Since most of the time you have to wait until 6/7th trimester
for Dr. Solecki to review the TMJ and the treatments involved in
actually FIXING the TMJ, I figured I would give a brief
introduction from the seminars I've attended.
Did you know one study by Pennfield and Rasmussen found 35-40%
of all the motor nerves in the body are related to the TMJ--and
they concluded it was the MOST IMPORTANT JOINT IN THE BODY! Wow.
Maybe we should learn how to treat it, huh?
First: The TMJ is COMPENSATORY to the spine and the feet. If you
do a good job on the spine (especially C1/C0, fix SCM and upper
Trap) and the feet, most of the TMJ issues will clear up. Don't
believe me? Assess the jaw before and after a treatment. Guarantee
if you know what you're doing, it improves. Might not be perfect,
but that's for the next part :)
Put your fingers on each side of the temporomandibular
joint. Ask the patient to slowly open their jaw. Does it pop? Does
it click? Does it DEVIATE? If they can't get 3 knuckles of their
NON-dominant hand in their mouth, they have TMJ dysfunction. It
might not hurt, but when was the last time we chased pain? We
don't. We fix dysfunction. I've seen a girl who couldn't get 2
knuckles in her mouth with constant painful popping and after a
10-minute treatment, she could get 3.5 knuckles in with no more
popping upon opening and closing. That will get your patients
noticing! Measure before and after; the patients love not only
feeling better but also having PHYSICAL results they can see!
Muscles of Importance in Fixing TMJ
- External Pterygoids
- Internal Pterygoids
- Temporalis m (anterior, middle, and posterior divisions)
- Masseter (deep and superficial fibers)
14 different divisions in total. Muscles move bones (duh! lol).
Fix the muscles and the joint will move accordingly. It's not
The jaw will DEVIATE AWAY FROM THE TIGHT EXTERNAL
The jaw will DEVIATE AWAY FROM THE TIGHT EXTERNAL PTYERGOID
The jaw will DEVIATE AWAY FROM THE TIGHT EXTERNAL PTYERGOID m.
It's that important to remember.
In other words, it deviates TOWARDS the WEAK external pterygoid
m. You might notice the orbit/eye is SMALLER on the side the jaw
deviates away from. Why? What does the external ptyergoid attach
to? Sphenoid. The tight muscle will 'tilt' the sphenoid and distort
the orbit. Don't believe me? Fix the jaw and usually the posterior
atlas on that side, and then reassess their eye. It works! (I fixed
it on my brother.) Time to get out the gloves! Get up in the
lateral pterygoid pocket and with your pinky finger 'swipe/strip'
the muscle quickly. It will be PAINFUL. This technique facially
flushes the tight pterygoid and will balance the external
ptyergoids and prevent deviation. MUSCLES MOVE BONES.
So, how do you figure out which of the other muscles are
screwing with the jaw mechanics?
Well, you could just guess and start stripping away. Ouch. Don't
try this. Believe me. It hurts.
Or you could use your tool of manual muscle testing.
So, have the patient sit on the edge of the table and test their
rectus femoris m. A strong muscle in the clear can be used as a
1. Have patient Bite Down and
Test strong indicator muscle. If strong, move on.
If the muscle weakens, we know there is a problem.
Check the Closing
Muscles of the TMJ. When you bite
down, you stimulate the periodontal ligament, which reflexively
inhibits the closing muscles to allow the opening of the jaw again.
If you have hypertonic closing muscles, you will mess with that
reflex and your TMJ range of motion. It's a beautiful reflex that
allows us to shovel food in after biting down. We take it for
granted. Closing muscles of the jaw: masseter, temporalis and
internal pterygoid. Recheck which muscle negates the previous
weakness. Facially flush those fibers.
2. Then Deviate the Jaw to a
Side and Test a strong indicator
muscle. If strong on both deviations, move on. If weakens on one
deviation, Check the Ipsilateral
fibers of temporalis muscle (check anterior, middle
and posterior fibers) or Contralateral internal
pterygoid. Facially flush to balance the muscles on either
side of the mandible. Tip: bring gloves because you need to go into
the mouth to fix the pterygoid muscles. Make sure you know what
you're doing because it's not comfortable!
3. Next, Protrude the
Jaw forward, test a strong indicator. If
strong, move on. If weakens, check the external pterygoids. It's
the pterygoid that the jaw deviates away from upon opening (during
your initial assessment you note this). Strip it out with a pinky
finger with one quick swipe.
4. Then Retrude the jaw backward and
test. If strong, move on. If weak, check the DEEP fibers of
Masseter and the posterior division of temporalis m. Facially
Hopefully your patient doesn't want to punch you in the face
after all the facial flushing!
Reassess their jaw by asking them to slowly open and close. Put
3 knuckles in. Listen for pops. If you did it right, they should
have a look of shock on their face because it will be working
correctly for the first time in a while. :)
And that's how you fix 85% of TMJs in 10 minutes. There are a
few more steps for advanced cases but I don't have the room. If
your TMJ has been bothering you, come find me on campus. I need
some more practice!
Keep Smiling Big!