Ross Hauser, MD
In many patients who come to our center, we see primary problems related to neck pain and cervical instability. One of the symptoms of these problems is temporomandibular pain disorders. We also see a lot of people with primary problems with the temporomandibular joint. One of the symptoms of this problem is cervical neck pain. Surprisingly, despite the research suggesting the connection, many patients were not made aware that their jaw pain could be a problem originating in the neck and their neck pain can be a problem originating in their jaw, and with this, can come a myriad of unexplainable or misunderstood symptoms and conditions beyond jaw and neck pain.
Part 1 TMJ and neck problems have long been linked together
It has long been known that there is a strong association between neck disability and jaw disability. To put it another way, whenever the neck is affected by a structural issue, it affects the jaw and vice versa. Despite TMJ and neck problems being linked together, it is not often that a patient will report to us that their previous healthcare providers made this connection between their TMJ problems and their neck pain and offered treatments addressing both concerns. In the following research the links and the treatments for both TMJ problems and cervical neck instability point to a problem in the neck.
CT Scan Of A Patient With Malocclusion
In the medical journal Clinical Oral Investigations, (1) oral surgeons in Belgium made this connection between TMJ and cervical instability. This research is from 1998, so the problems of TMJ and neck disorders are hardly a new idea. We will bring this research forward 26 years to 2024.
The researchers conducted a study looking for possible correlations between clinical signs of temporomandibular disorders (TMD) and cervical spine disorders.
- Thirty-one consecutive patients with symptoms of TMD and 30 controls underwent a standardized clinical examination of the masticatory system, evaluating the range of motion of the mandible, temporomandibular joint (TMJ) function, and pain of the TMJ and masticatory muscles.
- Afterward, subjects were referred for clinical examination of the cervical spine, evaluating segmental limitations, tender points upon palpation of the muscles, hyperalgesia, and hypermobility.
- The results indicated that segmental limitations (especially at the C0-C3 levels) and tender points (especially in the sternocleidomastoideus and trapezius muscles) are significantly more present in patients with TMJ than in the control subjects.
Doctors detail the connection between neck pain and TMJ disorders, going further to demonstrate a connection between neck pain and people who suffer from asymptotic TMD.
Let’s now jump to a 2021 paper, citing this research. Publishing in the journal BioMed Research International (2) and led by the Orthopaedic and Rehabilitation Department, Medical University of Warsaw, Poland, doctors detailed the connection between neck pain and TMJ disorders, going further to demonstrate a connection between neck pain and people who suffered from asymptotic TMD. Here are the learning observations:
“In most (patient) cases, it is difficult to identify the cause of neck pain (as one clear factor), which is a substantial obstacle when customizing congruent therapy and preventing further recurrences. Chronic idiopathic neck pain is defined as neck pain lasting more than 3 months, without the presence of trauma, cervical hernias with clinical symptoms, or radiculopathy. On the basis of its etiology, it was divided into specific neck pain, trauma-induced neck pain, and idiopathic (nontraumatic) neck pain. The complicated anatomical structure of the cervical spine, its complex biomechanical function, close proximity of nervous system structures, and symptom inhomogeneity (mysterious and accountable symptoms) are a challenge for clinicians and researchers dealing with diagnostics and treatment of neck pain.”
Let’s stop here for a simple recap.
- Doctors may find it difficult to determine the cause of idiopathic or unexplainable neck pain.
- The cervical spine is complicated and because it contains the nervous system structures, there can be a myriad of mysterious symptoms, such as described throughout this article.
The TMJ connection
“Some (researchers) have reported a relationship between craniofacial and neck pain, including biomechanical, neuroanatomical, and neurophysiological aspects. Close anatomical connection of the cervical spine to the masticatory system and frequent comorbidity of the neck and temporomandibular joint dysfunction (TMD) suggest the need to study the relationship between these areas.
Incorrect tension of the masticatory muscles was found to be associated with head posture and was suggested as one of the causes of dysfunctions in cervical paravertebral muscles. The possible explanation could be the neurophysiologic connections between the cervical spine and temporomandibular area, such as the convergence of trigeminal and upper cervical afferent inputs in the trigeminocervical nucleus.”
Let’s stop here for a recap.
What the researchers are suggesting is that there is a connection between problems of the cervical spine and TMJ, and as the doctors of 1998 suggested, here in this 2021 paper the connection needs to be explored. They also point out the problems of the trigeminal nerve.
In our article Non-surgical treatment for Trigeminal Neuralgia: I discuss why we examine the neck of a patient who comes in for a Trigeminal Neuralgia consultation. Here I write:
We examine the neck of a patient who comes in for a Trigeminal Neuralgia consultation because we are looking for compression of the nerve. The head and neck, as all parts of the body, live in complex relations. Something in the neck can cause problems in the jaw, face, shoulders, fingers, etc. Problems in the jaw can cause problems in the neck. Any musculoskeletal problem can cause problems of headaches. Back to the keyword compression. We are looking for problems in the neck that can be influencing problems of the head and jaw. When a physician and a patient believe that a nerve is getting compressed, it is easy to see why surgery would be recommended. Unfortunately, when cervical neck instability is the cause of neuralgia, the surgery does not help relieve the pain. Cervical instability can also be responsible for almost all painful neuralgias of the head and face including occipital and trigeminal neuralgia, as well as structural headaches including tension, migraines, and clusters. This is not a new concept for us, the examination of the cervical neck area is a crucial component of our comprehensive non-surgical Trigeminal Neuralgia program.
The challenges of accurately assessing patient issues with cervical posture in TMJ
A September 2024 study (3) discusses the challenges of accurately assessing patient issues with cervical posture in TMJ. The authors write of the standing balance of the skull on the spine in its cervical portion is a factor of consideration for the diagnosis of cranio-mandibular disorders, however over time, this element (balance of the skull on the spine) had not been taken into account in the differential diagnosis protocol, despite the fact that biomechanical alterations and dysfunctions in both hard and soft tissues are evidenced in a lateral skull (imaging).
Using the Rocabado-Penning (testing) analysis. doctors looked at the standing balance of 30 patients. 66.7% were female, 96.7% were brachyfacial type (smaller face, lower jaw pressing forward), 63.4% had Ricketts (vitamin D deficient) skeletal Class I, 63.4% had deep bites, the position of the hyoid bone was low for 63 .4% and the depth of the cervical spine is rectified by 96.7% (straightened spine). (The straight spine) could result in pain, tinnitus or other symptoms if not treated in time.
Posture and muscle strength
An April 2024 study (4) from Turkish researchers suggests: “It has been concluded that TMJDs with jaw and neck pain seem to negatively affect muscle strength and proprioception (your body’s ability to move without thinking about moving) of the TMJ and cervical region, postural stability, endurance of deep neck flexors and mandibular functions. Considering the strong connections between the TMJ and the neck region, evaluating not only jaw pain but also neck pain in patients with TMJDs is clinically important in terms of improving proprioception and postural stability.
Understanding the TMJ temporomandibular joint itself. What are we seeing in this image?
In this simplified view of the TMJ, we can get an understanding of the mechanisms behind TMJ disc displacement. When this person would close their mouth, they would get the characteristic clicking sound and accompanying “pop” or feeling of displacement. See that the disc in this image has ligaments behind it. The ligaments are there to provide structural stability between the jaw bone at the skull. The ligaments are holding the jaw to the skull. In front of the disc towards the face are the powerful jaw muscles. Attaching these power muscles to the jaw are the muscle tendons. Notice how the muscle turns white as they approach the bone. The tendons are the muscles attached to the bones and they are white. They hold the muscles to the jaw. If the ligaments or tendons are weak, damaged, stretched out, or lax, the jaw is floating, and the disc can be displaced.
The temporomandibular joint connects the mandible (lower jaw) to the part of the skull known as the temporal bone. The joint allows the lower jaw to move in all directions so that the teeth can bite off and chew food efficiently. Temporomandibular joint ( TMJ ) syndrome occurs when the joints, muscles, and ligaments involved do not work together properly, resulting in pain.
Temporomandibular joint syndrome and TMD or TemporoMandibular Disorders have been demonstrated to be caused by ligament weakness in many patients, often as a result of clenching the jaw or grinding the teeth, sleeping position, or a forward-positioned mandible (lower jaw).
Malocclusion, or a poor bite, places stress on the muscles and may also lead to temporomandibular joint syndrome, as may an injury to the head, jaw, or neck that causes displacement of the joint. If left untreated, jaw osteoarthritis can result.
The TMJ altered your posture by stressing your cervical spine. Isn’t posture a problem of swallowing and breathing difficulties?
Let’s make one more connection as observed by doctors writing in the European Journal of Orthodontics (9).
- In this study, the doctors compared the mandibular stress distribution and displacement of the cervical spine. In simple terms, how TMJ instability and hypermobility of the jaw negatively affected the cervical spine.
- What did they find? “(an) imbalance between the right and left masticatory muscles antagonistically act on the displacement of the cervical spine, i.e. the morphological and functional characteristics in patients with mandibular lateral displacement may play a compensatory role in posture control.”
The TMJ altered your posture by stressing your cervical spine. Isn’t posture a problem of swallowing and breathing difficulties?
Cervical Muscle Tenderness in Temporomandibular Disorders
A 2020 study appearing in the Journal of Oral & Facial Pain and Headache (10) examined 192 patients with TMD and cervical muscle tenderness. What they found was cervical muscle tenderness was notable only in those with a myogenous (muscle problems) TMD diagnosis, but not in arthrogenous (degenerative TMJ disc disease). (Our note: the problem was not in the TMJ joint but likely a problem of cervical spine instability). This is something the researchers concluded as well:
“cervical muscle tenderness differentiated between TMD patients and controls and between TMD diagnoses. Specific patient and pain characteristics associated with poor outcomes in terms of cervical muscle tenderness included effects of interactions between myogenous TMD, female sex, whiplash history, comorbid body pain and headaches, and pain on opening. It can, therefore, be concluded that routine clinical examination of TMD patients should include assessment of the cervical region.”
Jaw pain, neck pain, dizziness, headache, tinnitus
A September 2023 paper in the Journal of Personalized Medicine (12) compared dry needling to manual therapy. In discussing the various results, the researchers in conclusion wrote: “Finally, it is important to remark that patients with TMDs present clinical signs and symptoms of cervical disability or dysfunction. Pain in musculoskeletal cervical structures may manifest in jaw muscles due to the connection and convergence between craniofacial and cervical afferents (sensing deep muscle pain) in the upper cervical nociceptive neurons (nerves that provide pain sensation) and trigeminocervical nucleus (where dysfunction creates jaw pain, neck pain, dizziness, headache, tinnitus, among other symptoms). The greatest reduction in the magnitude of pain in the temporomandibular joint zone may explain the reported improvements in cervical disability assessed with (the neck disability index survey) after the therapy. Our findings showed that both therapies are effective in reducing cervical disability after the full treatment.”
We hope you found this article informative and that it helped answer many of the questions you may have surrounding your TMJ issues. If you would like to get more information specific to your challenges please email us: Get help and information from our Caring Medical staff
More reading
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Neck pain and Lyme Disease: Will treating neck pain make Lyme Disease symptoms go away?
Our 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]
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