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38 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 9 More invasive interventions include trigger point injections, injections into the joint space (this might be with a steroidal anti-inflammatory and/or an anesthetic), and Botox injections into chronically tight muscles. And if surgery is conducted, it is usually because specific structural damage has been identified and needs to be corrected. This might require a repair to the meniscus, or a whole joint replacement. It is important once again to emphasize that when TMJ-related pain is a whole-body phenomenon, it is not realistic to expect that repairing the biomechanical structure will eradicate symptoms. This is a condition with deep and complex psychosocial factors that accompany the biomechanical ones. "I've been to the dentist; the massage therapist; the chiropractor; the ear, nose, and throat doc; the naturopath. I know they won't fix me. I have to do the work. I can't expect any one treatment to be my miracle." IMPLICATIONS FOR MASSAGE THERAPY It seems like highly skilled massage therapy could play a useful role for clients with TMD, but the research on this topic is inconsistent. That said, many dental professionals enthusiastically recommend massage therapy as an early intervention for TMJ disorders. As we stated before, the jaw appears to be a point of reflection for function and dysfunction throughout the body. If someone has chronic TMJ pain, the chances are good that they have pain elsewhere too, and a holistic approach that considers all the factors is probably more likely to have a positive outcome than a piecemeal approach. So, as we consider the jaw, let us also look at the shoulder girdle, the position of the pelvis, and how the feet hit the ground—they're all connected, obviously. SYMPTOMS OF TMD Pain is the number-one symptom of TMD. That pain can be sharp, dull, jabbing, or electrical. It can be at the jaw; in the teeth; and/or in the eyes, ears, and over the back of the head. It is often exacerbated by activity at the mouth—not just eating, but any kind of vocal expression can elicit pain. "When I sing, or laugh, or even smile, I know I'll pay for it later. It makes it hard at my daughter's soccer games or dance recitals." In addition to mouth and facial pain, TMD can cause headaches. This can be a reflection of trigeminal nerve irritation, a trigger for migraines, or a referred pain pattern from trigger points in the jaw muscles. Trigger points can also form in overactive muscles that stabilize the neck and head; the sternocleidomastoid and splenius muscles are frequently involved here. TMD can lead to vertigo, possibly because the proprioceptors in the jaw help to determine our orientation in space, and when they send messages that don't match our eyes and inner ears, we get dizzy. Neck pain, arm and shoulder pain, back pain, and changes in gait can all be considered as ripples of TMJ dysfunction, as the body tries to compensate for problems at this keystone location. TMD TREATMENT OPTIONS Treatment for TMD begins with noninvasive, nonpharmacological interventions. These may include identifying and avoiding triggers, taking care with food and sleeping, using a splint to limit grinding, and addressing the psychological aspects of jaw pain with appropriate types of therapy. If drugs are called for, they will typically include NSAIDs, tricyclic antidepressants, muscle relaxants, and antianxiety medications, including benzodiazepines. How Strong is the Human Bite? In 1861, Dr. G. E. Black, president of the Chicago Dental University, designed an instrument to measure bite force. He called it a gnathodynonometer. He found that the variable most likely to interfere with bite strength was the health of the teeth and gums. People stopped biting the testing device, he reported, because their teeth hurt. Of 1,000 test subjects, he found the average pressure at the molars at peak clench was 171 pounds on each side, and the very highest pressure he measured was about 275 pounds. In 2010, a researcher named Stephen Wroe recreated a human skull in a way that could test bite force in three dimensions. He established that with this model, the human bite is stronger than what Dr. Black found. It turns out we exert about 1,300 Newtons (almost 300 pounds) at the molars. That is surprisingly strong; the only primates with stronger bite force than humans are gorillas and chimpanzees. Interestingly, while jaw disorders cause pain and limited range of motion, they do not appear to affect bite force.

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