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By Simon Coghlan
Facial or head pain can be unbearable. Toothache, migraine or a bad ear infection are just some causes of facial pain. A less known cause of widespread pain in the head, face and upper neck region comes from the temperomandibular (TMJ) or jaw joints.

These two joints, one either side of the face, are situated on the cheek just in front of the upper part of the ear. TMJ pain is sometimes centred right over the joints. However, because the muscles that work these joints extend over the face, skull and upper neck, pain is often widespread.

The TMJs and their muscles open and close the mouth, switching on and off millions of times every day as we speak, eat, breathe and yawn. The region can become symptomatic gradually through overuse.

Occasionally pain and movement restriction may come on suddenly. In acute cases a little disc of cartilage within the joint gets caught, blocking movement. The joint will need to be manipulated to release the disc; painful, but effective!

If suspicious of TMJ dysfunction it is worth noting what happens to pain while eating or yawning. Perhaps you avoid eating certain foods like biting into a whole apple or chewing steak. A classic symptom is grinding the back teeth while asleep (often noted by or a dentist ones’ bedfellow rather than the TMJ sufferer themselves). Grinding wears down the biting surface of the back teeth and is a sign of excessive jaw muscle activity.
A combined approach from GP, dentist and Chartered Physiotherapist is required in order to successfully address dysfunctional TMJs. For grinding, the dentist can supply a custom bite guard to be worn at night. The guard keeps the muscles from cramping and working too hard, allowing the joint and its squeezed disc to rest and heal.

A musculoskeletal Chartered Physiotherapist undertakes a comprehensive physical assessment of the painful structures, joints, muscles, and contributing postures and activities.
Clearing pain is the first priority. Medical acupuncture is a highly effective and rapidly acting pain reliever, often achieving 50% pain reduction in a single session.

Once pain is controlled therapy sessions address the mechanical dysfunction within the joint. Manual mobilisations improve how the joint moves in talking, eating and such. Incorrect muscle activity patterns that have developed over time need to be individually identified and corrected with targeted exercises. Even speech strategies may be looked at to prevent future re-occurrence of facial pain. If the dysfunction has been there for years, patience and persistence is required in rehabilitation.

Lifestyle factors impacting on TMJ dysfunction include stress, chewing gum, or fingernails, pens and pencils, all of need modification for long term success.

This complex joint presents a real treatment challenge. However the end result, a painfree face, is worth it!

Copyright TherapyXperts

Simon Coghlan MISCP is a senior Chartered Physiotherapist and Medical Acupuncturist. He practices at TherapyXperts Mount Merrion. Tel: 0818 333 611/01 2834043.
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TherapyXperts: Registered business address: Kandoy House, 2 Fairview Strand, Fairview, Dublin 3, Ireland|Phone: +353 818 333 611|Email: info@therapyxperts.ie
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