Temporomandibular Joint Disorder or TMJ or Bruxism or Teeth Grinding or Clenching

Ever wake in the morning with sore teeth, a headache, or ear pain? This could be due to TMJ Disorder. Imagine, at night instead of laying in repose you are actually re-living and relieving the stress of your day by clenching or grinding.  The worst part for many is that they really have no control over what they do all night.

Clenching is when the mandible, or jaw, is drawn up to press against the upper teeth with force. Grinding is when the mandible is slid back and forth over each other. It is common to clench during the day as well, it is less common to grind during the day.

Muscles Involved:

TMJ1
Areas affected by TMJ

There are 4 main muscles involved in these activities, or 8 if you account for your right and left sides. Most people are familiar with themasseter, that big muscle on the back part of your cheek, many TMJ suffers unconsciously massage. Less familiar may be the temporalis, a muscle that originates on the side of your head just beyond your forehead and eye and inserts, almost secretly, on the top of your jaw bone passing under your cheek bone. When a client is on the table and I begin digging around in these muscles clients are often surprised at how painful and tight their masseters are.

pterygoids

More obscure muscles that get deep towards to root of teeth grinding are the pterygoids. The pterygoids often hide trigger points thatperpetuate TMJ Disorder, these are guitar string like muscles accessible only inside your mouth! I’m not going to sugar coat this, working on these muscles is almost like torture. However, I can attest from personal experience that getting this work done can reduce the servility of your TMJ for at least a couple weeks. Massage professionals can take continuing education classes about working on these muscles and receive an Intraoral Massage Certification. I haven’t gotten this certification, partly because, really, your mouth is a personal place and I’m not sure how many of you would really want me to do that. Another reason is that you really need to be on top of reciving this treatment regularly to see changes, obviously this is another great self care segue!

Self Massage for TMJ

While not the most professional presentation, this is a great video uses accessible language to get you started:

Stress Management:

Create a good bed time routine that includes sometime to let go of whatever stress from the day you haven’t let go of yet. Deep ‘let it go’ sighs, accepting what you can’t change before it’s time to crawl into bed (at least until tomorrow morning), and contemplating what you have to be grateful for are good practices to try out.

Mouth Guards:

I can’t stress enough the need to get a good mouth guard to protect your teeth from your grinding. It is possible to grind away the surface of your teeth, to crack them under the repeatedly nightly pressure over years, and to develop tooth sensitivity to hot and cold. Generally, mouth guards reduce the impact of grinding. There is one mouth guard, the NTI, claims to prevent grinding, it’s custom made and not inexpensive. About 50% of people I’ve spoken with have said it’s worth it, others say it hasn’t changed their symptoms much. NTI requires a visit to your dentist for a proper fit.

I’ve done a fair amount of research about the materials used in retail night guards. With growing awareness about the hormone disrupting effects of plastic many people don’t want to suck on a piece of plastic all night long every night! As far as I can tell Sporting Smiles’ formula is the safest, it’s made from EVA which doesn’t use chlorine or plasticizers like BPA or phlatates.

Braces & Invisalign:

I recently went to a talk by Dr. Huggins who is a pioneer in the Holistic Dentistry world, along the lines of Weston A. Price. He said that any mistakes made when your teeth were realigned, or failure to wear your retained and maintain proper alignment can contribute to TMJ because your body is literally trying to push your teeth into some kind of alignment. He recommends Invisalign because it is more hypoallergenic than the metal in braces.

 

Living Life Fully with Fibromyalgia

Massage schools try and touch on as many pathologies as possible to give students some ideas about how to work with myriad of clients with unique lives and bodies.

Since every body truly is different and each body differs from day to day it can be challenging for a massage therapist to give the right massage for the person on the table.

I had been a massage therapist for about a year when I realized there was a pattern among some of myclients. I had a few who loved the really deep, deep tissue techniques, but then we’d get to some spots where even gentle pressure sent them jumping off the table. Often these spots were just inferior and posterior to the greater trochanter and the inferior portion of the adductors, or in plain English the hips and the inner thighs. The same clients would sometimes report that they felt “out of it”, “slugglish”, or really tender for a day or two after their treatments.
I thought, “Huh.” And I decided to keep paying attention to how this client group progressed.

These clients became regulars, their massages were the times they felt their best. They wanted that deep table time even if they had to pay in the form of brain fog, achiness, or low energy.

One day one of my clients mentioned starting the Abascal Diet at the recommendation of their naturopathic doctor.

This new tidbit was hungrily filed into these clients’ folder in my mind.
I thought, “How could inflammation connect to these symptoms?”.  A few things floated around and due to the power of the Internet I found this article, published in 2004. I asked this client pool to do an experiment with me and try the techniques. Many of them had talked before with other health care providers about inflammation being related to their health issues, especially their pain. We had good success in terms of short term pain relief. We learned a lot and we found great hope and deeper body awareness.

Quelling Inflammation is like Herding Cats

Connective Tissue Massage, the techniques described in the article, is designed to turn off the sympathetic nervous system. You’re probably heard of this nervous system as putting you into a ‘fight or flight’ state. New research points to women’s unique response to this cascade of hormones more as a ‘tend and befriend’ stress reaction.

Well, maybe we had a really great session and the client felt awesome at the end. This client then arrives home to a disaster and has to do some heavy lifting that sends him into a “flare”. He feels low back pain that night, and the next morning has a migraine. The migraine goes away after 2 days but his neck is stiff. When he’s finally feeling better he picks up his toddler in a funny position and the whole cycle starts over again!
If it’s not one thing it’s often another.
Or maybe it’s a gluten intolerance that creates a lot of inflammation for another client. She dutifully avoids gluten and then a coworker snaps at her, causing a stress reaction. She has to cope with a few days of reduced mental acuity and some grumpiness.
And, sometimes stress is unavoidable. Your parent gets sick, your child isn’t doing well in school, you’ve got a deadline at work, all at the same time! Stress is a part of life and some of my clients’ internalize this stress into inflammation. They get a flare even though they’re doing everything else right.

Goldilocks Rule

My client group all found exercise really difficult. They would have the same kind of brain fog and low energy symptoms they got after massage, only more often accompanied by achiness. Many of these clients worked with a Physical Therapist to strengthen their bodies. Finding a PT that was experienced working with inflammation was important to building muscle without sending them into pain.
Goldilocks Rule applied to our massage sessions too. We could go pretty deep in some areas to bring pain relief but not too deep or else we’d trigger the sympathetic system and induce a pain response.

Acceptance

My clients who had the most success with the technique could accept that some days would be painful and other days would be blissful. They took each day as it came and didn’t feel doomed to pain for the rest of their life. Good luck with this one!

For more information on massage and inflammation email me!