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Jaws

How massage can help clients dealing with temporomandibular dysfunction.

By Patricia O’Rourke & Michael Hamm

Healers have wrestled with jaw-related pain since Hippocrates’ time, and they’ve gained a lot of insight along the way. But there is still an impressive amount of disagreement surrounding temporomandibular dysfunction (TMD). Doctors, dentists and other practitioners struggle with how to precisely define TMD, as well as how best to treat it.1,2 Purely structural fixes like oral splints don’t produce consistent results,3 and therapists who focus on pain or stress reduction sometimes don’t address some of the physical causes. It seems clear that TMD demands a multidisciplinary approach, and that practitioners should strive for awareness beyond their own specialty.3,4

The challenge for massage therapists is one of integration: how can you meaningfully draw from multiple disciplines to effectively treat TMD? The goal of this article is to focus on the practices that best empower our clinical intent. We’ll make the case that TMD is deeply connected to the rest of the body, both structurally and neurologically. Based on those influences, we’ll discuss some useful assessment and treatment options. Finally, we hope to provide a good collection of references for therapists who want to deepen their knowledge of this fascinating subject.

Anatomy & Pathophysiology

TMD is commonly defined as “a cluster of conditions characterized by pain in the temporomandibular joint (TMJ) or its surrounding tissues, functional limitation in the mandible, or clicking in the TMJ during motion.”3 We can find some hint of TMD in quite a few people, though the severity and specific pattern of dysfunction varies widely. Up to 75 percent of adults show clinical signs at some point, but only 5 percent ever need treatment.3 Two questions seem to be particularly important: What are the structural influences on the mandible, and how is the pain being generated?

Let’s begin with structural influences on the mandible. Imagine the whole bone, suspended in three dimensions by muscles and fascial planes, and strapped to the skull with ligaments. What is normal movement? How can imbalances arise?

When we examine the structures surrounding the mandible, we find that the local connections must be linked to the systemic whole. While it’s important to address this muscle or that fascial sleeve, we cannot separate the jaw from the whole body.

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