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Aches and Pains Above the Neck? It could be TMD

Category: Patient Stories
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Michael Cheslak, PT, DPT, OCS, examines a patient's jaw for TMD.Published in Duluthian Magazine, January-February 2019 Issue

Headaches, ear pain, neck pain and even vertigo can all become a problem when the jaw is not functioning properly. Designed to act like a hinge, the jaw is connected to the skull on either side by the temporomandibular joints (TMJs), creating one of the most complex systems of joints and muscles in the body. These small joints are located in front of each ear and are only about the size of a fingertip. However, when they don’t function as they should, these little joints can create big problems.

TMD Symptoms

Issues with the TMJs and the associated muscles that control them are known as temporomandibular disorders (TMD). While over 33% of the US population experiences at least one TMD-related symptom, only 5% seeks treatment. The most common symptoms are pain or fatigue in the cheeks or temples. This may be accompanied by tightness or difficulty opening the mouth fully. For some, clicking or popping of the TMJs can develop. In more advanced cases, the TMJs may lock or catch, painfully inhibiting jaw function.

Types and Causes

There are three main categories of TMD: myofascial pain, internal derangement of the joint, and degenerative joint disease.

Myofascial pain is the most common type of TMD. This includes discomfort or pain in the muscles that control the jaw as well as neck and shoulder muscles. Many habits can contribute to this kind of TMD such as teeth clenching, teeth grinding, and lip, cheek or nail biting. Other factors may include poor sleeping or sitting postures.

TMD resulting from internal derangement of the joint refers to a dislocation of one of the joints, displaced disc or another injury. In some cases, TMD can be the result of trauma, or extended mouth opening associated with dental procedures or intubation during surgery.

Degenerative joint disease may also be contributing to symptoms of TMD, including osteoarthritis or rheumatoid arthritis in the jaw joint.

The Solution

The good news is that noninvasive treatment is available. Pain and other TMD symptoms may be significantly reduced with physical therapy. Before receiving physical therapy, a comprehensive evaluation by a physical therapist is needed. For the best care possible, talk to your primary care provider about finding a physical therapist with special training and education in the treatment of TMD.

Following the initial evaluation, the physical therapist will create a personalized treatment plan. The suggested number of physical therapy sessions in the plan will vary according to each individual. This treatment plan will address any habits or factors that can be changed, as well as techniques to help stretch and strengthen the muscles involved. Most often, this treatment plan will include education and practical instruction on postural correction. Prolonged posture in certain positions can put a great amount of stress on the muscles involved in TMD, and changing this can be extremely helpful.

Improper sleeping positions can contribute to TMD as well. For example, sleeping on the stomach puts significant stress on the TMJs, neck and shoulders and should be avoided. The physical therapist can suggest ways to adopt more appropriate sleeping positions that put less stress on these areas.

Manual therapy can be included in the treatment plan to address pain, muscle tightness or joint restrictions. This could include massage, soft tissue mobilization techniques, manual stretching or special techniques designed to improve joint mobility.

Finally, the physical therapist may develop an exercise program to help with muscle relaxation, stretching, strengthening or re-education. Learning and sticking to an exercise program that contains these elements will help a person continue to make progress even when formal therapy has concluded.

If you think you may be experiencing the symptoms of TMD and could benefit from physical therapy, contact your primary care provider for a referral. To establish care with a St. Luke’s primary care provider, call 218.249.4000 or visit