A Step by Step Treatment Plan – How To Give A TMJ Massage

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In this Post: Learn how to give a TMJ massage, by using this step by step instruction guide. You will be walked through which muscles to address during this effective treatment. Learn causes, signs, and contraindications.

As Massage Therapists, we are in the unique position where we can actually help alleviate the pain associated with Temporomandibular Joint Dysfunction (TMJD). If you are in the 12% of the 35 million people in the United States who are affected by TMJD, you know how painful it can be! Forget about chewing gum, making out with your beau, or singing at the top of your lungs! These activities only lead to agony! Here you will learn how to give a TMJ massage.

In the following post, I have outlined a bit about the dysfunction, a step by step treatment plan to implement with your clients, and some self-care techniques. I have been using this protocol with many clients for years and the results are amazing.

What is the Temporomandibular Joint?

The Temporomandibular Joint (TMJ) are the joints in our jaw. These joint are the most frequently used joints in the body, moving 2000-3000 times a day. We have two TM joints that work together as a pair, one in front of each ear. The joints connect the mandible to the temporal bones of the skull on either side of the head. The muscles controlling the joints are attached to the mandible and allow the jaw to move in three directions: up and down, side to side, and forward and back.

When you open your mouth, the rounded upper ends of the mandible on each side of the jaw (the condyles) glide along the joint socket at the base of the skull. They slide back to their original position when you close your mouth. To keep this motion working smoothly, a soft tissue disc, think soft lifesaver, lies between the condyle and the socket. The disc absorbs the shock to the joint from chewing and other movements. The combination of synchronized as well as three-dimensional movements of the paired joints distinguishes them as the most complicated joints in the body. TMJD is the dysfunction of the muscles of mastication, the TM joints, and the associated structures.

What Causes TMJD?

Adding to the complexity of TMJD is that there can be multiple causes — as well as cases where no apparent reasons can be found. Some known causes are the following:

• Predisposition – Genetic development of the muscles and ligaments.
• Autoimmune diseases (in which the body’s immune cells attack healthy tissue).
• Infections.
• Stress.
• Muscle overuse from gum chewing, singing, playing the violin, talking on the phone.
• Trauma to the neck, face, jaw, and head.
• Dental procedures (even prolonged mouth opening).
• Insertion of a breathing tube before surgery.
• Postural imbalances and tissue alternation that create malocclusion (bite being off)- Forward Head Posture, kyphosis, hypermobility, imbalances of the muscles of mastication, scoliosis, tooth loss, cranial bone misalignment, TP’s, sinus blockage, incorrect swallowing patterns, mouth breathing, teeth grinding, and incorrect respiration.
• Various forms of arthritis.

It has been observed that jaw problems are commonly found in women in the childbearing years which has also led to research to determine the role of female sex hormones, particularly estrogen, in TMJD.

Signs of TMJD

• Tenderness
• Limited jaw mobility
• Clicking (though clicking alone does not indicate TMJD)
• Headaches
• Spasms
• Pain
• Ear stuffiness and blockages
• Can be unilateral or bilateral
• Tinnitus
• Sensitive teeth

Muscles Involved

The muscles involved in the dysfunction include temporalis, masseter, medial pterygoid, lateral pterygoid, digastric, geniohyoid, infrahyoids, and mylohyoid. But trigger points in the sternocleidomastoid, trapezius, scalenes, and the pectoral muscles can also restrict opening of the mouth. Areas associated with the cranium also can be involved with creating imbalances, the sagittal suture, and suboccipital region. Therefore it is essential to address all of these areas when treating this dysfunction.

Step by Step Massage Treatment Protocol for TMJD – How to give a TMJ Massage

1) First begin by warming up the sternocleidomastoid, trapezius, scalenes, and pectoral muscles with some nice massage. Use techniques such as MFR (Myofascial Release), and TPT (Trigger Point Therapy) work the muscles.

2) Next use flat thumbs on either side of the sagittal suture to gently provide traction in opposing directions. This should be a slow and methodical undertaking. I like to think about using the same amount of pressure you would feel if you rested a nickel on your arm.

3) Next use palms or fingers to pump the temporal bone. This should be a slow and smooth process.

4) Gently move maxilla and mandible in the opposite direction from the frontal bone, (this creates space in the joint). Space is a good thing! When people suffer with TMJD the joint is compacted. By creating space we are allowing room for the joint to glide more freely.

5) Using fingertips, effleurage from frontal bone to squamous temporal region.

6) Apply friction from squamous temporal to suboccipitals.

7) With your fingertips, pickup and jostle all facial muscles. This might feel goofy performing at first, but it feels great to the client!

8) Apply exterior TPT of the masseter.

9) Put gloves on and instruct  the client to lick their lips. Give explicit instruction about how you will be entering their mouth. Take frequent breaks when working inter-orally, and make sure to watch for signs that your client needs a break.

10) With clients mouth open aim your fingertip straight back between the lower and upper teeth. Move just slightly medial and feel the tendon/muscle belly of medial pterygoid. TPT work here.

11) Move slightly superior and ever so slightly medial to locate the lateral pterygoid, perform TPT work here.

12) Pincer palpate the masseter and petrissage internally and externally at the same time.

13) Under the tongue, right toward center line TPT internal the geniohyoid and external on the anterior belly of the digastric muscle. Move slightly lateral to massage the mylohyoid. Move slightly more lateral and posterior to massage the posterior belly of the digastric.

14) On either side of the trachea GENTLY massage the infrahyoids. (Warning: Only use this technique with clients you have an extremely good working relationship, as this area hold a lot of triggers!)

15) Lastly, finish with AROM (Active Range of Motion) of the masseter. Have your client slowly open and close their mouth as if they are slowly yawning. As they do this pin and stretch the muscles of their jaw.

Contraindications

• Do not use latex gloves if the client has a latex allergy.
• TMJD may be a result of trauma the client did not disclose. For instance, sexual or physical abuse or a traumatic injury. Above all else, make sure to be present and mindful and watch for cues that the client needs you to back off. I have seen more emotional releases when performing this type of massage than any other type. Use this as a cautionary tale to remain watchful!

In conclusion, your clients should leave this treatment feeling like there is more space in their joint. They should experience a decrease in popping or clicking, and should feel better when they chew food! I hope you now feel more equip on how to give a TMJ massage!

Your clients may benefit from splints, night guards, NSAIDS, hydrotherapy, self massage, self-care tools such as the RAD roller, and my favorite diaphragmatic breathing exercises. Making sure to equip them with the instructions needed to maintain relief between sessions will keep them coming back for your latex torture and relief!

All of the images in this post are from the book “Trail Guide to the Body” by Andrew Biel. If you have never gotten a chance to look through his book, you are missing out! It is the most complete, in-depth book I have found to help understand origin and insertion of muscles. The drawings are incredibly detailed and beautifully illustrated! Please check out this wonderful resource, you won’t be sorry you did! Purchase “Trail Guide to the Body” here.