10. TMJ & Jaw Pain Causes, Treatment, and What Actually Works

Jaw pain can feel overwhelming — especially when it affects your ability to speak, eat, or focus. In this episode, April Patterson breaks down what TMJ (temporomandibular joint) dysfunction really is, why it happens, and most importantly — what actually helps.

From muscle tension and poor posture to stress, hypermobility and compensatory movement patterns, we explore the many reasons why jaw pain can arise — and why treating it isn't just about the jaw.

Learn how conservative care (no surgery, no injections) can lead to real results through manual therapy, exercise, posture support, and patient-centred education. April shares practical insights from clinical experience, pain science, and personal understanding to help you take back control — whether you’re living with TMD or supporting others who are.

You’ll also hear tips on:

• How posture affects jaw stability
• Why strengthening (not just stretching) matters
• What to look for in a good practitioner
• The link between stress, pain, and the jaw
• And how to build long-term resilience, not just quick fixes

This episode is a must-listen for anyone dealing with persistent jaw pain — or wanting to better understand it from a whole-body, whole-person approach.

Disclaimer: Before making any health changes, consult with a healthcare professional.

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Transcript

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Welcome to the RX Physiotherapy Podcast, your go-to destination for all things physio, rehab, health and wellness. I'm April Patterson, and each week we will dive deep into fascinating topics within the health world. From physiotherapy to nutrition and beyond. We cover it all. So sit back, relax, and enjoy the journey as we explore the exciting world of health and wellness. Let's get started. So what is TMJ? Let's start with the basics. The TMJ is your temporomandibular joint. The hinge that connects your jaw to your skull just in front of your ears, lets you talk, chew, yawn, sing, and make weird faces. The mirror, you use it constantly more than you realize you want. Something goes wrong in that area. We call it TMD or tibular disorder. Common symptoms include jaw pain and tightness. Clicking or popping when you're open and close your mouth, headaches, neck stiffness, trouble chewing harder foods, and even ear pressure such as fullness or just struggling to actually hear out of that ear. So TMD affects up to one in 10 people and women between 20 and 40 are four times more likely to be affected. So what causes it. Well, it's actually a mix of a few things, so it can be muscle tension from clenching or grinding, poor posture, especially forward head posture, which a lot of us exist in these days. Neck and thoracic issues that affect the alignment of the jaw mechanics, and of course stress and anxiety, which can cause the three above to occur. So what is the best treatment for TMD? So what the evidence shows is that most people get better with conservative care, which means no surgery, no injections, no fancy gadgets. What actually works is first. Very thorough patient education, understanding what the joint is, what the jaw, the TMD is. A lot of people think that their jaw is dislocated or they're worried that it's just gonna get worse and there's nothing they can do to manage it, which is totally understandable from experience of having TMD symptoms myself. When you've got constant pain on your face that you just can't get rid of and it comes on when you are. Trying to work or when you're stressed and pain medication just doesn't take the edge off it. It can be all encompassing. Even more so from my perspective than say if you had a foot injury when it's on your face, it's really hard to ignore. So that's one of the reasons that I start off with educating patients on the anatomy of the jaw while you're in pain and giving you some hands-on strategies to. Wind down your pain, start giving you back control again so that you are not just sitting there feeling like this is the way it's always gonna be. So I start off by going quite deep into the pain science behind it. The body's main goal is survival would much rather you be in pain than in its perspective, further injury or dysfunction. But the body is quite shortsighted for this. It thinks about surviving now, not if we clench our jaw constantly for 10 years. What's gonna happen to the joint? Or if we're in so much pain that it causes us psychological stress? Or say if we are already under psychological stress and pain just exacerbates that, what that's gonna do to our quality of life. It just thinks about how to survive right now. So I think that's really important to understand because. And to thank your body for that. It's doing its job, it's trying to protect you, and it's sensing that there's a threat, which could be that you've sat in a posture that is too much for it to cope with for a long period of time, and it would rather give you pain so that you lie down versus staying that posture and continue to overload all the joints and ligaments. But a good example is, say you're someone who had an injury to your neck and your jaw was compensating for it. Even after that injury has healed your jaw may continue to stay in that short term loop because it lowers its threshold to be set off for pain once it's already actively in a pain process. So we need to use the conscious part of our brain to retrain it for long-term term effective movement. And this is managed through consciously understanding what's going on. Some hands-on stuff to get those muscles to just relax and stop being so tight and overused, and some exercise strategies to build strength into different parts of the body to. Port the jaw so it doesn't feel like it has to do everything. So with manual therapy, which just means hands-on, hands-on release for a certain part of the body can look like massage, some joint movements, dry needling, even. What it's doing is it's disrupting the pain signals in that area and allowing your body to come back to homeostasis so that we can start to get your body moving more effectively. Back to the way that. It was optimally designed to move. So if you are, you've, you've probably all been in this cycle before you know that you're in pain and you haven't been moving enough. But when you move, you're in, it's causing so much pain that you wanna avoid it. What the manual therapy side of things can do is just get your nervous system and your muscles to relax enough that you can move effectively. And this is where once we've done that, we can start to look at. Once we get the jaw to settle down, we can start to look at why it's overworking in the first place. And a lot of the times it is due to your posture, your neck and your upper back, and you could argue further down the chain as well causing those. But we'll just focus from the thoracic, which is your rib cage area, up every centimeter that your head is forward puts a huge. Increase of pressure onto the neck and the jaw. The jaw stabilizes the first three levels of the spine. So when we're in positions where our head weighs way more, the muscles have to work way harder to control it against gravity. So the jaw will come in to help stabilize those levels and add some stiffness so that we don't have to work as hard. And you'll see with boxes, they have massive jaws because when they're going to punch, they're having to stabilize their neck so the force doesn't go through their neck on impact. So the jaw is so heavily involved in stabilizing the neck. So I would say 90% of the time. Yes, I'm assessing the joint and giving pain man management strategies there, but it's mostly the upper back and the neck that I'm going for. In terms of the underlying cause, the thing that makes it harder is that there's a lot of different structures that can refer into the neck as well, which can be the inner ear, the neck, the upper back, even the eyes. There's quite a lot of crossover in terms of the neural pathways that referring to the jaw. Another interesting one is that you'll see. You gestation dysfunction, which is the little tube that goes from your nose to your mouth. If that gets blocked, it can refer into the jaw. And this is just another example of how with the jaw, if you are not getting better with relaxation strategies and all the usual jaw staff, it's important to see a physio that is educated in this who can help refer you. To the appropriate specialists. I regularly refer to ENTs, orthodontists, different health professionals that look at all the different structures through there and their influence. When we go back into the exercise side of things, a lot of the evidence is around the postural side of things, so strengthening the muscles, the posterior chain, which is the upper back, the neck. Et cetera and helping those overloaded joints to relax with certain techniques, but another. Really interesting aspect is the proprioceptive side of stability, and you'll see a lot of hypermobile individuals have jaw issues. Proprioception is the body's ability to know where it is in space. If you couple a reduced proprioception, which is what we see in hypermobility with increased range of motion, you've got a joint that just doesn't know where it is, and it's really hard to coordinate movement when your joint doesn't know where it is. So there's a whole area for just proprioceptive training as well too. If you've never heard that word before, just think of it like your body, knowing how to move effectively. Think of your arm going above your head. Your arm knows how to smoothly move above your head so that it's stabilized. If it didn't, it would be like shaking around as you're trying to lift it up, thinking about how much more energy that's gonna take. Then just the smooth movement that's coordinated correctly. So what's really important is that you think about the individual. So it's one thing to do all these different assessments and go, oh, they have this much range of motion at the jaw. They can't move their jaw in this direction, and they can move it in this direction. That's all really helpful when we're looking at the physics side of things. You also need to be guided by what the individual's symptoms are. Otherwise you can make the wrong conclusion. An example of this is if an individual comes into you and says, I sit at a desk. My posture's terrible. My jaw comes on after about an hour of work, it's relieved when I'm relaxing for the night, I wake up best in the morning. You're thinking of this joint is chronically overloaded, and although there's reduced range of motion. In different directions. The number one thing we need to do is improve the posture of that individual first. Otherwise, I can go and work on increasing more mobility through your jaw. And if you are still sitting in a poor posture, it's gonna do basically nothing. Even though if you just did an assessment, you could argue that the jaw needed to be increased in mobility versus the individual who comes in. And says, I've had jaw pain for 10 years. I've had endless routes of Botox without any sort of strengthening. Um, I'm so weak to the point now where even just talking is hard. And then you look at that individual and they've got lots of tightness in the jaw, that tightness is protective. The body feels so weak that it can't come out of those ranges as a protective mechanism. So increasing their range of motion is gonna make them worse and needs to be done in a strategic way where you're strengthening into that, not just increasing mobility. So these two examples show that you could assess someone then be reduced in mobility, but based on. Who they are, what their experience is, and what their different parameters of causing pain are, are gonna guide you towards how you actually approach that. So this is where we come into outcome measures, and at the start of my treatments and start of all of our practitioners, we all do the same. We ask the individual what their goal is and you can build an outcome measure around that. So if they say. I want to be able to have a conversation with my partner for 20 minutes without feeling like I wanna cry 'cause I'm in so much pain. That would be the goal directed outcome measure. How close are we getting to that versus, and it's not to say we don't use things like how, how far can they open their mouth or what's their strength of their rotator cuff muscle? But there's a million different things that you could improve. And you could be totally missing what that individual is actually after to make it patient centered and what their quality of life is. So now that we've touched on that, we might go back into a bit more of the physics side of things. So if an individual struggling to open their mouth, but it's equal on both sides. Some simple muscular release through the temporalis and the. Masseter a lot of the times will help to let that joint just relax. You wanna be adopting things like correct breathing techniques. You wanna be assessing where their tongue is in their mouth. So when you say the word N, you'll naturally put your tongue where it should be in your. So you're going, hmm, thinking about rest, that your tongue is sitting in the correct position in your mouth. Your jaw shouldn't be clenching unless you're eating the back teeth shouldn't be touching. And we want to where we can avoid that poke neck position. So what you're thinking, like if you're, think of the poke neck, you are relaxing into cervical flexion extension. Your necks poked out the front of your neck's completely relaxed. Not helping to stabilize at all, and your jaw is now further away from your midline. If you just focus on these few things, getting them right, you go a long way to start to improve the physics in the area. Once you've got good alignment, your tongue and your jaw in the right position, then you wanna start to build some strength into. The muscle surrounding it to build, we call it redundancy, which just means that the muscle has more capacity than it needs and therefore it's, it's more able to deal with day-to-day pressures. And a good example is if you could lift 10 kilos, one kilo is pretty easy, but if you could only lift two kilos, one kilos, now half of that. So we're trying to build. Redundancy into the body so that when we have an individual who's sitting at the desk all day or having up their child, that the body has enough strength that it's not going, oh, we need to now use the jaw as well because the neck can't cope with this. So a final tip for anyone listening, this has been quite a general overview today, and we'll go deeper into each aspect in further podcasts, but. Yeah. Number one, don't panic. A huge percentage of the population have TMJ pain and it is treatable and manageable without surgery. 99% of the time when you are flared up, avoid things that flare you up more, which sounds obvious, but really identify what they are because it can be a bunch of things that accumulate. Could be that your favorite lolly is a super hard chewy type, and then you're also, when you're sitting, your hand is on your jaw and it's stretching that side of the jaw where you're leaning onto it. At the same time, you're probably irritating your jaw in so many different ways that if we could take away a few of those stimuluses, then we don't have as much pain inhibition to be trying to mitigate when we're strengthening you. Start to really check in with your body when you're clenching. Do that whenever you are unsure as to where your tongue should be in your mouth if you feel that you're grinding. Splints are super helpful. One to protect your teeth, but two, at nighttime, if you get the right splint made, it puts your muscles at a mechanical disadvantage so that they can't actually clench is easy. So breaking that cycle, making sure you're seeing and. A practitioner, whether it's a physio, a gp, A ENT dentist that understands TMD, because not all do and don't get stuck just doing passive stuff forever. Massaging and relaxation techniques are all super important to take away the intensity of the irritability, but we need to get to the bottom of this as well. And if you're a physio listening to this. Don't be afraid to treat the jaw. It's just a joint like any other. Think about it from a patient's point of view and then work backwards to help them to achieve their goal and reach out if you need anything. We're always happy to help other professionals. If we all work together, we only all get better. So thank you so much for your time and look forward to seeing you guys all in the next one. Bye.