Temporomandibular Joint (TMJ) Pain – Physiotherapy Management

This leaflet will provide you with guidance on the management of TMJ pain.

What is the TMJ?

The temporomandibular joint or TMJ is commonly known as your jaw. As with any joint, it can become irritable as a result of injury, growth disorders, poor habits/posture, or inflammatory diseases.

The joint is comprised of two main parts: the socket (called the temporal bone) and the lower jaw (the mandible). Between these in an intra-articular disc which helps to articulate the joint smoothly, held in place with various muscles and ligaments.

What are the signs and symptoms of TMJ pain?
Mostly commonly, people will experience pain in and around the jaw region and surrounding musculature, however other symptoms may include:

• Headaches & dizziness
• Clicking / grinding / locking of the jaw
• Struggling with opening and closing the mouth comfortably
• Discomfort with chewing (worse with hard food), yawning & sometimes even talking
• Hearing loss, ear pain or tinnitus (ringing in the ears)

What causes TMJ pain?
Symptoms will often originate from a combination of the following reasons:

• Trauma – e.g. a blow to the jaw / to the TMJ itself
• Overactive jaw muscles – e.g. people who regularly grind or clench their teeth
• Arthritic changes
• Increased pain sensitivity, sometimes attributed to stress

What are the aims of physiotherapy?

• Relieve pain
• Reduce stiffness
• Regain normal mobility where possible and restore function
• Learn how to make it easier to help yourself

Advice

• Try using heat or ice packs regularly over the site of discomfort for no longer than 10-15 minutes, with a towel placed between the source of the heat / ice and your skin to protect it. Discuss with your physiotherapist or doctor if you are unsure how best to do this safely, to avoid any burns to the skin. This is not advisable if you suffer from any facial numbness, sensory or circulation issues.
• Massage the musculature surrounding the joint
• Take regular painkillers – discuss with your GP if unsure what to take

DOs:

• Complete your physiotherapy exercises regularly as advised
• Cut chewy and tough foods into smaller chunks
• Try and avoid clenching and grinding your teeth where possible – consider consulting your dentist for further advice on this
• Substitute harder/chewy foods for softer foods if able

DON’Ts:

• Avoid chewing more than you have to (e.g. biting nails, chewing gum etc.) as this prevents your jaw from having periods of rest
• Try not to open your jaw/mouth excessively wide (e.g. when yawning)
• Avoid holding a mobile/telephone between your shoulder and ear
• Sleep on your front/face down (as this puts excess strain on the neck)
• Try and avoid hard/crunchy/chewy foods where possible (e.g. apples, steak, corn on the cob, chewy toffee sweets)

Postural Considerations
Sitting or lying in poor positions for sustained periods of time can cause over-stretching of the ligaments and tissues at the jaw, or strain your neck. Being aware of postural advice can help to avoid over-stressing structures which may contribute to your TMJ or neck symptoms. Ask your physiotherapist for further guidance on this.

Exercises
Try the below exercises along with any other guidance provided by your physiotherapist:

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you. 

Feedback
Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: [email protected]

Opening times:
The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day.

If you are unable to understand this leaflet, please communicate with a member of staff.  

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