The Story of Sally

Temporomandibular Joint Disorder (or TMJ) is no laughing matter. It certainly wasn’t for one teenager, who came to see me this year suffering from headaches and chronic pain in her jaw.

By the time she came to my office, Sally was 15 years old. She had been suffering from TMJ for three years. Her jaws popped and made harsh grinding sounds when she chewed. She felt a terrible searing ache from her chin to her cheek and sometimes experienced blinding headaches.

Three years earlier, in response to the pain (and on the advice of her dentist and orthodontist), she stopped chewing gum and started wearing a guard at night to minimize tooth grinding.

The pain subsided after making those adjustments, but then inexplicably returned – this time with a vengeance. The pain was so intense Sally’s father reported, “She had problems concentrating, would cry herself to sleep, and stopped eating.”

Sally’s parents took her to see an oral surgeon, who specialized in TMJ and was put on anti-inflammatory meds and muscle relaxers. She was put on a diet that consisted of soft foods only. She was even given Botox shots to reduce the pain.

In each case, after an initial honeymoon-phase in which the throbbing would become bearable, the pain would return often with multiplied intensity.

The Incredible Moving Pain of TMJ: Now You Feel It. Now You Don’t.
Why did the pain in Sally’s head, neck, mouth and jaw subside with each of those traditional medical and dental treatments -- only to return with greater force later?

The answer lies in the nature of TMJ itself.

Like many causes of chronic pain, TMJ is not a single disorder. It is a series of dysfunctions in the body, that can be triggered by still more events.

In other words, TMJ is like one of those complex, interrelated works of “Domino Art”. The trigger can come from the left or right, top or bottom, inside or outside. And each string has

the potential to touch several other strings – triggering a cascade of tipping, falling, painful dominos.

In the case of TMJ, the muscle spasms cause tension, torsion and imbalances that affect the way the sufferer holds her mouth, chews her food and even talks. One side of the mouth may become tonic (or tense) and over-muscled as the patient chews her food on the same side of her mouth day after day, meal after meal.

The other side becomes weak and atrophied.

Eventually, the lopsided musculature pushes the angle of chewing further and further into unnatural angles. . .

• Pinching nerves
• Triggering more tension
• Creating overcompensation in related muscles and in tendons of the neck and cranium.

Over time, the imbalances spread and pain grows in intensity and regularity.

TMJ can be triggered by. . . .

• Acute Trauma – Falling or being hit in the mouth can impact proper alignment, and if not treated can alter overall tracking of the mouth
• Oral Health Disorders – cavities, advanced periodontal disease, loose teeth  and mouth ulcers are just some of the oral health disorders that can cause a patient to begin chewing, talking and holding their mouth in unnatural positions
• Stress – many people grind and chew their teeth while sleeping in response to stress that has built up during the day
• Genetics – often people who are strongly left handed or right handed are also left-side or right-side chewers.

Treating Pain Points

In many cases, dentists, oral surgeons and general practitioners are able to treat TMJ. However, when the pain becomes chronic and returns again and again, it is highly likely there is soft tissue injury (muscle, tendon, and fascia) to the chest, neck, head and face. For that, the patient requires supplemental treatment designed to address imbalances, torsion points, and irregular tracking of the jaw and chronic pain.

The Goal of Structural Bodywork

The goal of Structural Bodywork is to get to the root of the patient’s pain and suffering.  My goal in treating patients with TMJ is to look beyond the immediate pain and contracted muscles, and to consider the entire, connected, interrelated structure, so I can create a better-functioning structure, overall.  So before I begin treatment, I spend time up front interviewing my client to understand what events led up to their very individual case of TMJ. Once I understand the source of the disorder, I can begin unwrapping the layers of imbalance, pain and adhesion that have built one upon the other.

How Sally’s TMJ was Treated with Structural Bodywork

For Sally, treatment began on the face and cranium with the goal of releasing the external patterns of tension that are often so unconscious among TMJ sufferers. After a noticeable release of tensions was achieved with the ‘outer’ layers, I then moved inside the jaw to work on the critical that impact the mechanics of the jaw and mouth. I released spasming in her masseter (chewing muscles). Then I turned my attention to her pterygoids (the muscles above her molars) that had become tense and tight causing her jaw to track unevenly and making it difficult for her to open her mouth. I went on to stretch and reposition strained, weakened and over-developed muscles on one side of her face and along her cranium (temporalis).

In addition, to address secondary and contributing factors to strain patterns in the face and cranium, I worked to release tensioned muscles at the base of her cranium (sub-occipitals), which often contribute to headache patterns.   

Following that initial treatment, Sally is now fully-functioning, pain free. . .
These are the results of Sally’s treatment, in her father’s words:

During that first session, Joe was able to have her open her jaw fully without discomfort.The pain literally went away overnight.  After two months of treatment, we discontinued use of anti-inflammatories and muscle relaxants and eased her back into a normal diet (still minus the gum and other similarly chewy foods). 

Now, five months later, our daughter’s severe jaw pain is a distant memory.  She does daily stretching exercises and sees Joe every six weeks.  There are occasional episodes of jaw pain, which can be associated with some stressful event; however, the pain is quickly relieved using the exercises that Joe provided.  

*The patient’s name has been changed to protect her privacy.

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