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WILLING TO TRY ANYTHING TO MAKE THE JAW
PAIN STOP?
That is a good attitude!
However, before you go to the extreme…. Let us talk a moment about what might be
the cause of the pain and how Neuromuscular (NMT) Therapy can help you, without
going to the extreme.
You are not going to believe this at first I know and hopefully after reading you will
understand; how our posture, especially forward head posture, plays a vital role in the
development of Temporomandibular Joint Disorder (TM Disorder), Myofascial PainSyndrome, TMJ Pain Dysfunction Syndrome or TM Dysfunction, Malocclusion, or
Occlusal Disharmony.
A lot of names for this jaw pain, ‘this stems in part from the poor success experienced by
researchers in achieving a consensus of definition, they are however virtually unanimous
in agreement that its diagnosis is complex and controversial’ (Kalamir et al 2007).
That is right, our Forward Head Posture has the tendency to pull on our anterior neck
muscles (Suprahyoids and Infrahyoids), which in turn pull on the mastication muscles
(Masseter, Temporalis, Lateral Pterygoid and Medial Pterygoid), which in turn pulls in a
dysfunctional manner, on the incredibly unique, complex bilateral articulating,
Temporomandibular Joint (TMJ).
The two, TM joints are composed of a synovial joint composed of lower hinge
(ginglimoid) joint between the mandible and the articular disc, which comprises the disccondyle complex, and an upper sliding (athrodial) joint between the disc-condyle
complex and the mandibular fossa of the termporal bone.
Ready? Ok, here we go.
Forward Head Posture is developed in many ways; the way we sleep at night, lack of
lumbar support in chairs including our vehicles, where the computer monitor is located,
the tv, holding our phones against our ears with our shoulders, mouth breathing or upper
chest breathing and my favorite STRESS.
Not only do humans have the tendency to clinch there teeth together during stressful
moments, but we also want to protect our necks and chest; so we roll our shoulders
inward and pull our chin downward. Kind-of like a standing fetal position.
Since your habits and your mind wants you to stay in this head forward position, your
body starts making adjustments to keep your eyes and ears level to the horizon.
© 2010 Murphy’s Law Neuromuscular Therapy
As your body starts tightening down on this muscle or that muscle; pulling your head into
a dysfunctional, but functional alignment with the horizon, and just like a see-saw when
one end goes up the other goes down.
Therefore, if one muscle is pulled short, the antagonist (opposing) muscle becomes
stretched and lengthened and this change reaction will continue through out the body.
Janda (1986) termed the chain reaction Upper and Lower Cross Syndrome, he also has
hypothesized ‘that the muscular pattern associated with TMJ problems may be the
considered as locally involving hyperactivity and tension in the termporal and masseter
muscles while, because of this hypertonicity, reciprocal inhibition occurs in the
suprahyoid, digastric and mylohyoid muscles. The external pterygoid in particular, often
develops spasm.’ He also states a typical pattern of muscular dysfunction of an
individual with TMJ problems involving ‘upper trapezius, levator scapulae, scalenii, and
sternocleidomastoid.
Simmons et al (1999) ‘Anterior head positioning with reflex elevator muscle activity also
causes increased intraarticular (inside) pressure in the Temporomandibular Joint (TMJ)
and can precipitate mild internal derangements in joints with compromised discs.’ They
also note ‘that mandibular positioning; such as occurs in forward head position, can
activate the temporalis muscle and/or its trigger points.’
A muscle in a shortened state is at its weakest state.
When we ask, ok demand a shortened muscle/muscles to move quickly ex... turning your
head to look at something, bending and twisting to pick something off the floor and for
the jaw, yep, hollering for your favorite team can cause a creation of a TrP within a
muscle band, as the muscle try’s to protect itself from tearing.
What is a TrPs? Scientifically, “A cluster of electrically active loci, each of which is
associated with contraction knot and a dysfunctional motor endplate in skeletal muscle.”
TrPs in Layman’s terms… An area of a muscle where the muscle fibers have matted
together into a nodule, in a taunt band of muscle fibers, due to a chemical and electrical
imbalance and blockage.
Once a TrP forms in a muscle, it has a tendency to cause the formation of more TrP’s
within the same muscle and to other muscles. A TrP within a muscle will refer pain to
different region or regions of the body.
Which could be the reason other approaches to your pain may have not worked.
How?
By not looking in the right places for the culprit or culprits of this most elusive, baffling
and painful of condition.
Photograph of a miniature from a Byzantine manuscript "Photo courtesy of History of Medicine”
© 2010 Murphy’s Law Neuromuscular Therapy
So where would a Neuromuscular (NMT) Therapist look?
After evaluating of the whole-body posture, paying particular attention to the hips,
shoulders and head position, the Hyoid bone, and TM joint function ability.
Because of postural influences through the base of support, elimination of TrP activity in
the muscles of the neck, and even of the lumbosacral region and lower limbs, may be
critical for complete lasting relief of myofascial pain and dysfunction due to TrPs in the
masticatory muscles (Simmons & Travel).
A good NMT Therapist will release TrPs in the necessary muscles to affect symmetrical
balance of hip, shoulders and head positioning. After that, a NMT Therapist is going
hunting for the TrPs that are causing the referral pains from common symptoms of TM
Joint Dysfunction.
Symptoms tend to be chronic, and treatment is aimed at eliminating the precipitating
factors. Many symptoms may not appear related to the TM Joint Dysfunction itself. The
following are common symptoms of TM Joint Dysfunction.
Headache: Most individuals with a TM Joint Dysfunction complain of tension type
headache, and some reported facial pain. Pain is often made worse while opening and
closing the jaw. Exposure to cold weather or air-conditioned air may increase muscle
contraction and facial pain. Muscles: Sternocleidomastoid (SCM), Masseter, Temporalis
Ear pain: Many individuals with a TM Joint Dysfunction notice a deep ear pain and do
not have signs of ear infection. The ear pain is usually described as being in front of or
below the ear. Muscles: Sternocleidomastoid (SCM), Masseter, Lateral & Medial
Pterygoid, Digastric
Sounds during Opening and Closing of the Jaw: Grinding, crunching, or popping
sounds, medically termed crepitus, are common for individuals with a TM Joint
Dysfunction. In TM Disorders, this involves primarily displacement and distortion of the
articular disc, as well as remodeling of the articular surfaces, and joint hypermobility
(Solberg 1986). These sounds may or may not be accompanied by pain. Muscles
affecting articular disc: Lateral Pterygoid
Dizziness: Some individuals with a TM Joint Dysfunction reported a vague sense of
dizziness or imbalance. Muscles: Sternocleidomastoid (SCM)
Fullness of the ear: Some individuals with a TM Joint Dysfunction describe muffled,
clogged, or full ears. They may notice ear fullness and pain during airplane takeoffs and
landings. These symptoms are usually caused by eustachian-tube dysfunction, the
structure responsible for the regulation of pressure in the middle ear. It hypothesized that
individuals with TM Joint Dysfunctions have hyperactivity (TrPs) of the muscles
affecting and responsible for regulating the opening and closing of the eustachian tube.
Muscles: Medial Pterygoid, Tensor Veli Palatini
© 2010 Murphy’s Law Neuromuscular Therapy
Ringing in the ear (Tinnitus): Individuals may experience noise or ringing in the ears
called, Tinnitus. Muscles: Masseter, Lateral Pterygoid
Tooth Pain: Individuals experiencing pain, with no signs of infection of other dental
cause, in the

Upper/Lower Molars: Muscle: Masseter

Maxillary (Upper) Toothaches or Tooth sensitivity. Muscle: Temporalis

Four Lower Incisor teeth. Muscles: Digastric
Difficulty Swallowing: Some Individuals with a TM Joint Dysfunction describe pain in
the throat or difficulty swallowing. Muscles: Medial Pterygoid, SCM, Digastric, possibly
Longus Capitis and Longus Colli
Changes in Voice Range: Some Individuals with a TM Joint Dysfunction describe a
scratchy voice or hoarseness, loss of tone or capability of hitting the notes. Muscles:
Infrahyoid (Sternohyoid, Thyrohoid)
© 2010 Murphy’s Law Neuromuscular Therapy