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Physical Therapy

Dry Needling for Temporomandibular Joint Disorder (TMJ)

September 21, 2020
By Health Loft

Dry Needling for TMJ (Temporomandibular Joint Disorder)

The National Institute of Health reports that every year 5-12% of the population will suffer from temporomandibular joint and muscle dysfunction. This condition causes significant pain and debility leading people to search for any relief possible. The good news is that this condition can be treated with dry needling and physical therapy.

 

What is Dry Needling?

Dry needling is a technique used in physical therapy to deactivate trigger points (muscle knots), therefore decreasing pain and increasing range of motion. This technique uses a thin needle to penetrate the skin and muscle fibers. The treatment itself can be mildly painful but improvement in symptoms is normally noticed within the first treatment session. Ordinarily, dry needling is performed as part of a physical therapy treatment plan and may need to be repeated on more than one occasion.

 

What is TMJ?

One of the conditions dry needling has been shown to help with is temporomandibular dysfunction, frequently known as TMJ, TMD, or TMJD. The temporomandibular joint (TMJ), is the joint where the jaw bone (mandible) meets the skull (temporal bone), located in front of each ear. The movement at this joint allows the jaw to move up and down, right and left, in and out. Surrounding this joint is a large collection of muscles that are responsible for chewing, and assist with talking as well as breathing. To complicate matters a little more, there is also a large nerve (the trigeminal nerve) that enters the face in this area that can cause pain itself if it becomes irritated. 

When pain develops around the TMJ then it is frequently diagnosed as temporomandibular dysfunction (TMD) or temporomandibular joint dysfunction (TMJD). Pain from this complex anatomy paired with the frequent use of this region can lead to debilitating symptoms. Common symptoms include pain with chewing, headache, limited mouth opening, and facial pain. 

Numerous factors can lead to TMD, such as habitual behaviours (i.e. teeth clenching), stress, anatomical variations, and trauma. There are three different classifications of TMD:

  • Type I dysfunctions are muscle disorders. 
  • Type II dysfunctions are subdivided into IIa and IIb
    • The distinction is related to the movement of the disc between the jaw bone and skull bone when the jaw is opened then closed. This disc is responsible for shock absorption when chewing and enhancing the gliding of the jaw bone. The disc should move with the jaw bone, however it can be displaced and no longer return to its resting position when the jaw is closed. 
  • Type III dysfunctions are related to true joint pain which is pain from the bones or ligaments surrounding the joint. 

 

How can Dry Needling help with TMJ?

Since dry needling is able to decrease pain caused by muscles, it is helpful in treating Type I TMD. Frequently, when dry needling is used to treat TMD, three muscles are targeted: the lateral pterygoid, the masseter, and the temporalis.

  • The lateral pterygoid is responsible for pulling the jaw bone forward helping to open the mouth. 
  • The masseter is responsible for pulling the jaw bone up or pushing the teeth together for chewing. 
  • The temporalis has two sections, one is responsible for opening the mouth and the other is responsible for closing the mouth. 

Inserting the needle into various “trigger points” in the musculature will allow the musculature to “relax” and subsequently a reduction in pain will be experienced.

A recent review of treatments for TMD showed that dry needling improved pain and reduced sensitivity to touch (pain pressure threshold) better than alternative treatments. Another group of researchers looked at multiple studies regarding dry needling for TMD and found that dry needling demonstrated significant improvement in pain and function. Additionally, dry needling as part of a comprehensive physical therapy treatment plan has been proven to improve pain, function, and increase maximal mouth opening.

 

Additional Physical Therapy Treatments for TMJ

Though dry needling is an effective treatment for TMD, physical therapists have multiple proven treatments up their sleeve to help relieve pain from TMD. 

Manual therapy and joint mobilization for TMJ

Physical therapists are trained to use their hands to help move joint structures or muscle tissues to reduce pain and improve range of motion, this is called manual therapy. Specifically for TMD, multiple studies have shown that mobilizing the temporomandibular joint can reduce pain and improve mouth opening. Additionally, mobilizing the neck and upper back has demonstrated improvement in functional outcomes and reduced pain in persons with TMD.

Exercise for TMJ

There is some research to support strengthening of muscles around the TMJ to reduce symptoms. To know if exercise is appropriate for you specifically, a licensed physical therapist can perform an evaluation and examination for any strength discrepancies that may be related to your pain. Furthermore, a physical therapist is able to prescribe individual exercises to retrain poor habits linked to TMD.  For more information, check out our article on exercises for TMJ. 

Posture Examination and Training

Neck and head posture has been shown to be related to TMD. Categorically, people with TMD are more likely to have increased neck angles, meaning their head sits farther in front of their shoulders, compared to people without TMD. Physical therapists are experts in movement and posture. They are able to determine the optimal posture for an individual, as well as creating a plan to achieve the optimal posture.  For more information, check out our article on posture.

For an individualized treatment plan to help you with your TMJ disorder, consult with one of our physical therapists in Chicago (virtually via our telehealth platform or in person) by calling us at (312) 374-5399 or by scheduling an appointment online. If you have further questions regarding dry needling, we would also be happy to answer them.  Remember to also check out our FacebookInstagram, and Twitter pages for more fun facts and articles on nutrition, physical therapy, and exercise!

 

Submitted by Kellie Stickler
Reviewed by James Caginalp PT, DPT, CSCS, CES, PES

 

REFERENCES

  1. National Institute of Dental and Craniofacial Research. (2018, July). Prevalence of TMJD and its signs and symptoms. National Institute of Health. https://www.nidcr.nih.gov/research/data-statistics/facial-pain/prevalence.
  2.  Butts, R., Dunning, J., Perreault, T., Mettille, J. & Escaloni, J. (2017). Pathoanatomical characteristics of temporomandibular dysfunction: Where do we stand? (Narrative review part 1). Journal of Bodywork and Movement Therapies, 21(3):534-540. doi: 10.1016/j.jbmt.2017.05.017.
  3. Vier, C., Almeida, M.B., Neves, M.L., Santos, A.R.S.D & Bracht, M.A. (2019)The effectiveness of dry needling for patients with orofacial pain associated with temporomandibular dysfunction: a systematic review and meta-analysis. Brazilian Journal of Physical Therapy, 23(1):3-11.doi: 10.1016/j.bjpt.2018.08.008.
  4. Butts, R., Dunning, J., Pavkovich, R., Mettille, J. & Mourad, F. (2017). Conservative management of temporomandibular dysfunction: A literature review with implications for clinical practice guidelines (Narrative review part 2). Journal of Bodywork and Movement Therapies, 21(3):541-548. doi: 10.1016/j.jbmt.2017.05.021.
  5. González-Iglesias, J., Cleland, J.A., Neto, F., Hall, T. & Fernández-de-las-Peñas, C. (2013). Mobilization with movement, thoracic spine manipulation, and dry needling for the management of temporomandibular disorder: a prospective case series. Physiotherapy Theory and Practice, 29(8):586-595. doi: 10.3109/09593985.2013.783895.
  6. Joy, T.E., Tanuja, S., Pillai, R.R., Dhas Manchil, P.R. & Raveendranathan, R (2019). Assessment of craniocervical posture in TMJ disorders using lateral radiographic view: a cross-sectional study. Cranio: the Journal of Craniomandibular Practice, 13:1-7. doi: 10.1080/08869634.2019.1665227.
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