Some people use their bodies more than others. The body part that gets the most use – now that is what this article is about. You see, I used to play basketball and rollerblade daily, and participate in Jiu-Jitsu several times a week. My joints received a lot of movement back then (20 to 30 years ago) and from time to time I am reminded of those days with an ache or two. The joint that gets the most use these days… is my jaw. Now that I am thinking about this, I am wondering why we don’t refer to the jaw as “jaws” – after all, we do have two of them; a right and left jaw. But I digress.
The jaw, also known as the Temporomandibular Joint (TMJ), is the union of the mandible and the temporal bone. The mandible is the bone that forms the part of your face that you typically think of when you think “jaw bone”, and the temporal bone is one of the bones that form your skull. The TMJ can become dysfunctional in the same manner that any other joint can. We refer to TMJ dysfunctions as Temporomandibular disorders (TMD). The dysfunctions can be a result of the bones, the cartilage covering the bones, the disc between the mandible and the temporal bone, the muscles attaching to the jaw, the nerves innervating the muscles of the jaw, or something else. Let’s dive into this.
Of the more than 10 million people affected by jaw pain in USA (https://newsinhealth.nih.gov/2020/09/more-jaw-pain), the most common symptoms are pain, restricted motion, and clicking (Chisnoiu AM, Picos AM, Popa S, Chisnoiu PD, Lascu L, Picos A, Chisnoiu R. Factors involved in the etiology of temporomandibular disorders – a literature review. Clujul Med. 2015;88(4):473-8. doi: 10.15386/cjmed-485. Epub 2015 Nov 15. PMID: 26732121; PMCID: PMC4689239). In a 2015 literature review by Chisnoiu et al, the authors reported that the causes of TMD are poorly understood. However, they identified abnormal jaw motions during speaking and eating, increased estrogen levels, and psychosocial factors including “stress, anxiety, or depression” as the most notable contributing factors of the development of jaw pain.
The first professional many people think of for the treatment of jaw pain is a dentist. Indeed, splinting or a mouth guard is a popular choice of treatment for patients with jaw pain. Without going into the details here – I will leave that up to a dentist – and a 2004 article by Littner et al reported between 70% to 90% success rate using hard occlusal splinting when the presence of abnormal jaw motion during eating is observed. They also emphasized that the application of a splint should not replace a through assessment of the muscles of the face. Now, is there a professional more qualified to assess the muscular system than a well-trained physical therapist? I think not.
The efficacy of the musculoskeletal manual therapy approach in the treatment of temporomandibular joint disorders was discussed in length by Martins et al in a 2016 systematic review published in Manual Therapy, and they found over 308 articles reviewing treatment showing a confidence interval of 99% improving mouth opening and pain as compared to other conservative treatments. Included in manual therapy are dry needling and manipulation techniques, both of which are a part of routine and standard care at Bellaire Therapy SPOT – Bellaire – Bellaire (Formerly Therapy SPOT – Bellaire). Therapeutic exercises are prescribed and performed to strengthen the weak muscles of the head, face, and neck, and neuromuscular reeducation is applied to change the way the patient uses his or her muscles during repetitive daily tasks such as speaking and eating.
Dry needling is a technique that may be used in physical therapy for TMJ. Dry needling involves the insertion of thin needles into trigger points, which are areas of muscle tension or knots, to help release the tension and improve range of motion.
Here are a few sources that discuss the use of dry needling in TMJ physical therapy:
- Chisnoiu AM, Picos AM, Popa S, Chisnoiu PD, Lascu L, Picos A. Acupuncture and Dry Needling in the Management of Myofascial Trigger Point Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Evid Based Complement Alternat Med. 2015;2015:943018. doi: 10.1155/2015/943018.
- Gonzalez-Iglesias J, Fernandez-de-Las-Penas C, Cleland JA, Gutierrez-Vega Mdel R. Thoracic spine manipulation for the management of patients with neck pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2009 Aug;39(8):20-7. doi: 10.2519/jospt.2009.2930.
- Schabrun SM, Chipchase LS. Neurophysiological effects of dry needling in the management of musculoskeletal pain. J Orthop Sports Phys Ther. 2014 Mar;44(3):142-51. doi: 10.2519/jospt.2014.5092.
- Venancio Rde A, Alencar FG Jr, Zamperini C. Different substances and dry-needling injections in patients with myofascial pain and headaches. Cranio. 2008 Jul;26(3):206-11. doi: 10.1179/crn.2008.031.
It’s worth noting that while dry needling has shown promise as a treatment for TMJ, more research is needed to fully understand its effectiveness and safety. As with any treatment, it’s important to discuss the potential benefits and risks with a healthcare professional.
Martins, Wagner R. “Efficacy of musculoskeletal manual approach in the treatment of
temporomandibular joint disorder: A systematic review with meta-analysis.” Manual Therapy, vol. 21, no. 1, 2016, pp. 10-17. https://doi.org/10.1016/j.math.2015.06.009, https://www.sciencedirect.com/science/article/pii/S1356689X15001381. Accessed 14 03 2023.