Ross Hauser, MD, Danielle Matias, PA-C, Demi Foster, APRN
Physical therapy can help people with TMJ disorders by reducing jaw and TMJ joint pain. Mouth opening can be helped with manual therapy and exercises which address the jaw, neck, and shoulders.
In November 2022 in the medical journal Biomedicines (1) doctors tested the effectiveness of physical therapy as a treatment of temporomandibular joint dysfunction and the impact the treatment would have on pain coming from the neck. In this paper, 64 patients were divided into two groups. Thirty-three patients underwent conservative drug treatment and physiotherapy treatment, and 31 patients in the control group underwent only conservative drug treatment. The participants were examined at baseline and re-examined after 3 months. In this study, there was a higher incidence of female patients.
The doctors found that “After 3 months of treatment of the TMJs and cervical spine, pain decreased in both groups. Muscle testing at the cervical spine and temporomandibular level showed a decrease in pain and muscle spasms. The average percentage values of the Neck Disability Index (NDI) and the Jaw Functional Limitation Scale 8 decreased significantly in both groups . . .” The researchers noted however that pain reduction and increase in function were specifically seen in the patients receiving conservative drug treatment and physiotherapy treatment. The researchers concluded: “Physiotherapy treatments could maintain the functional state at the temporomandibular and cervical levels, thus contributing to increasing the quality of daily life.”
But how does physical therapy help? The researchers citing previous studies noted that TMJ disorders can impact the boy well beyond the jaw. TMJ disorders may negatively affect not only mastication, swallowing, and breathing but also distort the muscle movements of the cervical, thoracic, and lumbar spines. “Balancing TMJs through exercise corrects the dysfunctions and changes the position of the center of gravity, which has effects on the mobility of the spine and the stability of the limbs. . . A direct relationship exists between the movements of TMJ and the cervical spine and posture.
Manual therapy to the neck for TMJ
A 2023 paper (2) in the Journal of Oral and Facial Pain and Headache examined the effect of cervical spine manual therapy for reducing pain and improving mouth opening and jaw function in people with TMDs. In reviewing outcome data of 213 patients, 90% were women, the researchers found manual therapy applied to the cervical joint decreased orofacial pain and improved PPT (pressure pain threshold) and jaw function.
A March 2023 paper (3) in the journal BMC Sports Science, Medicine, and Rehabilitation suggests that patients with myofascial TMD and headaches may get significant treatment duration-related reductions in headache severity and TMJ pain from manual therapy and stretching exercise therapy in the cervical spine.
An April 2024 study (4) in the Journal of Indian Prosthodontic Society evaluated different kinds of treatment modalities for temporomandibular joint pain and its impact on chronic cervical pain after 12 months of treatment. Forty-eight patients with chronic cervical and TMJ pain were divided into groups of 12, which included a control group and treatment groups of soft splints, transcutaneous electrical nerve stimulation (TENS), and low-level laser (LLL). The patient’s cervical and TMJ pain was recorded using visual analog scale (VAS 0 – 10 patient reported pain) scores at baseline, 3 months, 6 months, and 12 months. TENS and low-level laser (LLL) were found to be equally effective in reducing pain in the jaw joint region, followed by soft splints. The treatments for the TMJ had no impact on cervical neck pain. The question asked was, does treating TMJ help neck pain? The researchers here found the answer as no.
In a 2017 study (5) from researchers at the University of Comenius’ Faculty of Medicine in Slovakia, doctors suggested that physical therapy could improve craniocervical dysfunction and myofascial pain symptoms in the head and neck. Here are the highlights of this study:
- The group of patients diagnosed with myofascial dysfunctional pain syndrome contained 98 patients out of which 79 patients (81 %) were females and 19 patients (19 %) were males.
- The majority of the patients were aged between 26 and 35 years; the total age range was 14-77 years with an average of 38 years.
- Observed patients were subdivided into three groups.
- Standard therapeutic methods aimed at the temporomandibular joint were provided to the patients of the first group.
- The second group of patients received therapy aimed at cervical muscles only.
- Complex rehabilitation was applied in the third group of patients.
According to the study’s results, all three groups of patients saw an improvement in pain perception, but the overall subjective remission of painful sensations in the third group took place in as many as 88 % of patients. In this group, there was a significant decrease in the tenderness of trigger points in the trapezius and sternocleidomastoid muscles. This was achieved by a combination of simple relaxing and stretching exercises of cervical muscles with a standard method used in the therapy of masticatory muscles that are significantly more efficient.
In this study, the focus was on muscle spasms and the pain they cause. If you can relax the muscles of the TMJ and cervical neck region, you will have less pain. For some people, this will be very effective. For others, it will not. Typically, the people who will not find success will be people who have ligament damage or weakness and tendon attachment weakness or damage. For muscle techniques to work, there needs to be a resistance that allows the muscles to strengthen. If ligaments and tendons are damaged, there is lesser resistance and the treatment will not succeed as wished.
A May 2024 study in the journal BMC sports science (6) , medicine & rehabilitation suggested that massage therapy combined with post-isometric relaxation (isometric contraction motion with a sustained stretch) is more effective than massage therapy alone in managing pain and improving mouth opening in TMD patients.
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Our published research
The association between mandibular position to cervical spine and internal jugular vein diameters in upright position. Have we been ignoring critical generators of head and neck pathology? Lockerman LZ, Hauser R. The association between mandibular position to cervical spine and internal jugular vein diameters in upright position. Have we been ignoring critical generators of head and neck pathology? Cranio. 2023 Sep;41(5):403-406. [Google Scholar]
Dextrose Prolotherapy and Pain of Chronic TMJ Dysfunction Hauser R., Hauser H, Blakemore KA. Dextrose Prolotherapy and Pain of Chronic TMJ Dysfunction. (2007) [Google Scholar]
Caring Medical published research
Lockerman LZ, Hauser R. The association between mandibular position to cervical spine and internal jugular vein diameters in upright position. Have we been ignoring critical generators of head and neck pathology? Cranio. 2023 Sep;41(5):403-406. [Google Scholar]
References
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