Many of our referrals at Physiohaus are for Temporomandibular Disorder (TMD). TMD is a broad term that encompasses disorders of the temporomandibular joint and its associated anatomical structures. The disorder may be intra-articular (within the joints), due to inflammation, internal structural changes (internal derangement) or degeneration, or it may be extra-articular (outside of the joints) due to imbalance or over-activity of the jaw muscles, commonly the muscles of chewing or the neck muscles. There is a strong correlation between poor postural and TMD. There are numerous other conditions that can cause pain in the TMJ region. It is important to make an accurate diagnosis to ensure that the correct treatment is given and that potentially serious problems are not overlooked.


Intra-Articular Causes

1. Inflammatory conditions within the joint are often caused by direct trauma, such as a blow to the chin or jaw (often seen with soccer ball contact during sport), indirect trauma, such as a whiplash injury, heavy chewing, grinding (bruxism), clenching of the jaw or loss of dental height due to worn down or missing teeth.

2. Internal derangement describes conditions where there are structural changes within the joint and can involve disc related injuries to the joint. This can be caused by direct trauma, such as a blow to the jaw or falling on the chin, indierect tauma, such as a whiplash injury, long term clenching or grinding, heavy or hard chewing or prolonged periods of mouth opening, such as a dental procedure or a general anaesthetic.

3. Arthritis

  • Degenerative Arthritis can occur in the TMJ. It can often be seen on x-ray as a flattening of the condylar hea. Crepitus (joint noise) can often be felt or can be heard with a stethoscope. It can be age related degeneration, usually seen in the over 50s, or secondary to trauma occurring at a younger age.
  • Inflammatory Joint Diseases can affect the TMJ, including rheumatoid arthritis, ankylosing spondylitis, infectious arthritis, Reiter syndrome and gout.

4. Hypermobility can result in excessive anterior movement of the jaw and the articular disc. There are usually some clicking sounds in the TMJ and there may or may not be pain. Hyper mobility may be related to connective tissue disorders. Long term hypermobility can cause the articular disc to be stressed and degenerate. The disc can then fail to reduce on closing, causing the TMJ to become stuck in an open position (Open Lock). This can often occur after opening the mouth to an extreme position, such as when singing or yawning or after a prolonged dental procedure.


Extra-Articular Causes


1. Muscle Spasm can cause significant pain and limitation of movement of the jaw. It often affects one or more muscles, (masseter, temporalis and the pterygoid muscles). Causes include prolonged dental procedures or anaesthetics where the mouth has been held open for extended periods of time, stress, bruxism and postural dysfunction.

2. Cervical Postural Disorders can cause jaw pain. The anterior belly of the digastic muscle runs from the point of the chin to hyoid bone. With prolonged poor posture or stress-related posture the mandibular condyle is pushed back against the retrodiscal tissue, eventually causing swelling, pain and gradual degeneration of the disc.

3. Temporal Tendinopathy is caused by excessive contraction of the temporalis muscle usually as a result of clenching and grinding.

4. Fractures of the mandible often occur at the mandibular symphysis or the condylar neck. Commonly there will be a fracture of the mandibular symphysis combined with a fracture/dislocation of one or both condyles. The mechanism of injury can be caused by a fall onto the chin. Treatment can usually begin within a week or two of surgery to begin early mobilization of the TMJ and to restore function.


Treatment of TMD

TMD is a recurring, but self limiting condition that tends not to be progressive. Physiohaus clinicians note that treatment is very effective in relieving and managing TMD, even when the symptoms are long-standing and severe. With appropriate physiotherapy most patients will see a significant improvement in their symptoms within 3 to 6 weeks.
Treatment may include soft tissue releases to affected muscles and joint mobilization techniques. It may also involved treatment of any associated neck pain and headaches. Posture correction is essential and will address head, neck, shoulder and tongue position. At Physiohaus, patient are often taught exercises to improve coordination, stability and alignment of the jaw.

Our clininicians coordinate Dentists if they believe that an occlusal splint may be appropriate to discuss with their Dentist. Occlusal splints hold the TMJ slightly apart as the patient clenches or grinds, preventing compression of the TMJ. This can help to relax jaw muscles and reduce swelling and inflammation. Other dental problems, such as cavities, that are causing pain or uneven chewing, lack of dental height or missing teeth may also need to be addressed.


Manual Therapy

A systematic review was published in 2015 to summarize the effectiveness of manual therapy on signs and symptoms of TMD. It showed that protocols of mixed manual therapy techniques, upper cervical mobilization or manipulation, had considerable support for TMD symptom control and improvement in maximum mouth opening. The manual techniques included intra-oral myofascial release and massage on chewing muscles, and upper neck manual therapy.


Our clinicians use evidence-informed assessment and treatment. We coordinate care with your Dentist or Oral Maxillofacial Surgeon. We work closely with many specialists in London and our treatment is individualized and specific to your assessment findings. If you have questions about TMJ related issues and treatment, call us at Physiohaus at 519-204-4445 or visit physiohaus.ca