Let’s start with the take home message: can a physiotherapist successfully treat temporomandibular joint (TMJ) problems?
The answer is “yes”, but only when the correct variables are involved. Specially trained physiotherapists, including some CAMPT-Certified therapists, are able to successfully treat TMJ pain and disorders for many people suffering with problems related to their jaw.
What is a TMJ Problem?
In short, the labels TMJ, TMD, and TM disorders typically refer to a group of primarily orthopaedic problems that affect the jaw joint (TMJ) and surrounding tissues. Using any one of these labels is as specific as saying “knee pain” or “knee problem”. If someone tells a physiotherapist that they have knee pain, that identifies a starting point from which an examination can begin, but it does not identify what is causing the knee pain. Similarly, there are many tissues such as muscles, tendons, ligaments, discs, and other connective tissues surrounding the TMJ. Many different problems can affect these tissues including, but not limited to: tightness, muscle knots, tendonitis, hyper-mobility, nerve irritation, and joint dislocation. Patients can have different combinations of tissue problems, and it is rare for a patient with a TMJ problem to have only one thing going on. As a result, there is no easy or simple answer when attempting to define what a TMJ problem consists of. One must conduct a thorough examination to properly identify and treat the problem(s), and then determine if it resolves the issue(s) prior to arriving at a confident conclusion about what was causing the jaw or face pain.
How Prevalent Are TMJ Problems?
The available evidence is very inconsistent regarding the prevalence of TMJ problems, but really good estimates tell us that between 5-16% of people will develop some sort of TMJ problem. However, this statement is very general because the phrase “TMJ problems”, which are often called temporomandibular disorders, TM Disorders, or TMD, actually refers to a group of problems that affect different people in very different ways.
Are Oral Splints (a.k.a. Mouth Guards) Helpful for TMJ Problems?
There certainly are some patients that respond very favourably to oral splints. However, this is not true for most people. In fact, the research studies on oral splints tend to come to one conclusion: oral splints are useful when attempting to protect the teeth in people that clench or grind their teeth. Apart from that purpose, oral splints generally cannot get rid of a TMJ problem.
What can a Physiotherapist do to help?
There are many different treatment options for TMJ problems. Physiotherapy is a very good option as long as the physiotherapist is trained in, and reasonably confident, with handling this type of problem. A physiotherapist can use manual therapy, various types of massage, education, dry needling, and other approaches to decrease pain and improve mouth opening. Many people with TMJ problems can have tissue restrictions in the upper neck, so treating the neck is also very important for patients with TMJ pain. Additionally, variables such as stress and poor sleep can drastically impact TMJ pain, which means that any treatment approach that can alleviate negative psychological variables and/or improve sleep quality can be very helpful as well. Physiotherapists can often help to a certain extent with these variables but sometimes a patient needs to also seek treatment from more than one provider to handle different variables successfully. In the end, search for a skilled physiotherapist with solid experience in the TMJ and you’ll be headed in the right direction.
About Stephen M. Shaffer
Stephen M. Shaffer is a full-time clinician and has managed patients with musculoskeletal disorders since 2003. He completed residency and fellowship training in orthopaedics at the Institute of Orthopaedic Manual Therapy in Woburn, Massachusetts and the University of Illinois at Chicago, respectively. Additionally, he completed academic doctoral training in orthopaedics at Texas Tech University Health Sciences Center in Lubbock, Texas. He is a credentialed fellow and member of both the Canadian Academy of Manipulative Physiotherapy and the American Academy of Orthopaedic Manual Physical Therapists. He currently works full-time in Cornwall, Ontario and continues to participate in both clinical practice and academic research. He is also an adjunct faculty member at the University of Hartford Orthopaedic Physical Therapy Residency Program, where he teaches TMJ content. You can find more about Stephen online or at ResearchGate and Google Scholar.