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Best Physical Therapy for TMJ

November 10th, 2024
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By Brett Sears, PT | Updated on June 3, 2024

nic pain condition of the jaw experienced by 5% to 12% of the adult population to varying degrees. Although TMJ can be controlled with medications, oral devices, and surgery, physical therapy remains an important tool in reducing TMJ pain, clicking, locking of the jaw, and other distressing symptoms.

TMJ is commonly diagnosed and treated by dentists, including specially trained dentists called orofacial pain specialists who are qualified to treat TMJ along with neurovascular pain disorders, headache disorders, and sleep disorders,

This article explains how physical therapy can help manage symptoms of TMJ over the long term.

PT Evaluation

Your first visit with a physical therapist will involve a discussion of your symptoms, lifestyle, and activities that make your symptoms better or worse. This includes reviewing eating, sleep, and work habits,

Several tests will be performed to get baseline measurements that the PT will use to build a treatment plan. The tests aim to:

Once your evaluation is complete, your physical therapist will discuss the findings and work with you to develop a treatment plan involving in-office and at-home procedures.

How Can Physical Therapy Help?

If you have TMJ, your physical therapist (PT) can help decrease pain and restore jaw function using different non-invasive modalities (methods of treatment). Many of these are “hands-on” procedures and some can self-administered.

Your dentist or healthcare provider may be able to refer you to a PT qualified to treat TMJ. PTs who have completed a fellowship in temporomandibular disorders (TMD) and craniofacial pain (CP) are best qualified. Do not hesitate to ask for qualifications.

Here are some of the physical therapy modalities that may be used:

Heat or Ice Application

Heat application (thermotherapy) can help relax your jaw muscles, thereby decreasing spasms, stiffness, and pain, especially in the morning. Ice application (cryotherapy) can help decrease acute swelling and pain around your jaw.

Thermotherapy can be done at home with a heating pad set on a low temperature or by soaking a washcloth in water no hotter than 140 F. You can heat therapy every hour or so as needed.

Cryotherapy can be done at home with a cold compress or a bag of frozen peas. This should be done for no more than 10 to 20 minutes, moving the compress around constantly to prevent frostbite. To further prevent frostbite, place a kitchen towel between the compresses and your skin.

Therapeutic Ultrasound

Therapeutic ultrasound is a treatment sometimes used for TMJ to improve joint mobility. It is a non-invasive procedure that uses ultrasonic waves to create vibrations and raise the temperature of tissues in a targeted area. Doing so can relieve pain and loosen tight muscles.

One study published in the Journal of Physical Therapy Science found that therapeutic ultrasound used with home exercise provided greater pain relief and jaw mobility than exercise alone.

Soft Tissue Release

Your PT may use various massage techniques to treat TMJ pain. Also known as soft tissue release, massage therapy may be applied to your jaw muscles, facial muscles, or neck and shoulder muscles.

The goal of therapeutic massage is to relax the temporalis, medial pterygoid, lateral pterygoid, and masseter muscles involved in mastication. Massage can also help improve circulation, thereby reducing inflammation that can contribute to TMJ pain.

Examples of TMJ massage include:

  • Masseter muscle massage, in which you apply circular motions to the masseter muscle extending from your cheekbone to the lower part of your jaw
  • Temporalis muscle massage, in which you apply gentle pressure and small circular motion to temporalis muscles situated near the temples
  • Intraoral massage, in which massage is performed inside your mouth with gloved hands

Joint Mobilization

Mobilization is a technique used in physical therapy to manually move a joint to correct its position and alignment. In people with TMJ, it can help relocate a displaced articular disc.

The mobilizations can be a bit awkward and uncomfortable as some of the manipulations involve the placement of the PT’s thumb or finger in your mouth. Other mobilizations are performed on the outside of the jaw, exerting lateral (side-to-side) pressure.

These manipulations are performed with gloves on.

PT Exercises

Jaw exercises are arguably the most important part of a TMJ treatment program. Your PT will teach you exercises to correct jaw misalignment, often with a hand mirror so that you can check the position of your jaw. The goal of these exercises is to restore normal, pain-free jaw motion.

Examples of TMJ exercises include:

  • Controlled opening rotation, which teaches you how to open the jaw without jutting the jaw forward
  • Jaw opening with resistance, in which you manually hold the jaw in the correct position as you open and shut the mouth
  • Tongue on hard palate, which strengthens the jaw muscle without opening the mouth by pressing and holding the tongue on the roof of your mouth

Other exercises employ the mobilization techniques used by your PT.

Stress Management

Stress contributes to TMJ by causing jaw muscle hyperactivity and increasing jaw movements (such as jaw clenching and teeth grinding). To alleviate this, PTs will often recommend stress relief techniques that you can perform daily to not only calm yourself but also increase awareness of tensions that lead to TMJ.

Stress management techniques include:

Postural Control

Sitting or standing with a forward-tilted head and rounded shoulders places excessive stress on your jaw joint by stretching the neck muscles downward. To correct this, your PT may show you how to maintain proper posture.

Postural control techniques include:

  • Slouch overcorrection, in which you sit upright in a chair, pull in the tummy, overaccentuate the curve of your spine, and square the shoulders
  • Scapular stability exercises, such as pulling your shoulder blades together to move your spine and shoulders into a better position

How Is TMJ Prevented?

If you have TMJ there are certain things you should avoid that place undue stress on the temporomandibular joint, including:

  • Chewing gum
  • Chewing pens or pencils
  • Leaning your chin in your hand
  • Eating hard foods
  • Clenching or grinding your teeth
  • To increase awareness and avoid teeth-grinding at night, ask your PT or healthcare about mouthguards and other oral devices that can help.

You should also wear a mouthguard and protective headgear during contact sports.

Summary

If you have temporomandibular joint disorder (TMJ), physical therapy can help reduce pain and improve jaw mobility. Your PT can help determine the cause of your pain and improve the way your jaw moves with exercise, joint mobilization, postural control, and soft-tissue release. Heat or cold application and stress relief techniques can also help.

If physical therapy and conservative management fail, botox injections can help in the management of TMJ pain.

At Pain Spa, Dr Krishna is highly experienced in treating patients with TMJ pain. Dr. Krishna is a pioneer in the use of Botox for pain management in the UK, with over 15 years of experience in the field. For further information please contact us at clinic@painspa.co.uk.

Please click the following link for more information on Botox injections for TMJ pain: https://www.painspa.co.uk/procedure/botox-tmj-dysfunction/