Introduction to TMJ Treatments

Hey all, 

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 :)

Step 1

Assessment:
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 Problems: 

  1. External Pterygoids  
  2. Internal Pterygoids
  3. Temporalis m (anterior, middle, and posterior divisions)
  4. Masseter (deep and superficial fibers)

2012-03-06_Pterygoid                     2012-03-06_Temporalis

14 different divisions in total. Muscles move bones (duh! lol). Fix the muscles and the joint will move accordingly. It's not rocket science. 

Couple Keys:
The jaw will DEVIATE AWAY FROM THE TIGHT EXTERNAL PTYERGOID m.
The jaw will DEVIATE AWAY FROM THE TIGHT EXTERNAL PTYERGOID m.
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 diagnostic indicator.

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 flush.

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!

CC