First, it is important to understand that the jaw, or TMJ (temporomandibular joint), serves many functions. Chewing is the most obvious one, but it also plays a role in swallowing, digestion, breathing, and communication. Since physiotherapists are experts in functional movement, it is essential for them to understand the pathologies associated with the TMJ. In fact, the TMJ is similar to joints such as the knee or shoulder. It includes articular surfaces, cartilage, a capsule and synovial fluid, ligaments, a disc, and an entire network of surrounding nerves.

Among the issues frequently encountered—aside from a painful TMJ—are patients who can no longer open their mouth wide enough, as well as patients whose jaw locks, either in a closed position or in an open position.

Here is a summary of the physiotherapy approaches used to help these patients.

Patients who come to the clinic with one of these conditions have almost always experienced previous episodes of pain or joint noises. They therefore present with a combination of underlying issues related to their current problem. Among these are many cervical (neck) problems. The cervical region is closely linked to the TMJ through anatomy, biomechanics, and neurology. As a result, a patient with TMJ pain may also experience neck pain, and vice versa. These conditions are also often accompanied by headaches.

Therefore, the physiotherapist must first evaluate the patient’s overall condition and determine the musculoskeletal elements relevant to treating the pathology. In the three cases of TMJ mobility loss mentioned above, the management approach typically includes the following:

 

A joint that no longer opens wide enough (progressive loss of mobility)

• Treat pain with gentle mobilizations and education on pain management strategies.
• Address associated postural, joint, and muscular dysfunctions.
• Treat TMJ stiffness using myofascial release techniques (both intraoral and extraoral) and direct TMJ mobilizations (distraction, gliding, and rolling).
• Guide the patient through exercises to maintain and improve mobility and to enhance movement control, since these patients often open their mouth with mandibular deviations.
• Educate the patient on activities and postures to encourage or avoid now and in the future.

In some cases, several weeks of treatment may be required depending on the severity of the stiffness and how long the condition has been present before consultation.

 

Acute locking in the closed position (e.g., maximum opening of 18 mm with pain)

• It is important to release the lock quickly, as the longer it persists, the more disabling it becomes.
• Myofascial release techniques must be applied to the masseter, temporalis, and pterygoid muscles (both by the physiotherapist and by the patient through self-treatment) to reduce muscle tension.
• Stronger passive mobilizations involving TMJ distraction and opening must then be applied quickly.
• After treatment, applying ice may help, as pain often accompanies this stage. A dentist or physician may prescribe appropriate medication if the pain is severe.
• The patient should also be guided through exercises and practical advice to maintain the newly regained opening.

In many cases, this type of blockage can be released in a single visit, but treating the underlying problems remains important, as they are often responsible for the locking.

 

A joint that locks in the open position (e.g., the patient cannot close their mouth)

• This type of blockage is much rarer and can also be multifactorial. It may involve disc displacement, intra-articular edema, or in rare cases, subluxation of the condyle beyond the articular eminence.
• The dysfunction, swelling, or subluxation must be reduced depending on the cause, which is usually relatively easy to correct. However, if a dislocation cannot be reduced, a visit to the emergency department may be required.
• Afterward, the physiotherapist evaluates and treats associated dysfunctions, just as in the previous cases, to prevent recurrence.
• Education is equally important to reassure the patient and help them manage the condition independently, as this type of blockage can often cause anxiety.

 

In summary

A TMJ blockage, regardless of its nature, can be treated with physiotherapy. However, it is equally important to understand and treat the underlying causes. For this reason, collaboration with a dentist specialized in occlusion and TMJ disorders is essential, along with strong communication between healthcare professionals.

For more information or if you would like to discuss a specific case, please do not hesitate to contact us by visiting our website:

www.evolutionphysio.com

Marc-André Sarrazin, Pht, FCAMPT