The Anatomy
The TMJ (the temporomandibular joint) is the joint between the jaw bone (the mandible) and the skull itself. The mandible, which is one bone, moves like a bucket handle in how it moves on the skull above. It pivots like a hinge at the location of the TMJ joint. So, you be wondering, what causes TMJ Disorder?
The skull, for its part, is the other bone of the joint. Specifically, it’s the temporal bone of the skull, and that’s how we get temporomandibular joint. Remember hearing about how an infant skull takes a year or two to fully fuse together? Well, what is “fusing together” here are different growing cranial bones, and the temporal bones under each ear are just one of the many different ones found in our skulls. Together with other bones like the nasal bones, the frontal bone, and the occipital bones, they have grown together to complete the domed architecture of our skull.
The temporomandibular joint itself can have several different problems, including clicking, dislocation, arthritis, and simple pain with activity. However, with all of them, there are frequently missed dysfunctions that play a major role in the pain. If you have TMJ issues, it’s important that you and your healthcare provider rule out these commonly overlooked culprits:
Tight Upper Neck Muscles
Specifically, the upper cervical spine gets tight. This can happen in those who have habits such as poor sitting or lying posture. This region gets stiff, and consequently the head loses just a small amount of “nodding” motion. This might not even be perceptible to you, but it affects the opening ability of the TMJ, and is something that needs to be loosened in therapy.
Often, the upper neck is tight because of an issue lower in the spine. We get out of alignment in these lower joints, but our bodies are wired to keep the eyes level with the horizon. Our lower spines may be tipping us to the right, for example, but somewhere higher up in our spines we compensate by tipping back to the left. It’s here, higher up, where we can have excessive stresses from our bodies trying to compensate that can throw off the mechanics in our necks, TMJ, and cranium. So, it’s important to look at the whole body. It’s amazing sometimes what we find.
A Bad Bite
Part of the problem may be that your teeth aren’t coming together just right. The TMJ moves into jaw closing until the teeth occlude together, and if the teeth aren’t hitting properly or symmetrically, with chewing and clenching that mandible is forced into an awkward movement. This will ultimately mean abnormal stresses at one of both of your TMJs.
You’re probably thinking “Hey, I’ve had the same teeth all my life. Why am I just having trouble now?” The answer is that yes, your teeth are probably the same as they’ve always been but the way they’re coming together has been dysfunctional, likely for years. This can occur when the chewing muscles get tight (often on one side more than the other) which makes the mandible skew out of alignment and prevents your teeth from coming together properly. This muscle tightness could be your body trying to counterbalance upper neck tightness (see above), or it could be due to other factors such as general stress or even a problem in the shape of your mandible bone itself. Most of us in the western world have an underdevelopment of our mandibles and roofs of our mouths, giving us a slight “overbite” which abnormally strains the TMJ. This may be related to changes in our diet that have come with industrialized society.
If the bite is part of the equation for you, and things aren’t resolving, a PT and a dentist who specialize in TMJ disorders may be needed to team together to loosen your muscles and develop a bite appliance for you to protect the joint. The dentist should also look at your airway, as issues here (think sleep apnea) can also be at the root of the problem.
Persistent Issues
Sometimes pain or problems in the TMJ require a release of the tension in cranium, most likely around the temporal bone. This requires the skills of a therapist versed in craniosacral techniques.
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