TMD: Temporomandibular Disorder

The arrow is intended to point at the general area.

Since I am trained to treat TMJ pain and dysfunction related to the temporomandibular joint—which also happens to be something that many people suffer from; yours truly included—I decided this would be a great topic for today’s post.

Temporomandibular disorder (TMD) rears it’s ugly head when there are problems with the jaw, jaw joint(s), and/or when surrounding facial muscles are imbalanced. This disorder is often incorrectly called TMJ, which stands for temporomandibular joint… And every single one of us has two.

What is the Temporomandibular Joint (TMJ)? The TMJ is the hinge joint that connects the lower jaw (mandible) to the temporal bone of the skull, which is immediately in front of the ear on both sides of our head. (You can feel them move by placing your fingers where I just mentioned while opening and closing your mouth.)

The joints are flexible, which allows us to move our jaw smoothly; up-and-down, side-by-side. The joints make it possible for us to talk, chew, and yawn. The muscles connected to the joints make it possible for us to control the position and movement of our jaw.

What Causes TMD? Injury to the jaw, temporomandibular joint, or muscles of the head and neck—such as from a heavy blow, a fall, or whiplash—can cause TMD. Repetitive movements can adaptively shorten the surrounding muscles causing it as well. Other possible causes include:

  • Grinding or clenching the teeth, which puts a lot of pressure on the joints
  • Dislocation of the disc between the ball and socket
  • Presence of osteoarthritis or rheumatoid arthritis in the joints
  • Stress, which can cause a person to tighten facial and jaw muscles or clench the teeth

What Are The Symptoms of TMD? People with TMD can experience severe pain and discomfort that may be temporary or last for many years. Common symptoms of TMD include:

  • Pain or tenderness in the face, jaw joint area, neck and shoulders, and in or around the ear when you chew, speak, or open your mouth wide
  • Limited ability to open the mouth very wide
  • Jaws that get “stuck” or “lock” in the open- or closed-mouth position
  • Clicking, popping, or grating sounds in the jaw joint, which may or may not be accompanied by pain, when opening/closing the mouth or chewing
  • A tired feeling in the face
  • Difficulty chewing or a sudden uncomfortable bite—as if the upper and lower teeth are not fitting together properly
  • Swelling on the side of the face
  • Headaches
  • Dizziness
  • Pain and paresthesia in the upper extremities
  • Difficulty swallowing
  • Toothaches
  • May occur on one or both sides of the face
  • Ear symptoms

Ear symptoms associated with TMD include:

  • Fullness in the ears
  • Tinnitis (ringing in the ears)
  • Ear pain
  • Hearing problems such as ubjective hearing loss
  • The sensation of itching in the ears

TMD PREVALENCE
About 75% of the population has a least one sign, and 33% has at least one symptom. The age range at presentation is normally in the region of 16-30 years, but often persists for two or more decades.
Gender bias = 4:1 female.
AAOP TMD Guidelines: 1990, ’93, ’96

On another note, it is VERY important that I mention this… A sudden onset of severe pain within the jaw could indicate a heart attack. This is more common with females. Please keep this in mind for yourself and your loved ones as it could potentially save a life!

As always, I hope you find this information informative!

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me

Referred Pain At-A-Glance

Before I go on with my post, I would like to first state that I have inserted Wikipedia’s links for the following conditions in case some of you are unfamiliar; however, please keep in mind that they do not mention PNMT—or any specific modality of massage—as an option for pain-relief, aside from the brief-mention of “massage” in the carpal tunnel and piriformis syndrome links under Treatment. Traditional medicine is basically the main focus, which is one of the reasons why I felt it was important to start this blog. At the end of the day, PNMT is extremely beneficial for pain and dysfunction caused by muscular imbalances within the muscular-skeletal system. What’s even better is that it is non-invasive!

Referred pain is a phenomenon used to describe pain perceived at an area, adjacent to or at a distance from, the site of an injury’s origin. For example, carpal tunnel symptoms can be caused by muscular imbalances in the shoulder and/or upper arm. These imbalances can throw off the alignment of muscles and tendons down the arm. The result is not necessarily pain in the shoulder, but instead, pain that is similar to carpal tunnel. Interesting, huh?

Assuming you would agree, I’ll go ahead and get a little more specific, using sciatica as another great example. In my experience, it appears that many people aren’t aware of specific muscles in and around the buttocks that can mimic true sciatica. The piriformis, gluteus minimus, and hamstrings being perfect culprits. Most people are told that sciatica is directly related to the sciatic nerve; generally caused by compression of the lumbar nerves L4 or L5; sacral nerves S1, S2, or S3; or by compression of the sciatic nerve itself. There is also another diagnosis called piriformis syndrome. This is when the sciatic nerve is compressed or irritated by the piriformis muscle due to it being in the shortened position or from spasming. (Please read the portion on Davis’ Law in this post if you are unfamiliar with “shortened” muscles and how they occur.) Not only can muscles in the shortened position entrap or compress nerves, but they may also contain TrP’s that replicate nerve-related pain, such as the carpal tunnel and sciatic-type symptoms I mentioned, among others. (Please read this post for more detailed information on TrP’s.)

I know it may sound crazy that muscles could actually be the root cause of the above mentioned problems, but I promise you it is indeed very possible. If you have tried other options out there, up to and including surgery, but have had no relief or it was short-lived, I encourage you to look into this form of medical massage. If you live in the Cincinnati, OH area and are interested in reading some testimonials from my clients, please click here.

As always, I hope you find this information informative!

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me

Range Of Motion And Optimal Measurements

Range of motion (also known as ROM) refers to the distance and direction a joint can move to its full potential. If ROM is restricted, the joints ability to function normally becomes limited. Each specific joint has a normal ROM that is expressed in degrees, which can be measured using a goniometer; with the help of another person as well.


Below is a list of optimal measurements for certain areas of the body, but first, I’ve included what the mentioned movements mean in case you weren’t already aware…

Flexion – When the angle of a joint decreases, as in bending your arm at the elbow.
Extension – When the angle of a joint increases, as in straightening your arm at the elbow.
Rotation – When you turn your head, as in checking your “blind spot” while driving.
Lateral Flexion – This usually refers to the spine and would happen when you are holding your cell phone in between your ear and shoulder or bending your torso while running your arm down your leg.
Abduction – When you move a limb away from the midline of the body, as in raising your arm up perpendicular to your body.
External (Lateral) Rotation – Rotation away from the body, as in rotating your leg out so your toes point outward.
Internal (Medial) Rotation – Rotation towards the center of the body, as in rotating your leg in so your toes point inward.

According to my PNMT training manuals, the optimal measurements are as follows, but not limited to…

Cervical ROM:
Flexion – 40°
Extension – 75°
Rotation – 80°-90°
Lateral Flexion – 35°-45°

Shoulder ROM:
Flexion – 165°-170°
Extension – 50°-60°
Abduction – 165°-170°
External (Lateral) Rotation – 80°-90°
Internal (Medial) Rotation – 55°-60°

Lumbar Spine ROM:
Flexion – 60°
Extension – 35°
Rotation – 8°-10°
Lateral Flexion – 20°

Hip ROM:
Flexion – 140° (passive)
Extension – 30° (passive)
Abduction – 50° (passive)
External (Lateral) Rotation – 60° (passive)
Internal (Medial) Rotation – 40° (passive)
* Passive meaning the examiner moves the joint without assistance from the person being examined. 

As always, I hope you find this information informative! I’ll be MIA for a couple of weeks, but plan to have something good to write about for my next post.

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me