If you’ve ever had pain in your jaw (or currently have pain in your jaw) you’re not alone! According to the National Institute of Dental and Craniofacial Research, the prevalence of jaw pain is about 5-12% of the population. It is more common among individuals aged 20-40 years and is about twice as common in women as men. Jaw pain can range from a mild annoyance to something which is so severe that it limits an individual’s ability to talk, eat, and brush their teeth. Many providers - physicians and dentists alike - don’t quite know the best way to address their patients’ jaw pain, and many people have no idea that physical therapy can be so helpful in treating this condition. Before I tell you how physical therapy can help, let’s get a little better understanding of the anatomy of the jaw and the various things that can go wrong.
When we talk about jaw pain, we are usually referring to the temporomandibular joint, known as the TMJ for short. You can feel this joint just in front of your ears, try it! Place your fingers at the back part of your cheekbone just in front of your ear and open and close your jaw. That’s your TMJ! A fun fact is that you can also feel the TMJ move if you put your finger just inside the tragus of your ear, which is the little cartilage flap on the front of your ear. If you place your finger just on the inside of that and open and close your jaw, you can also feel your TMJ moving. The joint you’re feeling joins your mandible (jaw bone) to the temporal bone of your skull. There is an articular disk that separates the two joint surfaces.
When you come to physical therapy for jaw pain, you might be told that you have temporomandibular dysfunction (TMD for short.) This just means that something in that joint, or the structures surrounding that joint, isn’t functioning properly. Symptoms of this can be pain, clicking, popping, grinding, clenching, or tightness. It is important to note, though, that popping or clicking on their own don’t necessarily mean that something is wrong and that you need to seek treatment. In the absence of any other symptoms (such as pain or tightness,) clicking and popping can be just fine. Sometimes, you can also get symptoms which might not seem directly related to your jaw but can be associated with jaw dysfunction. These can include neck pain or stiffness, headaches, ringing in the ears, and even dizziness. These symptoms can be caused by dysfunction of the joint, the muscles around the joint, the articular disk, or any combination thereof. Your physical therapist will help narrow down which structures to focus on based on tests and measurements performed at your first visit, as well as from taking a thorough history to better understand how your symptoms began.
Treatment for TMJ pain often includes a combination of techniques including joint mobilizations, soft tissue techniques, home exercises, and even dry needling. Your therapist will tailor your exact treatment plan to you based on their findings at your initial evaluation. With this individualized treatment plan, physical therapy can be highly effective at treating any unpleasant jaw symptoms you might have!
Heather Shaughnessy, PT, DPT
Simply put, the deep neck flexors are the equivalent of the core for the neck. When we think about our core, we often are referring to our abdominal muscles in the trunk. These mostly support our low back or lumbar spine. The good news is that we have similar supportive musculature for our neck - the deep neck flexors!
There are two main muscles that make up the deep neck flexor group: the longus capitis and the longus colli. In as lay terminology as possible, the longus capitis muscle attaches from the base of the skull to the front side of vertebrae from C3-C6 and the longus colli muscle runs along the front of the spine from C3 down to T3. Any rehabilitation that is focused on improving a forward-head / rounded shoulders posture or any rehabilitation from a neck injury should include some form of exercise for these muscles. The typical exercise is something we call the “chin tuck.” I often refer to this as “the sit up for the neck.”
The challenging part of this deep neck flexor group is being able to isolate and access it without recruiting other neck musculature. When you truly look at the anatomy of the neck, you can see that this deep neck flexor group is named such because it lies “deep” to the esophagus and trachea. This is where the challenge of access comes into play because there are many muscles that work easily but are “superficial” to the esophagus and trachea. These muscles are used for swallowing, talking, chewing, etc. So, in physical therapy, we need to teach our patients how to turn those muscles off and turn the deeper ones on!
We learn in physical therapy school that strong deep neck flexor muscles are able to hold a chin tuck and lift position for 30 seconds. In my 8 years of working as a physical therapist, I can attest that upon initial evaluation of these muscles I have never had a patient be able to do that. With practice and guided exercise, my patients are able to strengthen this unique muscle group and this ultimately leads to improved stabilization of the neck. This equals significantly less neck pain and improved posture.
Most of our patients understand the importance of core strengthening to help maintain health and reduce injury in the low back. The same holds true for the “core of the neck.” If you have any questions or feel like this is an area of your routine that you are missing, any physical therapist at Altitude would be happy to help you properly learn how to strengthen this deep neck flexor group. It’s a small group of muscles but they sure are important!
Lisa Corken, PT, DPT
Bob Cranny, PT