Jaw Pain & Dysfunction

TMJ issues can be caused by:

• Jaw clenching or teeth grinding (bruxism)
• Stress and muscle tension
• Trauma or injury to the jaw
• Poor posture (especially of the neck and upper back)
• Arthritis or joint degeneration
• Dental misalignment

There are some cases where we don't know the root cause.  But physiotherapy can still treat your TMJ symptoms in those cases.

Not at our clinic - you can come straight to us for a physiotherapy assessment. That said, we often receive referrals from dentists, which does help us better understand your history, communicate with your dentist, and work with them as needed. It can be helpful for your care, but is not necessary.

With respect to referrals, however, consider any restrictions from the insurance company covering your physiotherapy.  Some insurance companies may have restrictions, such as requiring a referral. Read more here: our tips for getting the most out of your health insurance.

It really depends on your unique condition and the root cause of your TMJ issues. 

For example, if you have jaw clicking and mild pain due to muscle spasm or tightness, then yes, this can sometimes resolve with resting and reducing stress.  If you have jaw clicking from bruxism (grinding), unless you address what's causing your bruxism, it's doubtful your symptoms will resolve on their own. 

Regardless, if you're not sure what that means for you and your condition, our physiotherapists can diagnose the root of your condition, prescribe a customized treatment plan, and reassure you when needed.  You don't have to deal with this alone.

Only with your consent.

As part of a physiotherapy assessment, there may be some information the physiotherapist needs to get from touching (palpating) the muscles around your jaw - both inside and outside your mouth.  If they do need to touch muscles in the inside of their mouth, they'll get your consent first. And you can remove your consent at any time.

All our physiotherapists wear medical gloves with any in-mouth assessment or treatment, and we're trained in infection prevention and control measures standard for health professionals in Manitoba.

With a painful TMJ condition, we recommend you eat softer food.  Like any injured joint in your body, the first approach is to avoid overloading it. Avoid eating hard food that requires heavy pressure to chew it.  For example, ice, steak, and sandwich wraps are amongst the worst in this category.

We recommend you avoid chewing gum.  Chewing gum applies a constant workload on your jaw.  Chewing gum with TMJ pain is like running a marathon when you have knee pain.

In general, we recommend you limit your jaw movement as you rehabilitate.

If you need to yawn, control how wide you open your mouth. Pushing your tongue to the roof of your mouth is one way to repress your yawn, or reduce their size.

Someone with TMJ dysfunction should stay away from playing musical instruments that require you to hold a certain jaw position for an extended period of time.

That said, our goal is your goal. So if blowing into your musical instrument is one of your goals for physiotherapy, we'll do everything we can to guide you there quickly. 

We recommend you breathe through your nose whenever you can, plus use your diaphragm to breathe. 

Mouth breathing may be necessary at times, such as for intense exercise when you can't get enough oxygen through your nose. But when you're at rest, do your best to breathe through your nose.

Breathing with your diaphragm means a deep breath that naturally expands the large muscle at the base of your lungs. Here's an exercise to tell if you're doing it right i.e. diaphragmatic breathing:

• Lie down or set in a restful position.
• Put your hand on your mid-section - over top of your belly button. 
• Put your other hand on the front of your chest.
• Breathe in through your nose.
• Observe: Which hand moves? If your breath naturally pushes out the hand over your belly button, you're expanding your diaphragm and successfully doing diaphragmatic breathing. If your breath makes your chest move up, relax and try again.

Great question - teaching you how to relax your jaw is often a part of our physiotherapy treatment plans. 

Above is a simple diagram of your jaw, from the side. You know your jaw is relaxed when your tongue is up and your teeth are apart.  This should be your modus operandi at all times, except when you're chewing or talking.  

"Tongue up" means your tongue is just barely touching the backside of your top front teeth. Your tongue should feel like it's floating in this position - your tongue should not be pressing upward or forward.

"Teeth are apart" means your back teeth are apart, not just your front teeth. Your jaw can still be tense with just your teeth apart, so be aware of keeping your jaw relaxed as your practice this.

We recommend you practice this any time, but especially when you're under stress or feeling an increase in your jaw pain.

Your physiotherapist will teach you exercises to do at home, that are designed to help your unique TMJ condition.  These could include jaw muscle relaxation exercises, jaw muscle strengthening exercises, or exercises to improve how smoothly your jaw opens and closes. 

Your physiotherapist may also recommend drug-free pain relief techniques, such as applying moist heat to your aggravated muscles, or a moist ice pack.  Both can relieve pain, and heat can increase your range of movement.

We have both physiotherapists and massage therapists who have completed advanced training in treating TMJ conditions. If you're confident your TMJ issue only needs massage, book straight with one of our Registered Massage Therapists. Having spent their entire training and certification focusing on massage techniques, they have a wide range of massage skills to help you.

But if you're not sure, we recommend you see one of our physiotherapists for a full TMJ assessment. They'll analyze your symptoms and your history, and they'll assess your neck, headaches, and all the structures involved in your jaw movement. They'll recommend a comprehensive TMJ treatment plan, customized to you.

Plus, our physiotherapists will refer you to a massage therapist if that's what's best for you.