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MYOFASCIAL TECHNIQUES Key Points: Jaw Proprioception Techniques Indications • Jaw tension, movement restriction, or pain; temporomandibular joint dysfunction (TMD); bruxism (grinding); etc. • Neck pain, tension, or movement restriction • Headaches, particularly tension headaches • Bracing, tension, or movement inhibition associated with injury, whiplash, tinnitus, benign positional vertigo, etc. Purpose • Increase body awareness of jaw and neck tension/relaxation options • Calm sympathetic autonomic nervous system activation and stress responses Instructions • "Fly Landing" variation (Image 3): use the lightest possible touch on chin (no more than 2 grams of pressure) in order to draw client's awareness to any tension that would resist jaw depression (opening). Do not push on jaw, but instead, invite client to relax and breathe. • "Horseshoe Grip" variation (Image 4): with very soft hands, cradle the occiput and mandible with a "horseshoe" (curved) grip. Encourage client relaxation, as you slowly and gently motion-test for subtle side-to-side and depression/elevation jaw ease. Stay well within the client's comfort range, inviting relaxation and ease (support and wait, instead of mobilize—do not stretch, move, or use pressure when the client has acute pain or guarding). • Offer proprioceptive cues such as, "Just allow your jaw to soften," or, "Notice any tension or resistance to movement." Encourage relaxation and easy breathing. • Wait for signs of relaxation and ANS calming. • Repeat in a seated or standing position; offer as client self-care homework and practice. Considerations • When working with acute conditions, use a gentle touch and very subtle movements. Do not attempt gross mobilization or direct pressure, which can be counterproductive and aggravating. • Referral to a primary care physician is indicated for severe or persistent vertigo or tinnitus. • Many jaw problems resolve on their own after a few months of stress reduction and self-care. 1 Chronic or severe TMD sufferers can benefi t from a combination of methods that offer physical, educational, psychological, and social support. For More Learning • "Neck, Jaw & Head," "TMJ & Jaw Issues," or "Whiplash" in the Advanced Myofascial Techniques series of workshops and video courses. • Advanced Myofascial Techniques, Vol. 2, Chapters 14–16, "The TMJ" (Handspring, 2016). Note 1. The TMJ Association, "TMJ Science Overview" (January 7, 2016), accessed November 2016, www.tmj.org/Page/51/32. December 2009, later expanded and updated in Advanced Myofascial Techniques, Volume 2, Handspring, 2016). In the box at left, I offer two additional gentle techniques that focus on the proprioceptive or neurological aspects of jaw tension and coordination. Try them out, but rather than using them as physical manipulations, joint mobilizations, or fascial stretches, imagine these two techniques as gentle but effective ways to calm your client's nervous system arousal level, relax excessive unnecessary muscle tension, and increase body awareness. Notes 1. R. K. Ow et al., "Symptoms of Craniomandibular Disorder Among Elderly People," Journal of Oral Rehabilitation 22, no. 6 (June 1995): 413–19; The TMJ Association, "TMJ Science Overview" (January 7, 2016), accessed November 2016, www.tmj.org/Page/51/32. 2. R. Wassell et al., Applied Occlusion (London: Quintessence, 2008): 73–84. 3. Look, John O. et al, "Reliability and Validity of Axis I of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) with Proposed Revisions," Journal of Oral Rehabilitations 37, no. 10 (2010): 744–59. 4. Ibid. 5. D. Manfredini et al., "Research Diagnostic Criteria for Temporomandibular Disorders: A Systematic Review of Axis I Epidemiologic Findings," Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics 112, no. 4 (2011): 453–62. 6. L. J. Pereira et al., "Psychological Factors and the Incidence of Temporomandibular Disorders in Early Adolescence," Brazilian Oral Research 23, no. 2 (June 2009): 155–60; M. S. Medlicott and S. R. Harris, "A Systematic Review of the Effectiveness of Exercise, Manual Therapy, Electrotherapy, Relaxation Training, and Biofeedback in the Management of Temporomandibular Disorder," Physical Therapy 86, no. 7 (July 2006): 955–73; L. B. Calixtre et al., "Manual Therapy for the Management of Pain and Limited Range of Motion in Subjects with Signs and Symptoms of Temporomandibular Disorder: A Systematic Review of Randomised Controlled Trials," Journal of Oral Rehabilitation 42, no. 11 (November 2015): 847–61; S. Armijo-Olivo et al., "Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis," Physical Therapy 96, no. 1 (January 2016): 9–25; The TMJ Association, "TMJ Science Overview." Til Luchau is a Certifi ed Advanced Rolfer, the author of Advanced Myofascial Techniques (Handspring Publishing, 2016) and a member of the Advanced-Trainings. com faculty, which offers distance learning and in-person seminars throughout the United States and abroad. Contact him at info@advanced-trainings.com and through Advanced-Trainings.com's Facebook page. • When working with acute conditions, use a gentle touch and very subtle movements. Do not attempt gross mobilization or direct pressure, which can be counterproductive and aggravating. • Referral to a primary care physician is indicated for severe or • Many jaw problems resolve on their own after a few months of Chronic or severe TMD sufferers can benefi t from a combination of methods that offer physical, • "Neck, Jaw & Head," "TMJ & Jaw Issues," or "Whiplash" in the Advanced Myofascial Techniques series of workshops and video Vol. 2, Chapters 14–16, "The 1. The TMJ Association, "TMJ Science Overview" (January 7, 2016), of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis," Physical Therapy 9–25; The TMJ Association, "TMJ Science Overview." Til Luchau is a Certifi ed Advanced Rolfer, the author of Techniques (Handspring Publishing, 2016) and a member of the Advanced-Trainings. com faculty, which offers distance learning and in-person seminars throughout the United States and abroad. Contact him at info@advanced-trainings.com and through Advanced-Trainings.com's Facebook page.