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TMJ and Myofascial Pain Syndrome Animation
The temporomandibular joint â€“ the TMJ isthe joint between the lower jawbone the mandible and the temporal bone of the skull.The TMJ is responsible for jaw movement and enables chewing, talking and yawning. Temporomandibulardisorders, or TMD, refer to a group of conditions characterized by pain in the jaw area andlimited movement of the mandible. TMD may be caused by problems in the joint itselfor in the muscles surrounding the joint. Problems in the joint include: arthritis, inflammationand internal derangements. When the problem is in the muscles, the condition is calledmyofascial pain syndrome. Myofascial pain syndrome is very common andcan occur in patients with a normal temporomandibular
joint. The syndrome is characterized by presenceof hyperirritable spots located in skeletal muscles called trigger points. A trigger pointcan be felt as a nodule of muscle with harder than normal consistency. Palpation of triggerpoints may elicit pain in a different location. This is called referred pain.Trigger points are developed as a result of muscle overuse. Commonly, the muscles of chewing,or mastication, are overworked when patients excessively clench or grind their teeth unconsciouslyduring sleep. The medical term for this condition is â€œnocturnal bruxismâ€�. A trigger pointis composed of many contraction knots where individual muscle fibers contract and cannotrelax. The sustained contraction of muscle
sarcomeres compresses local blood supply,resulting in energy shortage of the area. This metabolic crisis activates pain receptors,generating a regional pain pattern that follows a specific nerve passage. The pain patternsare therefore consistent and are well documented for various muscles.Trigger points in the masseter refer pain to the cheeks, lower jaw, upper and lowermolar teeth, eyebrow, inside the ear and around the TMJ area. Trigger points in the temporalisare also associated with headache and toothache from upper teeth. The main culprits of myofascialpain in the TMJ area are the pterygoid muscles. Trigger points in medial pterygoid refer painto the TMJ region in front of the ear, inside
the mouth and upper outside of the neck. Theymay also manifest as sore throat and difficulty swallowing. Pain from lateral pterygoid triggerpoints can be felt in front of the ear and on the upper jaw.Treatments aim to address bruxism, to relieve muscle spasm and release trigger points. Treatmentoptions include: Therapies: stress management, behavior therapy,biofeedback to encourage relaxation. Dental night guards: Splints and mouth guards to protect the teeth from damage. Medication: pain relievers, muscle relaxants,botox injections. Trigger points release techniques such asneedling and â€œspray and stretchâ€�.
Massage Tutorial Myofascial release for TMJjaw pain
I'm Ian Harvey, massage therapist. Todaywe're going to talk about jaw pain, TMJ dysfunction, all this stuff that cango on with the clicking and discomfort. This is actually very common problem. Ifyou ask any of your clients that have neck or headache or shoulder pain, quot;hey, do you also have jaw painéquot; a lot morethan you think are going to say, quot;oh yeah, I do have that.quot; We're going to startwith an anatomy review, we'll talk about this very complex joint right here, andall the muscles that surround it. Then we'll get a client on the table and I'llshow you some easy myofascial techniques
that are very effective at reducing thispain and the dysfunction, without a lot of digging or discomfort. If you'd liketo skip ahead to any section, please click on the timecodes down in thedescription. So, first of all, what is this temporomandibular joint, this TMJé Well,let's start by talking about the mandible. The mandible is your jaw righthere, and it goes up in this broad flat surface of bone called the ramus, and the ramus has tw upward projections. The more anterior projection slides under thiszygomatic arch here, this cheekbone, so it goes up under here and it makes contactwith the temporalis muscle. We'll talk
about that more in a second. You can feel this projection if you openyour jaw wide, which I don't recommend if you've got jaw dysfunction yourself.There it is. And that's called the coronoid process. Posterior to that we'vegot another projection upward of the ramus, this is called the condyle of themandible, and this is the one that makes contact with the temporal bone formingthat temporomandibular joint. Now this is both a hinging and glidingjoint, it's a very mobile joint, and that's one reason why it can get intotrouble. And, one reason why it's so
mobile is because it's got an articulardisc in here. It's this little disc of fibrocartilage that's embedded withinthe joint space, and it allows this joint to do all sorts of fun tricks, like protrusion and sliding from side to side. And this disc actually interfaces with of your muscles of mastication, thelateral pterygoid muscle, and it can get pulled out of place, just during normalmovements of mastication (otherwise known as chewing), or while you areunconsciously clenching your teeth or grinding your teeth, known as bruxism. Now,our mission isn't to fix this disc, it
isn't to shove this disc back where it belongs. It's to reduce this high tension situation that's happening across thisjoint. And by doing that, that disc will start resuming its normal function. Ifind that getting this high tension situation to calm down will do the workfor us. There's nothing specific that we need to do to change this joint. The twomain muscles that we're going to be worrying about today are the masseter, themasseter is actually a twoheaded muscle, we're not going to worry about theindividual heads. It originates from this zygomatic arch, and it goes down ontothe entire ramus, and down to the angle
of the mandible. So it's a very broadinsertion. And it's a very interesting and convoluted muscle. If you feel lumpsand bumps and taut bands across here, don't assume that you found a trigger point,this is just a very lumpy bumpy muscle. And we've also got the temporalismuscle. The temporals has a very broad origin up here on the lateral skull,it covers the temporal bone, and it's in this temporal fossa. And the big broadfan of this muscle, it narrows narrows narrows down into a tendon that passesunder that zygomatic arch and makes contact with that coronoid process. We'vealso got pterygoid muscles which are