Ever yawned and felt your jaw 'catch'? Or chewed your food and heard a clicking noise in the joint close to your ear? Felt pain and soreness around the jaw and temple areas?
If so, you're one of the many people who has experienced something called temporomandibular joint disorder, more commonly referred to as TMJ.
TMJ affects the temporomandibular (TM) joint, where the lower jaw bone (mandible) connects to the temporal bones of the skull in front of the ears. From this hinged joint, the jaw is designed to slide back and forth, side to side, and move up and down. TMJ severely restricts these motions. One or both joints on either side of the head may be affected, and the jaw joint and surrounding tissues can become severely inflamed and sore, affecting a person's ability to talk, smile, chew and swallow. Some people with TMJ can't laugh and kiss. Some even have difficulty breathing.
TMJ primarily affects young and middle-aged adults, mostly women, and the prevalence of the condition seems to decline in seniors.1 However, studies vary widely as far as the number of people affected. For example, one study states that TMJ symptoms appear in 5 percent of the US population,2 while in another study, more than two-thirds of tested university students had at least one symptom.3 Another study states that one in six children and adolescents have clinical signs of TMJ disorders.4 TMJ also tends to show up in populations that are under high stress. For example, people with lower incomes are more subject to the disorder,2 as are college students studying higher-pressure subjects such as science or mathematics.3
When you have this condition, there's no doubt it interferes with your life. Up to 60 percent of men and women with TMJ symptoms report moderate to severe pain, and nearly 25 percent are affected so dramatically that it directly interferes with their work. TMJ sufferers are also six times more likely to experience a range of accompanying disorders, from severe headaches and depression to autoimmune disease, gastrointestinal problems like irritable bowel syndrome, sleep apnea, fibromyalgia, fatigue and arthritis.1
The causes of TM disorders are not well understood, at least in conventional medicine, and there is no standard definition for what TMJ really is. However, a major clue is the fact that TMJ problems are often accompanied by neck and low back pain. In surveys of over 8,000 Americans with TMJ, 64 percent reported that they also experienced low back pain, 54 percent had neck pain, and 53 percent had migraines.5
It's understandable that TMJ would trigger headaches, migraines, fascial pain in the face and referred pain to the teeth. It's also logical that such pain and tension in the head region would result in misaligned muscles and neck pain. But the low back? How can this association, so consistently puzzling to dentists and regular doctors, be explained?
According to Ruth Duncan, director of Myofascial Release UK, the correlation is easily understandable. "Because the jaw is the only bone in the body that crosses the midline of the body, any dysfunction anywhere in the body will always present in the jaw. When you have dysfunction from a mechanical injury or overuse of the jaw, then it will create a twist in the torsion through the central axis of the body, which is why you very often get people with TMJ who have pelvic dysfunction, which has to include the lumbar."
Few conditions highlight the delicately balanced, interconnected nature of the human body better than TMJ. From the perspective of 'biotensegrity,' adapted from the term 'tensegrity' coined by Buckminster Fuller and meaning 'tension with integrity,' everything in the body is connected. The fascia, muscles, bones and joints work together to respond to gravity. When the jaw is not working properly, the entire body begins to compensate, especially the low back.
Kelly Clancy, founder of Tensegrity Medicine in Seattle, Washington, says a balance occurs between the base of the skull and the sacrum at the base of the spine. "You can look at them as kind of like one joint," she says. "If one end of the joint is off, then it would have to be off on the other end. The head and sacrum are like a fulcrum in that they balance each other."
Joel Crandall, an exercise physiologist in northern Los Angeles and founder of the Voilà Method, explains yet another relationship between the jaw and the low back: the "Three P's"— the pterygoid muscles in the jaw, the psoas muscle at the front of the hip and the piriformis at the back side of the hip. These, in turn, define the three "keystones"—the areas in the body that must be balanced for proper jaw function: 1) the sphenobasilar joint (formed by the sphenoid and the occipital bones at the base of the skull), 2) the diaphragm under the ribcage and 3) the pelvic floor.
"If the psoas, piriformis and pterygoid aren't in balance, it will cause a rotation in your body," says Crandall. "You can't just go in and adjust the pterygoid muscle for TMJ. You have to make sure the hips are aligned as well. The keystone areas have to be stacked and work and move in harmony with each other."
According to Crandall, when we breathe deeply and fully, the TM joint moves, directly affecting the jaw (mandible). "As you breathe in, the mandible will drop down and forward," says Crandall. "And as you exhale, it will rise back up. That's part of the dance that has to happen. If that temporal bone isn't moving the way it should, then the mandible can't move the way it should."
Under stress, we don't breathe properly, which means that both the TM joint and the pterygoid muscles aren't working properly either. This not only leads to TMJ, but also affects the psoas and piriformis and ultimately the low back.
This cause-effect relationship between the jaw and the low back works the other way as well. "If there is direct force trauma to the pelvic region, or the psoas isn't functioning well or you have a tight piriformis, or an externally rotated leg stuck in that position, it will start affecting the pterygoid muscles, which will start trying to compensate for the hip not functioning very well. This tiny jaw muscle will try to make the hip function properly. But it will tire and have to let go, and that's when you start getting the jaw issues."
The central and peripheral nervous systems and the brain are also involved. When you're dealing with TMJ, Clancy says, you're not only dealing with the cranial nerves but also the nerve endings running through connective tissue throughout the body. "Whenever there is any abnormal traction, pulling or tugging on those nerve roots, the body will respond with an abnormal hyper-response of those nerve endings," she says. "If it's prolonged, the brain will start to adapt—something called central sensitization." In this instance, says Clancy, the brain starts to change the way it processes information from dysfunctional nerves. When it comes to diagnosis, Crandall says that when a patient presents a TMJ problem, the first thing he does is assess what keystones might be stuck—and it's not always in an obvious location.
Jodi Shepard from Binghamton, New York shares her experience. "Going through the jaw assessment during a demonstration seminar, moving my jaw left, right, forward and inward (which I have never been able to do), Joel found that my right talus (in the ankle) was not balanced. After making the correction I was tested again... left, right, forward. To my incredible surprise, for the first time in my life my jaw moved inward toward my spine."
Weird? Perhaps. But totally explainable. According to Duncan, something called the superficial backline connection runs from the soles of the feet, up the back of the leg, up the back and the back of the neck, and across the top of the head, ending at the forehead. "You can treat feet and you will get change in the head, neck and jaw," she says.
One of her best treatment stories concerns a woman in her seventies. An avid lawn bowler and curling athlete, the woman came in presenting with severe low back pain. Duncan asked whether she'd had any jaw or dental problems. "I find that somewhere along the line, people presenting with lumbar pain have worn bite splints at night or they've had a bad tooth extraction that left them debilitated for a while, or had dental surgery, or worn braces as a child."
Turns out, the woman had been having problems with her dentures. Duncan treated her pelvis, but also worked intraorally on her jaw muscles and externally on her cranium. "She never came back," Duncan says. "Of course, I feared that I hadn't helped her. A year later her grandson came in and said that one visit had cured her back pain."
Emotional and psychological issues are also often related to TMJ and low back issues. Craniosacral practitioner Robin Landsong of Olympia, Washington says that emotional traumas, such as divorce or the loss of a loved one, affect the pericardium, the protective membrane around the heart. "The pericardium has a fascial connection up to the sphenoid [in the center of the skull]," she says. "It can literally contract, like any other tissue in the body, affecting the sphenoid and everything forward in the front of the cranium—the sinuses and the jaw, the TMJ, etc. It's the critical cog of all the motion in the head."
Both Duncan and Clancy say they do a lot of dialoguing with their TMJ and low back pain clients around emotional concepts like, "How are you expressing yourself?" and "Are there times in your life when you feel like you can't be yourself?"
"There are often issues involved with TMJ and low back pain that are related to control and surrender, letting go and trusting your environment, those kinds of things," says Clancy. "The physical and emotional elements play off of each other. It's all about finding a balance."
The mainstream approach
Mainstream research is slowly catching up to the amazing connection between the jaw and the lower parts of the body. Small studies and case reports have begun to accumulate, showing a clear link between the position of the jaw and the spine, including the lumbar region. In patients with both low back pain and TMJ symptoms, treatment of the jaw problem has also brought about improvements in the back pain.6 Conversely, manipulation of the cervical spine (the upper region of the spine) and full spinal adjustment have been reported to positively affect TMJ.7
Unfortunately, traditional treatments for TMJ such as bite splints, dental adjustments to the teeth, surgery, ear canal devices, drugs, joint irrigation, cortisone injections, and even massage and stretches are localized, direct, symptom-driven approaches, and they're only partially effective for treating TMJ.
Many dentists now specialize in TMJ disorders, touting radical improvement using mechanical devices (bite splints), orthodontics (braces), and grinding down teeth to alter the patient's bite. Bite splints (also known as stabilization splints) are the most widely used treatment. Made from plastic or metal with a soft polyurethane interior, bite splints are designed to fit over the teeth, holding the jaw in a more aligned rest position.
Highly effective for stopping clenching and teeth grinding, bite splints are often considered the 'cure' for TMJ. However, studies indicate that while bite splints are effective for pain mitigation, they are not a definitive treatment.8 Bite splints are awkward at best—they impede speech and cannot be used while eating. Plus, long-term use of bite splints is not recommended because there is a risk they might cause changes to the shape of the bite that can be "severe and irreversible."9 The use of braces and filing down teeth to change the bite can have similar ramifications.
One new pain mitigation device that, so far, has no reported adverse effects is a type of ear plug designed to alter the width of the inner ear canal. Because the TM joint is so close to the canal, this widening can sometimes reduce pain in the joint. However, it doesn't address the root cause, which may originate in the pelvic region, from emotional stressors, or from the use of mainstream treatment protocols themselves.
Even surgery—open-joint surgery, arthrocentesis (irrigation of the joint to remove debris), TMJ arthroscopy and modified condylotomy (surgery on the jaw bone itself), all of which are highly prescribed for TMJ disorders—isn't very effective. In one study, nearly 40 percent of all survey respondents with TMJ had at least one surgery, and almost all had been prescribed various pain and anti-inflammatory medications, but the results of all these interventions had been "equivocal"—they weren't definitive.1
Another problem is the frequent lack of a proper diagnosis. Because they have similar symptoms, TMJ is often confused by dentists and doctors with myofascial pain and masticatory muscle pain and dysfunction.
Steroid injections are also of dubious value. There are no guidelines for the use of steroids for TMJ, such as an established dosage or proper injection protocol, and there can be complications such as joint infection and thinning of the nearby bone. Furthermore, it's always hard to justify a shot-in-the-dark that might cause damage to the cartilage and tissues of the joint itself.
Some chiropractors and advanced massage therapists address TMJ by working inside the mouth on the pterygoid muscles located on either side of the inner surface of the jaw. Applying pressure to this tiny muscle and getting it to 'release' can be effective, at least until tension in the jaw increases again due to stress or other issues. It can sometimes be a highly painful procedure for the patient, although a skilled myofascial release therapist can usually achieve the release with nothing more than slight and temporary discomfort.
The bottom line? The causes of TMJ may have little to do with the skull or jaw itself and everything to do with the major muscles of your lower body, your posture and the way you move. It's becoming clear that the only way to heal your upper body is to first tackle what's happening below it, and the solution lies in understanding something fundamental about yourself: everything is connected.
Jumping for relief
Jump lunges can help create alignment in the pelvic region—a movement that might assist people suffering from TMJ. Here's the protocol from Joel Crandall:
• Place one foot in front of the other about 1.5 feet apart (your normal walking stride length). Do a three-inch jump off the ground and then land fairly hard.
• Switch and jump again with the other leg in front.
• Place one foot to the side about 1.5 feet apart(your normal walking stride length), again jump.
• Switch sides and jump a fourth time.
Look to the way you move
A variety of influences can cause pain in your jaw. Tesegrity Medicine founder Kelly Clancy suggests you consider the following factors:
• How are you holding your body in space during the day?
• What is your general ergonomic positioning over prolonged periods?
• Do you have a balanced exercise routine that includes endurance, flexibility and strength training?
• How clean is your diet? Does it avoid avoid inflammatory foods, like sugar or wheat?
Home first-aid for a painful jaw
Most TMJ experts advise that even the most acute TMJ symptoms will eventually (if temporarily) subside using the following therapies.
Ice. Wrap an ice pack in a clean cloth and hold against the affected areas for no more than 10-15 minutes to reduce swelling, inflammation and pain.
Avoid opening your mouth wide. Don't eat 'big' things that require you to stretch your jaw, like apples or large sandwiches.
Soft diet. Stick to soups and soft foods like yogurt and cottage cheese. Break out the blender and drink smoothies to give your jaw a rest.
Exercises. Move your jaw slowly, incrementally stretching the muscles. Hold each increase for a minimum of 90 seconds to allow the fascia in your muscles to release.
Self-massage. Gently massage the painful areas in your jaw, cheeks and temples. Hold painful 'trigger points' for at least 90 seconds and allow the infra-red heat from your fingertips to penetrate the fascia and aid in creating release.
Meditation and relaxation. Slow, deep breathing through the nose can be very effective for inducing a relaxation response in the muscles of the face. Take short breaks throughout the day to consciously relax any tension that's building in your body.
Sleep on both sides. Use a pillow between your neck and shoulder to help support your head and vary your sleeping position. Sleeping on just one side will shorten the jaw muscles on the downward side and lengthen them on the other side, creating an imbalance.
If you have to yawn or open your mouth wide. Support your chin with your fist while doing so to prevent your jaw from locking open or causing irritation to the joint.
To sort out the problem for good, Tensegrity Medicine founder Kelly Clancy recommends that you choose a therapist who specializes in more postural and structural issues rather than a specialist in an isolated area of the body. "They tend to be too myopic in their viewpoint, and they're not looking at the big picture of how the low back is related to the TMJ and vice versa," she says.
Voilà Method: www.voilamethod.com
Myofascial Release: www.myofascialrelease.com
Tensegrity Medicine: www.kellyclancy.com
Robin Landsong, LMP: www.robinlandsong.com