The alignment of the TMJ complex is a key structure involved and responsible for maintaining the health and resilient of the soft tissue support. All TMJ muscles have their origin attachment in the jaw region and inserted point on the temporal bone, neck, and shoulder. Their corresponding tendons are used as powerful leverages to aid on the required movement. Therefore, when the TMJ complex is misaligned, this lack of mobility of the joint, makes the muscle support system having to compensate and contract harder in attempt to maintain the overall movement which eventually overload the muscle support system leading to the appearances of muscle and tendon injuries. Spinal dysfunctions may also contribute to the to the development of myofascial pain as per the increase neurological input to the muscles as seen in spastic muscles.

TMJ tendinopathies can be extremely painful as per the concentration of nerve receptors accumulated on the tendon. Generally, patients report chewing and mouth opening issues and localised sharp pain in the tendon and muscle evolving to possible referred patterns of pain patterns spreading towards the head, neck and shoulders.

Common muscles involved in TMJ myofascial pain syndromes

Temporalis, is a muscle that contribute on mouth closure, increase tension and trigger point activities generally cause pain in the TMJ and temporal and frontal headaches.

Masseter is the most powerful muscle in the body, hypertonicity in this muscle cause significant mouth stiffness and jaw pain as well as the inability to fully open the mouth.

Pterygoids are a collection of small muscles located inside of the mouth that contributes to either mouth opening and closure as well as controlling the side to side movement of the jaw. Dysfunction pterygoids, may cause issues with end range mouth opening predisposing to malocclusion syndromes.

Bruxism is a condition that refers to uncontrollable teeth grinding or jaw clenching. There are several predisposing factors responsible for this disorder, myofascial syndromes is a common cause for the development of this condition.

Assessment

Clinical assessment to identify the key joint dysfunctions of the jaw and the associated muscles compromised.

X-ray

Anterior – Posterior (AP) X-ray cervical/Jaw view is essential to check the patterns of TMJ misalignment

MRI

Locate the exact injury point; Allows the treatment to be more specific during the application of the treatment modalities, in addition aids to identify the type of tendinopathy (tendinitis or tendinosis) and the corresponding appropriate treatment care.

Identify the extent of tissue damage and the presence of scar tissue; Provides valuable information regarding prognosis and the application of friction soft tissue modalities to aid on scar tissue removal.

Treatment protocol

Specific jaw adjustments followed by a rehabilitation regime to strengthen the entire soft tissue support of the jaw

Muscles soft tissue techniques

Application of Low-level Laser and PEMF to aid on the cellular level of heling as well as improving the microcirculation for the area.

Friction soft tissue therapy helps to reduce dysfunctional scar tissue

Dry needling may be used to improve local blood flow and to reduce the deep muscle tension.

Specific selected essential oil application to enhance healing

Depending on level of misalignment and chronicity a minimum of 6 weeks up to 12 weeks of treatment care may be necessary to resolve this deformity.