Issue link: https://www.massageandbodyworkdigital.com/i/434495
100 m a s s a g e & b o d y w o r k j a n u a r y / f e b r u a r y 2 0 1 5 gapping technique (Image 4). To confi rm the correction was successful, look for any unusual movements as the supine client slowly opens and closes the mouth. If the jaw shifts to the left, there's still left-side muscle tweaking to be done. JAW CLOSERS VERSUS OPENERS Clients presenting with FHP are vulnerable to increased jaw stress and teeth grinding as tensile forces develop in the hyoid and digastric muscles. To compensate for FHP, the brain pulls the cranium back using jaw-opening muscles, such as the infrahyoids and digastrics (Image 5). As recorded in electromyography studies, the masseters and temporalis must overwork to close the jaw when the hyoid muscles are tight. 2 Janet G. Travell, MD, believed this to be a major cause of trigger points resulting in temporalis headaches and masseter pain. 3 Sustained hypercontraction in the jaw openers and closers forces the mandible to translate posteriorly, a condition called jaw retrusion. Thus, the battle begins, and the mouth closers usually win—at a terrible cost to the TMJ and neck. Antagonistic co-contraction of these opening and closing muscle groups promotes abnormal mandibular positioning (overbite), nerve compression, ligamentous strain, and disc compression, all leading to common TMJ disorders. Optimal head and neck functioning requires that TMJ surfaces retain their ability to glide freely on one another. I fi nd it helps to fi rst deal with FHP issues using soft-tissue techniques directed at the tight line muscles shown in Image 6 and then the jaw itself. Add the gentle gapping technique shown above and others from your tool kit to reset joint position and restore function. Note: Before performing intra-oral work, check scope of practice laws in your state. Notes 1. Marega S. Medlicott and Susan R. Harris, "A Systematic Review of the Effectiveness of Exercise, Manual Therapy, Relaxation Training, and Biofeedback in the Management of Temporomandibular Disorder," Physical Therapy 86, no. 7 (July 2006): 955–73. 2. D. F. Goldstein et al., "Infl uence of Cervical Posture on Mandibular Movement," Journal of Prosthetic Dentistry 52, no. 3 (September 1984): 421–6. 3. Janet G. Travell and David G. Simons, Myofascial Pain and Dysfunction: The Trigger Point Manual, Vol. 1 (Baltimore, MD: Williams & Wilkins, 1983), 171–3. Erik Dalton is the executive director of the Freedom from Pain Institute. Educated in massage, osteopathy, and Rolfi ng, Dalton has maintained a practice in Oklahoma City, Oklahoma, for more than three decades. For more information, visit www.erikdalton.com. The therapist's thumb glides under the client's teeth onto the mandible and gently distracts the jaw painlessly to barrier. The client is asked to slowly retract the jaw to a count of fi ve and relax. The therapist gently pulls with fi ngers and thumb to stretch the masseter, the temporalis, and the medial pterygoid muscles. Image courtesy Erik Dalton. 4 6 Hypertonic jaw openers retrude the mandible. Image courtesy Erik Dalton. 5 Digastric anterior Infrahyoids Digastric posterior Stylohyoid Tendinous sling Release tight line muscles to relieve FHP and jaw compression. Image courtesy Erik Dalton. Inhibited rhomboids and serratus anterior Inhibited neck fl exors Tight pectorals Tight upper trapezius and levator scapula