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TMJ pain - jaw pain and dysfunction

Temporo-Mandibular Joint Dysfunction (a.k.a. TMJ, TMD, TMJD, jaw soreness/pain) is a condition in which the mandible (i.e. the jaw bone) becomes painful to move, open, and close.


The joint (which most people refer to only as the jaw) is an interesting one. 

Let's start with some basic anatomy to give you some context.  The mandible is shaped like the letter "U" when looked at from above.  Looking at it from the side it looks more like a capital letter "L".  The mandible has a horizontal piece (with your teeth) known as the body, and another portion that moves up (for it to connect with the skull) which is called the ramus.  The ramus (the portion that extends up to meet the bottom of the skull) has a saddle-like shape at its top when viewed from the side.  At the front of the ramus (the side nearest the teeth) is a process (or extension of bone) that points upward called the coronoid process.  The coronoid process acts at an anchoring point for muscles (especially the temporalis muscle which is a large flat mucles located on the side of your head).  Heading back from the coronoid process, the bone dips down into a valley called the mandibular notch.  Continuing back further, we move upward again to the back of the saddle, and find another process called the condylar process.  This condylar process is the part of the mandible which makes contact with the base of the skull.  In the world of anatomy, anytime two bones come together at a joint, the surfaces where they meet are called articular surfaces.  Usually articular surfaces are smooth to allow easy motion, and that area of the bone is extra dense to withstand the forces placed upon them.  Between the articular surfaces of the mandible and the skull sits a small cushioning disk whose job it is to make the movement even more smooth.

Now here is the interesting point... Since the mandible only has small bony connections at the condylar processes (one on either side), how is it held in place?  The mandible is slung underneath the skull by a bunch of muscles, most of which attach to the ramus and along the body.  Because the mandible is in a sling of muscles, the muscles have great influence... not only on its movement, but also its resting position.  Muscles move it side to side (for chewing like a cow), front to back, up and down.  The muscles are also responsible for the movement of the little cushioning disk inside the joint, so that as the jaw moves forward the disk travels with it to continually provide cushioning.  This is an amazing piece of anatomical engineering!

So, where can (and does) this wonderful joint go wrong?  Why does it cause pain or not open easily?  Usually the problem comes from either the cushioning disk not moving correctly, or the muscles of the mandibular sling become unbalanced.  So effective treatment must address most of the muscles that sling and control the mandible.  As we have already discussed, some of these muscles are on the outside of your skull, along your jaw, and under your jaw.  But other muscles that need to be addressed are inside your mouth.  Yes, you read that correctly... INSIDE your mouth.  These must also be addressed for successful resolution of your jaw pain.

As the muscles that restrict your mandibular movement become soft and lengthen, losing their restrictions, your mandible will move much easier and will also be able to reposition itself properly.  Your pain will decrease and the movement of your jaw will become more smooth.  Any wiggle (or wobble) of the jaw (where your jaw moves to a side while opening, or one side releases down before the other) will be addressed during therapy too.  The goal is to get your mandible moving freely as quickly as possible.

Note: In the state of Washington, intra-oral massage (inner mouth massage) is regulated by the Washington State Department of Health.  So any massage therapist that works inside your mouth must be legally endorsed to do so while working in the state of Washington.

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