Beyond the Nightguard: How Physical Therapy Can Help TMJ Pain

The alarm clock rings waking you from sleep, you remove your nightguard, yawn, and instead of greeting the new day with excitement, you cringe and grab your jaw. Frustrated with the ongoing pain and soreness in your jaw, you wonder, “Why isn’t my nightguard working?”

jaw pain TMJ TMD physical therapy can helpSuffering from Temporomandibular disorder (TMD) or Temporomandibular Joint dysfunction (TMJ) can be frustrating. But what most people don’t realize is that it takes more than a mouth guard to address the underlying source of the dysfunction. That’s where physical therapy can help.

The Temporomandibular joint – the joint where your jaw and ear meet – can often be the site of pain and discomfort. Think of walking with one shoe on and one shoe off, eventually your back or hip will start to feel stress and irritated from the poor alignment of your joints. The same thing can happen with your bite when your teeth and jaw are not properly aligned. Typically, a mouth guard or bite guard, recommended by a dentist or orthodontist, is used to adjust the bite and jaw to a position that helps relieve some of the pain and discomfort associated with TMJ dysfunction. While a bite guard may provide some symptom relief, a physical therapist can help address the muscle imbalance and joint restrictions that can also contributing to tension at your jaw. This combination can typically help those who suffer from TMJ/TMD issues as well as headaches.


Imagine a stuck door hinge. The door can’t open fully if a hinge is “stuck” or not gliding correctly, nor can your jaw. It needs to glide properly to open and close. A manually trained physical therapist can evaluate your jaw and see how it is restricted. The joints in the upper cervical region (your neck) such as the atlas and axis vertebrae located just below your head, can get restricted from faulty postures or tight muscles. This can affect head, neck and jaw motions creating additional tension. Physical therapy for TMD/TMJ dysfunction includes manual joint mobility techniques to help the Temporomandibular move more easily. During your session your physical therapist will perform gentle muscle energy techniques or joint mobilizations to the neck to help restore proper motion to the vertebra. Soft tissue massage can also be performed, not only to the muscles along the neck and head, but also inside of the mouth. This helps to release tension in the muscles in your cheek near the TMJ.


upper cross lower crossThe saying goes “everything comes with strings attached” and it certainly applies to your jaw and neck. Certain muscles attach to the jaw to help you open and close it. The masseter, the pterygoids and temporalis muscles, among others, all must synchronize to help pull and navigate your jaw as it opens to talk, grind and chew throughout the day. Studies by Vladimir Janda, MD, show that muscle imbalances occur in the body can that affect the head and neck. Janda describes the upper cross syndrome where tightness of the upper trapezius and levator scapula (neck and shoulder muscles) occurs with tightness of the pectoral muscles (chest muscles). Weakness of the cervical flexors (anterior neck muscles) can be present along with weakness of the middle and lower trapezius located in your upper back near your shoulder blades.  This imbalance can create stress to your joints in the neck, and upper back and shoulders. This can all play a role with your posture and the way your jaw sits, opens, closes and the tension in the muscles that attach to your jaw.


Tongue position can play a role in your jaw pain. It is recommended that you rest your tongue up on the roof of your mouth as if saying “NO” or making a “clucking “sounds.  When your tongue is resting at the bottom jaw level you typically rest with the mouth open and this can “weigh your jaw down” and create tension of the muscles that attach to your jaw. Your physical therapist can teach you tricks to good posture and special exercises to perform gently with your mouth to help stretch tighten muscles and strengthen and stabilize that region fostering proper motion.


Practicing stress relief techniques, avoiding difficult to chew foods in your diet and scheduling an evaluation by a physical therapist and dentist can help you address this painful situation. A physical therapist can play an integral part of your TMD/TMJ dysfunction rehabilitation by evaluating your posture and joint mobility. They will also work with you to develop a stretching and strengthening program to help establish a more neutral posture and alleviate stress at the jaw and neck joints.


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Image of man with jaw pain by artur84

AmyMcGorry Physical TherapistAmy McGorry, PT, DPT MTC, Received her Bachelor’s of Science in physical therapy from SUNY Stony Brook in 1991 and earned her doctoral degree in physical therapy from the University of St. Augustine in 2011. In 2005 Amy, completed an advanced certification in Orthopedic Manual Joint Manipulation from the University of St. Augustine. In addition to her clinical skills, Dr. McGorry is a freelance news reporter for Channel 12 and contributes medical articles, short videos and slideshows to health and wellness websites.