TMJ Disorders

James Crow
Hello, I’m James from posturestars.com. And thanks for joining this Posture Stars podcast. Today we’ll be talking about posture for TMJ, which is your temporomandibular joint and temporomandibular type disorders, which is a bit of a mouthful, but that’s what we’re all talking about today. So I’m joined by Kathy Gordon, who’s co founder of the Association of Chartered Physiotherapists in Temporomandibular Disorders, ACPTMD. And she works in Cheshire, England, in the heart of our, very wealthy and beautiful part of England. So as you our listener, you’ll find this useful if you’ve got jaw pain, or you grind your teeth, have jaw locking problems or difficulty opening your mouth fully. Or maybe you get headaches, or jaw tension. So hello, Cathy.

Cathy Gordon
Hi, James.

James Crow
We’re going to talk about the relationship today of good posture to TMJ issues. Treatments for Temporomandibular joint issues such as muscle and joint treatments, manual therapy, heat, relaxation techniques, avoiding eating hard or chewy foods, all of those can help. But what’s the relationship between posture and TMJ problems?

Cathy Gordon
Well, it’s a very good question. The jaw joints, or the more technical term temporomandibular joints, are located very close to the neck and to the rest of the spine. So the optimal alignment of the jaw joints, where the jaw muscles, joints and teeth are in their best position, depends on good spinal alignment and good posture.

James Crow
Very good. That’s what we like to hear, we’re all about good posture here. So how common are these problems?

Cathy Gordon
TMD refers to temporomandibular disorders, and this consists of any pain or dysfunction, or any of the jaw regions of the jaw, and the lower facial areas, originating from the jaw joints, muscles and dental areas. So these problems are more common than people think. And they do affect approximately 10% of the population.

James Crow
Wow, that’s loads. I didn’t realise it was that many.

Cathy Gordon
Yes it is very, very common in this day and age when a lot of people are stressed with work, and there’s a lot more demands on everyday life. These problems are quite common.

James Crow
Okay, so I was about to ask, what sort of things caused these problems is it mainly stress and anxiety?

Cathy Gordon
I would say so, that many problems I see are caused by stress and anxiety. And so therefore, the most common structures affected are the muscles of the jaw, or the masticatory muscles. The problems with these muscles occur when people grind or clench their teeth. And there are also other common habits, such as nail biting, chewing your lip, chewing gum, that are all kind of causes of facial pain as well. So you can also get problems with the jaw joints, or the disc within the joints. And also trauma to the jaw area can also cause pain. And these can also cause symptoms, such as clicking and locking of the jaw.

James Crow
Well yes, that sounds very painful.

Cathy Gordon
There’s also a very close mechanical area of mechanical relationship between the jaw and the upper neck. So this is due to the proximity of the two areas, but also the nerve links between the two areas. So it’s very common to feel neck pain as well as jaw pain.

James Crow
Oh, that’s interesting. Now often when I’m working with people who presented with neck pain, there does tend to be a lot of jaw tension going on there. And I think that’s a relationship between the anxiety and stress that they have. That’s probably fitting into the sorts of work that you do as well.

Cathy Gordon
Yes, absolutely, these are these are very common causes.

James Crow
So what sort of signs should people look out for? You’ve mentioned clicking and problems with closing the jaw. What sort of signs would indicate to someone that they’ve got a TMJ problem?

Cathy Gordon
I find the most common symptoms are pain. That’s when people come to you, and want to seek medical advice. So clicking and jaw locking is also very common, as well as some people experience difficulty opening the mouth. People who do experience muscle pain in the face, usually they clench the teeth at night, or in the day, or both. And this again is very common, with stress occurring alongside stressful situations. Headaches are also quite common. And this is due to the links between the jaw joints and the neck, and also the fact that the structures in the neck and the jaw do refer pain into parts of the head as well.

James Crow
What’s the relationship between dentists and physiotherapy for temporomandibular joint problems?

Cathy Gordon
We do work quite closely with dentists. Dentists are becoming more aware of our role in the management of TMD. About 10 years ago, I co-founded the Association of Chartered Physiotherapists in Temporomandibular Disorders with a dentist who’s very highly recognised as one of being the most prominent TMD specialists in the UK. So we set this group up to promote physio, and also to work alongside. This enables us to train physio’s and to work alongside dentists so that we can actually really form a team in this area, because we both play very important roles.

James Crow
Excellent, that’s good to hear that you’re working together, we like a combined approach. So is there much that the dentist can do in association with you? Do you liaise with them and assign exercises? Or is it more about spotting what’s going on?

Cathy Gordon
Quite often, the dentists are the first line professionals that see these people coming in with jaw problems, because they often assess the jaw when they’re looking at teeth. They either refer their patients, usually back to the GP to be referred to physio, or they sometimes refer to the dental hospital. In our situation, patients tend to get referred to the dental hospital in Manchester. And then they access physio through the dental hospital if they need to.

James Crow
I got you. So people refer to you from the dental hospital or in person by the dentist themselves.

Cathy Gordon
Yes, that’s right. Quite often the patients have, especially if they grind their teeth, they’ve already had splints made and they’ve been wearing for a while, before we actually get to see them. So we do find that that does help to reduce a lot of the pain. And then we come in by restoring normal mechanics to the joints and the muscles and also the neck as well. And we also look further down into the thoracic spine, or even the pelvis area, if we feel there any problems there that are contributing to the patient’s symptoms.

James Crow
Oh, that’s great, because that brings me to my next question, which is how would you work with someone’s posture to help these issues,

Cathy Gordon
The basis of good spinal and jaw alignment depends on optimum core muscle activation from around the pelvis and the abdominal areas as well as the upper spinal areas. I find that if we can teach the patient to switch on their core muscles, then we can often free the upper neck and the jaw areas as well as the arms and legs, because a lot of people do hold tension unnecessary tension in these areas. And I find that unless you address, globally, the muscles around the spine, the important muscles that we need to activate, we don’t often allow for that lengthening of the neck and the freeing up of the muscles of the jaw, which are often over-tense and contributing to people’s symptoms. I also find that if people have poor core strength, or don’t hold themselves well, during posture, they tend to fix with the neck and the jaw muscles. And again, this can lead to problems.

James Crow
I see. So the longer they’ve had these problems, is it harder to work with as a result?

Cathy Gordon
I find that if we can make the correct diagnosis early on, that we can actually have quite an impact quite quickly.

James Crow
Oh, that’s good.

Cathy Gordon
If we’re working with the right people, as in the dentist, if appropriate, to look at the occlusion and make sure that the jaw joint muscles and teeth are working as well as possible, then we really need to be looking at the the jaw. But also in relationship to the neck and the back and lower limbs. So once we can establish what the problems are, if there’s any joint stiffness in the spinal joints, or the neck or the jaw. If we treat that, we then can activate the muscles better. And then we can achieve good posture in that way.

James Crow
That sounds very, very helpful. So for our listeners here, some of them will be thinking, “Oh my gosh, that sounds like me, I’ve got these problems.” What advice would you offer to those people today?

Cathy Gordon
If you feel that you have pain, and the pain shouldn’t be there, and you feel that you have any of these symptoms that I’ve mentioned, or you feel that you are experiencing symptoms that you shouldn’t be experiencing, I would definitely seek some help. The dentist is often the first line professional to go visit, but you could also see your GP. If you feel that a physiotherapist is appropriate, you could try and access physiotherapy earlier on. We also see patients via maxillofacial clinics. And that is another way to access physiotherapy as well.

James Crow
So how about some psychological help? Would that be of benefit?

Cathy Gordon
I was, I think that’s a very important question to ask. And, and it’s a very important part of a multidisciplinary approach to treating TMD. Quite often a professional such as a physio or a dentist or a maxillofacial surgeon, if they feel that’s appropriate, they can make those referrals. If you feel that your symptoms are caused by excessive stress, and you feel that you need help in this area to talk your problem through to somebody, I think seeking advice from a clinical psychologist or a counsellor is very appropriate and would be very beneficial.

James Crow
Yeah, I think that sounds like a good idea if that’s one of the primary causes of TMJ issues.

Cathy Gordon
Yes, absolutely. It’s really a matter of taking an approach and actually treating all the causes. And as I say, because stress and tension is a big cause of jaw pain, that it’s a very valid route to follow.

James Crow
Yeah, that’s, that’s good to hear. And there are lots of ways that we can reduce stress and anxiety and tension in our lives such as exercising, going for walks, taking therapy, taking time for ourselves, having enough sleep. Yes, of course, looking after yourself posturally, so that you’re breathing well and you’re digesting well. Listening to podcasts with myself and Cathy, that’s always a nice way to reduce tension.

Cathy Gordon
Yes, absolutely. There are also apps such as headspace which can be very useful in teaching you how to breathe and how to relax as well. And these can be carried out on a regular basis.

James Crow
That’s right. Headspace is a very popular app, isn’t it? That’s a mindfulness app that people can download from the Apple store or from the Android store. Yes, it’s very popular with a lot of my clients as well and although I can’t listen to it myself, as I like to do my meditations on my own, those people who do use headspace have said very good things about it.

Cathy Gordon
Yes, I’ve had good reports, too.

James Crow
There you go. You heard it here first go out and meditate guys get your posture sorted, sort out your TMJ problems, the world will be a better place. Great. So there are loads of ways to find your help. It’s just a case of people getting off their butt with their terrible neck and jaw posture and finding help and seeking a solution and getting themselves sorted.

Cathy Gordon
Yes, absolutely.

James Crow
Yes. That’s good to hear. I hope that’s useful for listeners today. There’s lots of useful information there from Kathy. It’s up to you as the listener if you’re having these problems to go and seek help. It doesn’t sound from what I’ve looked at and seen on the internet that there’s that much out there that you can do for yourself. So I would advise you to go and get some help there. And it just remains for me to say thank you very much, Cathy, for taking the time to talk to us today. It’s been really enlightening. I’ve learned some good stuff there. I do hope our listeners find this useful. So thank you very much for being on the show.

Cathy Gordon
Thank you for inviting me.

James Crow
It’s been a pleasure. Cheers, Cathy.

Cathy Gordon
Bye.