The TMJ or (temporomadibular joints) are the most frequently used joints in the body. It is composed of the temporal bone, articular disc and the mandible. It is a synovial, condylar and hinge type joint with fibrocartilaginous surfaces rather than hyaline cartilage. The joint is divided into 2 cavities by the disc. During opening, closing, protrusion and retrusion the convex condyle of the mandible moves across the convex surface of the temporal eminence with the disc acting as a cushion. There are also ligaments that help protect the joint and muscles that move the TMJ including the masseter, temporalis and pterygoids. It is innervated by branches of the auriculotemporal and masseteric branches of the temporal nerve.
Although pains in the TMJ area are usually dental, just like any other joint they can be musculoskeletal as well. Some of the causes of TMJ disorders can be:
- Disc displacement: the disc can sublux or dislocate causing painful clicking, popping or locking
- Arthritis: both osteo from overuse or trauma and rheumatoid due to autoimmune reasons can affect the joint
- Muscular: repetitive overuse such as during bruxism can cause muscle imbalances and postural changes that affects the forces on the disc and joint surfaces resulting in pain
- Other trauma such as major dental work like wisdom tooth extraction or sustained positions of the TMJ during procedures can initiate irritation and cause pain.
Other symptoms that often accompany TMJ disorders are headache, neck pain and shoulder pain due to its nerve supply.
At Recovery Physical Therapy (RPT), we believe that treatment of TMJ disorders is most effective when utilizing a team approach involving use of a mouth appliance, fabricated by a specialized dental practitioner, and physical therapy from a TMJ specialist. Wearing of the mouth appliance will put the TMJ in a better resting position and reduce stresses on the joint, discs and muscles. Physical therapy with a TMJ specialist involves a full musculoskeletal evaluation. Treatment includes specific postural reeducation of the facial and neck muscles to restore their normal function. Manual therapy is also used to stretch and release tight muscles and myofascial tissue as well as mobilization of stiff joint capsules and ligaments to increase motion. At RPT we know that specific instruction on the proper exercises and ergonomic education to prevent further problems is also integral to a successful treatment program.
Photos of TMJ (Temporomandibular Joint) Disorders at Recovery PT (click to enlarge)
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