Massage Tutorial: Myofascial release for TMJ/jaw pain


I’m Ian Harvey, massage therapist. Today
we’re going to talk about jaw pain, TMJ dysfunction, all this stuff that can
go on with the clicking and discomfort. This is actually very common problem. If
you ask any of your clients that have neck or headache or shoulder pain, “hey, do you also have jaw pain?” a lot more
than you think are going to say, “oh yeah, I do have that.” We’re going to start
with an anatomy review, we’ll talk about this very complex joint right here, and
all the muscles that surround it. Then we’ll get a client on the table and I’ll
show you some easy myofascial techniques that are very effective at reducing this
pain and the dysfunction, without a lot of digging or discomfort. If you’d like
to skip ahead to any section, please click on the timecodes down in the
description. So, first of all, what is this temporomandibular joint, this TMJ? Well,
let’s start by talking about the mandible. The mandible is your jaw right
here, and it goes up in this broad flat surface of bone called the ramus, and the ramus has tw upward projections. The more anterior projection slides under this
zygomatic arch here, this cheekbone, so it goes up under here and it makes contact
with the temporalis muscle. We’ll talk about that more in a second. You can feel this projection if you open
your jaw wide, which I don’t recommend if you’ve got jaw dysfunction yourself.
There it is. And that’s called the coronoid process. Posterior to that we’ve
got another projection upward of the ramus, this is called the condyle of the
mandible, and this is the one that makes contact with the temporal bone forming
that temporomandibular joint. Now this is both a hinging and gliding
joint, it’s a very mobile joint, and that’s one reason why it can get into
trouble. And, one reason why it’s so mobile is because it’s got an articular
disc in here. It’s this little disc of fibrocartilage that’s embedded within
the joint space, and it allows this joint to do all sorts of fun tricks, like protrusion and sliding from side to side. And this disc actually interfaces with of your muscles of mastication, the
lateral pterygoid muscle, and it can get pulled out of place, just during normal
movements of mastication (otherwise known as chewing), or while you are
unconsciously clenching your teeth or grinding your teeth, known as bruxism. Now,
our mission isn’t to fix this disc, it isn’t to shove this disc back where it belongs. It’s to reduce this high tension situation that’s happening across this
joint. And by doing that, that disc will start resuming its normal function. I
find that getting this high tension situation to calm down will do the work
for us. There’s nothing specific that we need to do to change this joint. The two
main muscles that we’re going to be worrying about today are the masseter, the
masseter is actually a two-headed muscle, we’re not going to worry about the
individual heads. It originates from this zygomatic arch, and it goes down onto
the entire ramus, and down to the angle of the mandible. So it’s a very broad
insertion. And it’s a very interesting and convoluted muscle. If you feel lumps
and bumps and taut bands across here, don’t assume that you found a trigger point,
this is just a very lumpy bumpy muscle. And we’ve also got the temporalis
muscle. The temporals has a very broad origin up here on the lateral skull,
it covers the temporal bone, and it’s in this temporal fossa. And the big broad
fan of this muscle, it narrows narrows narrows down into a tendon that passes
under that zygomatic arch and makes contact with that coronoid process. We’ve
also got pterygoid muscles which are less accessible, and that we’re going to
be worrying about a little bit less today. Some of them are most easily
accessed intraorally, so we would have to glove up and go into the oral cavity, and
I don’t tend to do those, I find that I can get a lot done just working
externally, and by working with all of this fascia that all these muscles are
embedded in, we can get everything to calm down, without having to focus too much on any one
individual muscle. By the way, in a past video, which you can see in the corner
there, I’ve shown you how to do a really neat self myofascial release technique
on your own lateral face and skull region, so if you’d like to feel what
we’re doing on the clients today on yourself, check out that other video. And I’ve got
my friend Rachael here. “Hi!” Alright, so let’s go back over the
anatomy her,e let’s find the zygomatic arch this is the origin of our masseter
muscle. Go find the angle of the mandible. That’s the bottommost portion as it goes
up into the ramus. And finally come up above that zygomatic arch and find that
temporal fossa, which extends much farther back than you might expect. So
I’m still in the region of temporalis here. And while temporalis does
attach to the skull, it also latches into this thick white
fascia of the scalp, so anything that you do with the scalp is going to affect
temporalis, and everything that attaches to that fascia, so, all the way
down. So, when i get someone in my office who has TMJ, I will start with the jaw,
just because I’m going to be working on the face and want to start with clean
hands, just so I don’t cause a breakout or anything like that. That’s no fun. And
also because having no oil on my hands allows me to go very slowly with this
first and second myofascial technique. So what we’re going to do, we’re
going to hook in at the bottom of the mandible, at the bottom of masseter. And
we’re going to be applying a few pounds of pressure inward, but mostly we’re
going to be applying that pressure upward. Up toward the top of their skull. So curve your fingers inward, press
in toward the mandible, and then drag up. And this is going to be a very slow
process. Depending on how broad your finger pads are, you may find that you can
fit three or four fingers into this move. You don’t want this to be sharp, you want
this to be a nice blunt instrument. And it might not really look like I’m moving,
but as the next few minutes pass, I am going to eventually make my way up all
the way to the top of the head. And this might be a good time to invite your
client to take some easy some breaths. So Rachael, some easy deep breaths, and if any
of this is ever too much, if it ever feels like any of this is pinching or
uncomfortable, or if you feel any sort of headache up in your temple region, let me
know, okay? Okay, so stay in good communication with your client. We’re not searching for trigger points
here, and we’re not really worrying about the underlying anatomy. So right now I’m
passing over the zygomatic arches, but i’m not letting up with my pressure. I’m
just cruising on superiorly. The reason I mentioned headaches in the
temples is because jaw pain and TMJ dysfunction are strongly correlated with
temporal headaches. If your client reports having headaches, ask them where
they are, if they say they’re up here, the sides of my head, ask about jaw pain. Even
if they don’t have any jaw dysfunction that they’re aware of, if they’ve got temporal headaches, I’m
definitely going to work with the jaw. Once again, try to keep this pressure
distributed across your fingers. I’m not pressing in too much with any one finger. And
this is fairly gentle, especially this first pass. And we’re covering the breadth of temporalis.
So start veering posteriorly as you get up into the temple region, so
that you can follow temporalis along. And then, as you get further and further
into the hairline, you can kind of forget about temporalis. Now we’re just
working with that thick white fascia that covers the skull. And going slowly with
this, we’re not trying to change the fascia here. We’re just creating some
fascial traction, which is going to have effects all the way down to the bottom
of the mandible, it’s going to have effects deep, working with those pterygoids,
without specifically targeting them. And now, for the second pass, we’re going to
do some recruitment on the part of the client. So Rachael, I’m going to do that
again. I’d like you to, just using a very tiny range of motion, and going very
slowly, I’d like you to open and close your jaw,
maybe half an inch or an inch. Your mouth might open just a little bit. And exaggerate
that just a little bit more, so that you’re opening your jaw just a bit more, perfect.
And just slowly open and close that. And notice how every time you open your
mouth, that causes my fingers to move. So you can control the pace of this
movement. And again, if this is ever too sharp, or if there’s ever any pain, please
let me know, okay? Thank you. And just some more easy deep breaths. So as your client opens and closes their
jaw, we’re doing a moving pin and stretch. We’ve got the masseter and all this
lateral face fascia pinned under our fingers, and they’re going to be pulling
the rug out from under us as they open their jaw. And every time that happens,
that will allow you to move up the face just a little bit further. This is going
to cause a bit of a different stimulus to this fascia, and to the muscles embedded
in it. They’re going to get some new information, and we’re going to check in
with the client about how their jaw feels after this. I’m betting it’ll take
just a little bit looser, I don’t mean to influence you unduly,
Rachael, but this tends to create a sensation of freedom and looseness in
the jaw. Something that can frequently happen with people who are suffering
from TMJ dysfunction is that they’ll just have this very high tone in their
masseter, and in their temporalis muscles, all the muscles of mastication. And it’s
unconscious. It stays like that all the time, their teeth will always be touching,
and there will always be pressure. Versus, after a good number of sessions, and
after having some discussions about maybe be mindful of their jaw position,
they can get to the point where there’s always a millimeter or two of space between
their upper and lower teeth. Their jaw can hang just a bit, instead of always
being so tight. And that’s a much lower stress situation for that TMJ. That disc won’t be under constant
pressure, and it won’t have that shear force as it glides, so over time that
locking that can happen, and that popping will either cease, or become less severe.
And Rachael you can go ahead and relax your jaw. Now, if your client were to
continue that motion, that would be fine. I just don’t want to make the massage
too annoying by making them do that for too long. And again come far up into the
hairline, much farther than you would think you would need to, because we’re
thinking myofascially: origin to insertion and beyond. Alright, and Rachael, just gently open
close your jaw, test it out, see if there is a different sensation there. Does that feel
different to you at all? “It does.” What are you feeling? “It feels, in general, a little more relaxed.”
Nice. Alright, so that’s what we’re going for. And I do like to give the client that
opportunity to get that kinesthetic sense of that change in their jaw, so
that they can feel what it’s like to have a low tone, low tension environment.
Suddenly things in this jaw region aren’t so crucial and
high-stress. From here, you can do some strokes downward. And Rachael, see if you
can allow your jaw to hang just a bit. And this can just be more to give them a
sense of what it’s like for that masseter to let go. And I’ve had my thumbs up here
in the frontal region, they’re not really doing anything, they’re just stabilizing
my hands. We can come up and kind of outline that zygomatic arch a bit. Tell
the story of their anatomy. Let them know how that masseter is shaped, let them know
how that zygomatic arch is shaped. And up into the temples, we can strum
across the fibers of temporalis, not trying to work out any knots or anything.
You’re going to feel some tight bands in here. Those aren’t trigger points, that’s just
how temporalis is shaped. It’s supposed to be stringy and twangy. And from here we can expand our scope a
bit. The SCM is tightly intertwined with all of this jaw and temporalis stuff.
The SCM inserts right here at this mastoid process, which is literally
millimeters away from the temporomandibular joint. So if there’s inflammation, if there’s
tendonitis, if there’s pain up here at this mastoid process, then that can be
affecting the TMJ. And I’ve often found that trigger points in the SCM can refer
up into the temples, so that’s definitely something to investigate. If you’d like
to see more about the SCM, check out that video that’s playing in the corner there.
And otherwise, just consider the entire neck shoulder head complex. If you can
get this high tension area to become less tense, then the jaw tends to follow.
If you’ve got a very high tension neck, upper back, chest area, then working with
the jaw can help in the other direction. These are tightly interwoven, they’re
related. So if I’ve got a jaw that’s dysfunctioning, i’m going to be working
in the neck and shoulders. If I got neck and shoulders that seem to
be in a very high tension situation, I will be interested in the jaw. So after
the massage, have a talk with your client about their jaw habits. A lot of people, I
find this very commonly, a lot of people with TMJ dysfunction will do things like
testing their jaw, they’ll pop it repeatedly through the day, because either they find
it to reduce the pain temporarily, or because they just feel compelled to. They
want to see, “oh, does my jaw still hurt? Yep, it does.” So they’ll be doing this you
know, 20, 30, a hundred times a day. So have a talk
with your client about stretching their jaw and testing their jaw. Let them know
that for the the next few weeks, you’d like them to be aware of when they are
doing these unnecessary jaw movements, and to try to reduce them as much as
possible, which will be difficult at first, because not popping their jaw is
going to be uncomfortable at first. Let them know that that sensation will pass,
just like when you don’t pop your knuckles for a while, that can be
uncomfortable at first, but eventually you stop feeling that. So encourage them
to stop purposely creating that sensation in their jaw, because that’s
displacing the disc, and it’s probably creating some inflammation. Next, stretching.
They probably don’t need to be opening their jaw to maximum width. There are a
lot of YouTube videos that are advocating jaw stretches for TMJ
dysfunction, but I tend to find that just by reducing this high tension situation,
we don’t need to be stretching those muscles out. And finally have a talk with
your clients about stuff like gum chewing. They can’t be chewing gum, not for
the next few weeks at least. Gum-chewing and other repetitive motion with the jaw
can definitely contribute to TMJ pain. Alright guys, that’s it for this week, let
me know if you have any suggestions, any routines of your own, anything that you
would change about this down in the comment section. Consider subscribing, and i’ll see you
next time! “Bye!”

67 Comments

Add a Comment

Your email address will not be published. Required fields are marked *