Our temporomandibular joint is one area of our bodies that we often overlook but is used more often than we realize. These joints exist along the jaw and connect directly to the skull, and work at every moment we are talking, chewing our food, drinking water, kissing, singing, yawning, or swallowing (1,4). It is a hinge joint that is immediately in front of our ear on both sides of the face and is the most used joint in our entire body (4).

Temporomandibular joint dysfunctions are dysfunctions in the jaw that can cause significant amounts of pain. These disorders and symptoms may arrive without any specific injury or event and can arrive gradually (6). Some people experience TMJ symptoms for a short period of time and then it goes away, while others may experience chronic TMJ instability and pain throughout their life (7). This joint is so prominent and complex in our head that a dysfunction to the area can truly cause issues with an individual’s quality of life. The American Dental Association explains that the joint provides a type of cushion while the jaw moves (3). If misalignment occurs in the joint’s system, the area will experience a flare up in pain, stiffness, and discomfort (3). Evidently, about 12% of the population, or as much as 10 million individuals, experiences TMJ disorders, with women more predominantly affected over men (3.9).

TMJ disorders and weaknesses can occur when the joints and muscles in the jaw experience an issue – such as injury, inflammation, or overuse (1). The disorders can occur from dental surgery, an infection, autoimmune system diseases, displacement of the articular disc, breathing tubes for surgery, arthritis, consistent clenching/grinding, stress to the joint, muscle spasms, and any trauma to the jaw (3,6). Some TMJ disorders can be caused from hormonal, genetic, or even environmental factors (3). For example, some violinists have developed TMJ due to the constant pressure and positioning of the instrument right underneath the jaw (3). These kinds of disorders present a number of painful or difficult symptoms like pain or tenderness in the face/ear/neck/jaw, clicking/locking/grating or popping in the jaw while opening or closing, buzzing/ringing in the ear, numbness, neck and back aches, earaches, limited mobility, dizziness, headaches, intense migraines, and pain while talking or chewing (1,2,3.4).

TMJ exercises can help alleviate pain by working to heal the jaw, relax the muscles, reduce clicking and locking, increase the jaw’s range of movement, and strengthen the muscles (1). According to the Journal of Dental Research, a study found that consistent TMJ exercises were able to increase the mobility of the mouth and jaw more than using a device such as a mouth guard (1).

Exercises To Do At Home

A physical therapist can help in planning a weekly routine of therapeutic exercises, while also adding modalities to reduce pain and tension. Here's a list of examples.

Relax Jaw (1)

For this exercise, rest your tongue at the roof of your mouth and then allow your teeth to slightly come apart. The lower jaw should drop slightly. Then, simply relax the muscles in the jaw.

Goldish – Half (1)

Place your tongue on the roof of your mouth. Place one finger near your ear where you experience the discomfort, and then use the finger of your other hand on your chin. Next, simply drop your jaw about halfway and then go back to close. Perform 6-10 times a day.

Goldfish – Full

Same as the above but a wider open. Place your tongue on the roof of your mouth. Place one finger of one hand near your ear where you experience the discomfort, and then use the finger of your other hand on your chin. Then, simply drop your jaw FULLY and then back to close. Perform 6-10 times a day.

Chin tucks

Keep your shoulders positioned slightly back to prevent hunching in this exercise. Pull your chin straight backwards, until your neck has a bit of a “double chin” appearance. Make sure this is a gentle pull of the chin backward and not full tense. Hold the position for a few seconds and then move back to start, repeating 6-10 times a day.

Resisted open (1)

Put your thumb right underneath your chin, or simply make a fist with your hand and rest your hand under the chin. Open your mouth slowly, using the thumb or hand under the chin as a form of resistance to the muscles trying to open the mouth. Hold for a few seconds on the open, then go back to rest. Repeat 6-10 times a day.

Resisted close (1)

Place your index finger and thumb on the chin and squeeze it gently, essentially placing the chin in the gap of space between the two fingers. Then, work on closing the mouth as you maintain the squeeze/hold on the chin. The hold acts as a form of resistance while you close the muscle. This will immensely help individuals who experience pain while chewing, as it strengthens those muscles (1). Repeat 6-10 times a day.

Tongue upward

Place your tongue on the roof of your mouth while it is closed. Then open your mouth, separating the teeth, and stretching the tongue as it continues to touch the roof of the mouth. Repeat 6-10 times a day.

Tongue movement (2)

Open your mouth fully, then place your tongue on the roof of the mouth, then slightly move the tip of the tongue back toward the back of your mouth near the tonsils (2). Then, use the tongue to push and apply pressure toward the roof and hold. Then, move the tongue straight out of the mouth as far as you can and hold again. Repeat this 6-10 times a day.

Side to side

Place a small object in between your teeth, such as a tongue depressor and slowly move your jaw side to side while maintaining the pinch of the object between the front teeth (1). Perform 6-10 times a day. You can slowly increase the thickness of the object between the teeth as your muscles get stronger.

Forward jaw

Put an object, like a tongue depressor in between the front teeth. Move your bottom jaw forward slightly, which would make your bottom teeth appear slightly in front of the top row of teeth (1). Increase the thickness of the object as the muscles get stronger.

Open wide (2)

Open your mouth as wide as possible, without causing discomfort or pain. Then place a hand on one side of the jaw and apply gentle pressure. Your jaw may move slightly to one side but continue with the movement as gentle pressure is applied. Hold this position and then repeat on the other side.

Oxford University Hospital Exercise (3)

Close your mouth and let the teeth touch, but do not clench. Place your tongue right behind the upper, front teeth. Then, run the tongue back until it is near the tonsils. Then, open your mouth until the tongue slightly pulls away from the roof of the mouth. Hold that position for a few seconds.

Wiggle

Similar to the side to side, just don’t use an object! Let your teeth fall slightly apart, and gently move the jaw side to side without going too far outward (8). The point of this exercise is to use a gentle stretch of the jaw muscles side to side.

Massage

Use your fingers to apply gentle, slow, circular movements to the entire jaw, and the hinge to the skull, where you experience pain or discomfort. You can also apply heat compresses before and after the massage treatment to help blood flow and reduce inflammation.

Physical Therapy

The first meetings with a physical therapist will be an assessment period to look at your specific TMJ pain, tenderness, immobility, and more. They will ask you questions about your daily activities, eating habits, previous injuries, previous treatments (and whether they benefited or not) and more. In addition, the physical therapy will evaluate your posture, your neck and shoulder range of motion, jaw mobility, the structures in the face and skull that surround the jaw, and the strength of the muscles in these areas (6).

A physical therapist will be able to assign the exercises above, and many others, by organizing a weekly routine that is unique to your specific concerns and pain. The weekly workouts and routine can also include relaxation techniques and flexibility exercises to improve mobility and reduce tension (5). All of the exercises will work to strengthen the jaw muscles, increase jaw mobility, improve blood flow, reduce swelling and inflammation, reduce pain, reduce tension, and more (5). If you opt to do surgery for TMJ, physical therapy is vital in reducing muscle tightness and scar tissue formation (5).

Along with weekly exercises, a physical therapy will utilize other modalities and devices to benefit the patient if they experience pain or inflammation, such as (4):

• Hot and cold modalities
  • heat to relax muscles, improve circulation, reduce pain and spasms
  • cold to decrease inflammation and pain
• Soft tissue mobilization
• Massage
• Ultrasound - Ultrasound utilizes a high-frequency sound waves at the joint to improve circulation and reduce pain swelling (5)
• Manual therapy
• Electrostimulation - TENS (Transcutaneous electrical nerve stimulation) applies an electrical current to the skin near the jaw joint, which relaxes the muscles, relieves pain, and improves circulation (5)
• TMD Joint Mobilizations (6) – the PT may use their thumb or fingers in your mouth to mobilize the jaw and improve its range of motion, especially if you displaced the disc

A physical therapist will also focus on education. They can teach you how to engage in self-care techniques at home when flare ups arrive. A PT will also educate on posture to make sure your posture is not contributing to the pain and tension in the jaw, especially due to the fact that the spine influences the TM joints (4).

Other Measures

If you want more symptom management beyond the exercises listed above, you can try:

• Warm compress against the TMJ side
• Ice, with a wrap over the ice, for only about 10-15 minutes at a time
• Stress relief behaviors and tools to reduce tension – such as meditation
• Mouth guards to not only align the jaw properly but also prevent grating and grinding of the teeth
• Improve posture (1,7) – ergonomic chairs, sit upright
• Avoid harsh and repetitive chewing behaviors, like nail biting, lip biting, or chewing gum
• Eat a softer diet
• Limit major movements of the jaw, like wide mouth singing
• Keeping the teeth slightly apart more often to reduce pressure
• Avoid resting your chin on your hand
• Get a good night of sleep – try sleeping on your back and support your neck (7)

Oral Hygiene

Maintaining oral hygiene may be difficult, especially if you experience pain or locking when trying to open the mouth to do basic dental activities. The TMJ Association recommends these tips to alleviate pain or discomfort during dental hygiene practices (1):

• Try an electric/sonic toothbrush, or one with softer bristles
• Use an antiseptic mouthwash to get rid of bacteria that may be missed
• Use ice and heat compresses before and after any dental appointment/procedure (1)
• Consider using a water flosser if you have difficulty opening your mouth to floss properly, especially on the hard to reach back molars

**NOTE**: For TMJ, surgery should only be considered a very last resort after all options have been exhausted. Surgery can be extremely risky and cause more complications than necessary.

By Ashley Gresko

Blog Editing Consultant for Health Industry Designs

References

1) https://www.healthline.com/health/tmj-exercises#:~:text=Keeping%20your%20tongue%20on%20the,times%20to%20complete%20one%20set

2) https://www.jagonept.com/5-tmj-exercises-for-jaw-pain-relief/

3) https://www.medicalnewstoday.com/articles/exercises-for-tmj-pain#causes-of-tmj-pain

4) https://www.atipt.com/blog/physical-therapy-for-jaw-problems

5) https://www.uofmhealth.org/health-library/hw209438

6) https://www.verywellhealth.com/physical-therapy-for-tmd-4582449

7) https://www.pennmedicine.org/updates/blogs/health-and-wellness/2020/september/tmj-pain-relief-8-best-practices-to-help-manage-tmd

8) https://biaphysicaltherapy.com/2017/05/09/can-physical-therapist-help-jaw-pain/

9) https://www.inmotionoc.com/ailments-we-treat/headneck/tmj-physical-therapy/

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