TMJ/TMD

Temporomandibular Joint Disorder (TMD) is a complex group of muscle and articular (joint) disorders that affect the temporomandibular joint (TMJ) and can lead to pain, dysfunction and eventual degeneration. Most causes of TMD are either muscular or articular, with muscular being the most common. (1) These can arise from muscular hypertonicity, trigger points, fascial restrictions and/or functional muscle imbalances of the muscles surrounding the TMJ. However, other causes of muscular TMD are grinding your teeth, clenching, cervicocranial dysfunction, postural syndromes typically involving a forward head posture and trauma. (2-5) Articular disorders of TMD usually involve disc displacement and osteoarthritis. 


Individuals with TMD typically have clicking, restricted opening, locking and/or pain. These symptoms are often made worse with chewing. The pain is described as an ache that is just in front of the ear but can refer to other areas of the face, head, neck or shoulders. Many times headaches will be present as well. 


Conservative treatment is very effective for TMD. It will typically consist of three points: manual therapy, exercise and avoidance of aggravating activities. Manual therapy will be aimed at issues of the chewing muscles, neck and upper torso. Mobilization of the TMJ can also be beneficial. Exercises will be done to address tight muscles while also performing postural corrections. (6-8) During the treatment plan, patients typically should avoid chewing gum, eating rubbery or excessively hard foods that require a lot of bite force. A dentist may also be consulted for a bite guard. 


  1. Fricton JR: Temporomandibular muscle and joint disorders. Pain 2004; 109:530.

  2. Cantanzariti J, Debuse T, Duquesnoy B: Chronic neck pain and masticatory dysfunction. Joint Bone Spine 2005; 72:515-519.

  3. Palazzi C, Miralles R, Soto MA, Santander H, Zuaiga C, Moya H: Body position effects on EMG activity of the sternocleidomastoid and masseter muscles in patients with myogenic-craniocervical-mandibular dysfunction. J Craniomandib Practice 1996: 14(3):200-9

  4. Gonzalez H, Mann A. Forward Head Posture: Its Structural and Functional Influence on the Stomatognathic System: A Conceptual Study. Cranio. 1996 Jan;14(1):71-80.

  5. Yun PL, Kim YK: The role of facial trauma as a possible etiologic factor in temporomandibular joint disorder. J Oral Maxil Surg 2005; 63(11):1576-1583.

  6. Furto ES, Cleland JA, Whitman JM, Olson KA. Manual physical therapy interventions and exercise for patients with temporomandibular disorders. Cranio. 2006;24:283–291.

  7. Nicolakis P, Burak EC, Kollmitzer J, et al. An investigation of the effectiveness of exercise and manual therapy in treating symptoms of TMJ osteoarthritis. Cranio. 2001;19:26–32.

  8. 18. Gavish A, Winocur E, Astandzelov-Nachmias T, Gazit E. Effect of controlled masticatory exercise on pain and muscle performance in myofascial pain patients: A pilot Study. Cranio 2006 Jul;24(3) 184-90