Trigger Point therapy - Typical Treatment Sequence for TMJD

 Trigger Points in the Upper Trapezius are often Associated with TMJD

Temporomandibular joint dysfunction, often abbreviated as TMJD or simply TMJ, can be an incredibly frustrating and painful condition for those who suffer from it.

As a manual therapist with years of experience, I’ve encountered countless clients who have struggled with the mysterious pain, jaw stiffness, and even headaches caused by this complex condition. The jaw, while a small area, plays a massive role in our daily lives, from speaking and eating to expressing emotions. When something goes wrong, the ripple effects can be significant.

One often overlooked contributor to TMJD symptoms is the presence of myofascial trigger points. These small, hyper-irritable areas in muscle tissue can refer pain to other parts of the face, head, and neck, complicating diagnosis and treatment. Yet, understanding and addressing trigger points, especially in muscles like the masseter, temporalis, and even the pterygoids, can provide significant relief. Let’s dive deeper into TMJD, its relationship with trigger points, and how specialized therapy can make a difference.

What Is TMJD?

The temporomandibular joint (TMJ) connects your jawbone (mandible) to your skull (temporal bone). This joint is a marvel of engineering, allowing you to open and close your mouth, chew, speak, and move your jaw side to side. It’s supported by muscles, ligaments, and cartilage, all working together to facilitate smooth and precise movements.

When something disrupts this harmony, TMJD can occur. Common symptoms include jaw pain, clicking or popping sounds, headaches, ear pain, facial discomfort, and difficulty opening or closing the mouth fully. The condition can be acute, following an injury or a period of intense stress, or chronic, developing over months or even years.

Causes of TMJD

TMJD is a multifactorial condition, meaning there’s rarely a single cause. It can result from physical trauma, arthritis, jaw misalignment, bruxism (teeth grinding), stress, or poor posture. Often, it’s a combination of these factors that leads to the condition.

In my experience, stress and tension are frequent contributors. When we’re stressed, we tend to clench our jaws or grind our teeth, often without realizing it. Over time, this can overload the muscles and joints of the jaw, leading to dysfunction. Poor posture, especially the forward head posture so common in today’s screen-focused world, can exacerbate these issues by creating additional strain on the neck and jaw muscles.

The Role of Trigger Points in TMJD

Trigger points are areas of hypersensitivity within muscles that, when activated, cause referred pain. This means that the pain you feel isn’t necessarily located where the problem is. For example, trigger points in the masseter muscle (the primary muscle used in chewing) can refer pain to the jaw, teeth, and even the ear.

In cases of TMJD, trigger points are often found in the masseter, temporalis, lateral and medial pterygoids, sternocleidomastoid, and even the trapezius muscles. These trigger points can exacerbate jaw pain, cause headaches, and limit jaw movement. What makes trigger points particularly tricky is their ability to mimic other conditions, such as sinus issues or tooth pain, leading to delayed or incorrect diagnoses.

Key Muscles Involved in TMJD Trigger Points

The masseter muscle is often the primary culprit in TMJD-related trigger points. Located on the side of the face, this powerful muscle is responsible for chewing and clenching. Trigger points here can cause pain in the jaw, teeth, and even the ear.

The temporalis, a fan-shaped muscle on the side of the head, is another common source of pain. Trigger points in this muscle can lead to tension headaches, jaw pain, and tenderness in the temples.

The lateral and medial pterygoids, located deep within the jaw, are less well-known but equally important. These muscles assist with jaw movements like opening, closing, and side-to-side motion. Trigger points in these muscles can cause deep, aching pain and contribute to the jaw locking or clicking.

Finally, the sternocleidomastoid and trapezius muscles, although not directly part of the jaw, can develop trigger points that refer pain to the jaw, face, and head, compounding the discomfort of TMJD.

Treating Trigger Points in TMJD

Treating trigger points associated with TMJD requires a skilled approach. Not all therapists are trained to address these specific muscles, especially the harder-to-reach ones like the pterygoids. However, those who are trained in trigger point therapy can make a profound difference.

Trigger point therapy involves applying sustained pressure to the trigger points, encouraging them to release and reducing referred pain. For muscles like the masseter, this can be done externally by pressing into the muscle from the outside of the face. For the pterygoids, however, internal techniques may be required, where the therapist accesses the muscle through the mouth. This requires specialized training and should only be performed by qualified professionals.

Massage therapy can also be highly effective for relieving TMJD symptoms. Techniques like myofascial release and deep tissue massage can help reduce tension in the jaw and neck muscles. Gentle stretching of the jaw can complement these techniques, improving flexibility and reducing stiffness.

Dry needling is another powerful tool for addressing trigger points in TMJD. By inserting thin needles directly into the trigger points, therapists can stimulate blood flow, release tension, and encourage the muscle to reset. While not everyone is comfortable with this approach, those who try it often report significant relief.

Step 2: Sitting ICT to:

Upper Trapezius

Posterior Cervical Muscles

Splenius Cervicis

Step 3: Massage the area generously

Step 4: Supine ICT to:

Masseter

Temporalis - especially at the muscle-tendon junction(STP)

Lateral and Medial Pterygoids

 Digastricus

Self-Care for TMJD

While professional treatment is essential, self-care plays a critical role in managing TMJD. Simple techniques like jaw stretches, heat or cold therapy, and stress management can help alleviate symptoms between sessions.

Using a tennis ball or massage ball to gently roll over the neck and jaw muscles can also provide relief. For clients experiencing bruxism, wearing a night guard can prevent further strain on the jaw muscles and joints.

The Importance of Holistic Treatment

TMJD is rarely an isolated issue. It often involves a combination of physical, emotional, and behavioral factors. Addressing all of these aspects is key to long-term relief. Stress management techniques like mindfulness, meditation, or yoga can help reduce jaw tension. Posture correction, particularly for those with forward head posture, can also make a significant difference.

Conclusion

Temporomandibular joint dysfunction is a complex condition that requires a multifaceted approach to treatment. Understanding the role of trigger points, particularly in muscles like the masseter and pterygoids, can provide a new avenue for relief. Whether through trigger point therapy, massage, or dry needling, addressing these hyper-irritable areas can significantly reduce pain and improve function.

If you’re a therapist looking to deepen your understanding of trigger points and their role in conditions like TMJD, I highly recommend the NAT Trigger Point Therapist Diploma Course. This course provides valuable insights and techniques to help you better serve your clients.

Disclaimer

This article is for informational purposes only and should not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for any concerns about your condition or treatment plan.

References

Travell, J. G., Simons, D. G., & Simons, L. S. (1999). Myofascial Pain and Dysfunction: The Trigger Point Manual. Lippincott Williams & Wilkins.

Okeson, J. P. (2013). Management of Temporomandibular Disorders and Occlusion. Elsevier.

de Leeuw, R., & Klasser, G. D. (2018). Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management. Quintessence Publishing.

Nixdorf, D. R., & Moana-Filho, E. J. (2011). Persistent dentoalveolar pain disorder (PDAP): Working towards a better understanding. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 112(6), 746-754.

Häggman-Henrikson, B., et al. (2020). The impact of orofacial pain conditions on oral health-related quality of life. Journal of Oral Rehabilitation, 47(8), 1056-1066.