Meyers
  • Motor Learning and Performance - By Richard A Schmidt and Timothy D Lee
  • Assessment & Treatment Of Muscle Imbalance - By Vladimir Janda
  • How To Eat, Move & Be Healthy by Paul Chek
  • Scientific Core Conditioning Correspondence Course - By Paul Chek
  • Advanced Program Design - By Paul Chek