Treating TMJ — Jaw-Stretching Exercises and Physical Therapy Modalities

 
 

Oral and facial pain disorders are common and sometimes debilitating conditions involving the head, face, and neck. Patients often experience symptoms including limited opening, joint locking, painful chewing, facial pain, or headaches.

What are the treatment goals?

Treatment goals for TMJ are to decrease pain, restore normal range of motion, and restore normal chewing and jaw function. Treating TMJ symptoms can often be partially managed through an at-home approach—and may be part of a more extensive, in-office treatment plan.

Exercises can reduce pain, improve coordination of masticatory muscles, reduce muscle spasm and hyperactivity, restore original muscle length, strengthen the muscles involved, and promote tissue repair and regeneration.

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What physical therapy techniques and stretching exercises can you do at home to minimize TMJ symptoms?

Physical Therapy Techniques

The primary goals of physical therapy as a treatment are to stretch chronically contracted and fatigued muscles, increase range of motion, and reduce muscular trigger point activity.

Try these techniques to lessen TMJ discomfort:

  • Rest the masticatory muscles by limiting jaw movements.
  • Limit jaw activity through reduced talking, chewing, and yawning for the duration of treatment and possibly, as a preventive measure, after symptoms have resolved. Avoid chewing gum and hard foods. Be aware of habits such as biting objects or finger nails, clenching, or grinding, that may make symptoms worse.
  • Try not to open the mouth wide when the condition is acute.
  • The resting position (lips together, teeth apart) is important in reducing and ultimately stopping daytime activity that contributes to the progression of TMJ/TMD pain. Try habit-controlling cues—throughout the day, check the position of your bite. For example, saying the letter “N” at various times during the day can serve as a reminder to unclench or to stop grinding your teeth.
  • A soft diet is crucial for muscle and TMJ pain management so that the condition is not worsened during treatment.
  • Moist heat and/or ice therapy overlying the painful areas of the face, head, and neck can be effective. Moist heat tends to work better for muscle pain or tension by increasing circulation and relaxing involved muscles. Ice works better for TMJ capsulitis by reducing inflammatory symptoms.

These exercises may also ease TMJ symptoms:

  • Jaw-Stretching, Relaxation, and Coordination Exercises
  • Chin to chest: Gently pull the head forward, bringing the chin toward the chest.
  • Head tilt: Turn the head to one side and then tilt it back.

These exercises must be done four to six times per day to be effective. You should also use moist heat for 10–15 minutes prior to stretching the muscles.

  • Elevator jaw muscle stretch: Move the jaw downward (open the mouth).
  • This stretch must be performed several times a day in order to be effective.
  • Open and close the mouth slowly in front of a mirror with a straight vertical line drawn. Try to keep the midline of the lower dental arch parallel to the mirror during the execution of movements.  You can also try placing your right and left index fingers in the lateral pole region of the jaw to assist with movement coordination.
  • Twenty repetitions of this exercise, three times a day, are recommended.
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Strengthening and Endurance Exercises

Isometric exercises for the masticatory muscles are performed by applying a counter-resistant force to the movement being performed. Forcefully placing the chin on a closed hand during depression jaw movement (mouth opening), and hindering its elevation (closing) by pressing the inferior incisors with the index and middle fingers are considered muscular strengthening exercises that depress and elevate the jaw, respectively.

In lateral jaw movements, the counter-resistance force is applied by pressing the lateral area of the mandibular body with the index and middle fingers, exerting a force opposite to the movement performed.

These exercises should be repeated several times a day. An excessive counter-resistance force should not be applied, in which case reciprocal inhibition would occur, causing loss of exercise function; that is, it would cease to be an exercise for strengthening and become an exercise for relaxation.

 

Sources:

1 Orofacial pain management: current perspectives, Marcela Romero-Reyes and James M Uyanik

2 Dental Press Journal of Orthodontics, Alberto da Rocha Moraes, Monique Lalue Sanches, Eduardo Cotecchia Ribeiro, Antonio Sergio Guimaraes