Temporal mandibular joint dysfunction is one of those issues similar rotator cuff problems in that we all have it, it’s a question of how bad is it. At some point Western medicine will consider patient’s complaint classifiable as TMJ: basically when you go to a doctor and complain.
Like any chronic pain, there is a ‘sponsoring pattern’ to TMJ, at least in LMD’s view and in bodywork’s view in general.
Definitely in LMD’s view, begin with the SI joints, looking to get movement and balance in them. Analyze the movement and balance in the ankles, feet, and hips. In a client with TMJ, it is highly unlikely the SI joints are issue-free, and so any anomalies in ankles, feet, and hips are directly related to the TMJ.
No surprise, psoas-iliacus-diaphragm will be integral players in TMJ, count on it. Go slow, be thorough (see last week’s blog for reference).
For those of you who have taken our Advanced Tensegrity Techniques course or my Patterns class at WMTI, TMJ is really a part of the #2 Lever. Briefly, the #2 Lever is focused on Occiput, C/1 and C/2, but it includes the dynamic of how the forces of the arms and the balance of the head interplay, and how the body deals with them.
Appreciate, or begin to appreciate, how much the emotions will always be a factor in every issue that plays out in our bodies; certainly with TMJ, which is probably directly a stress issue. We have an emotional response to everything. The primary way a massage therapist makes progress with the client’s emotional factor in any situation is to elicit as powerful a parasympathetic response as possible. We will reiterate this in many of these articles, and will devote an entire future article to the subject.
There are four areas I believe are of particular significance in TMJ: the masseter, temporalis, sternocleidomastoid (SCM), and pectoralis minor, all bilateral. Always go through these with particular attention – go slow and be thorough.
Some tips for these areas are:
- With the masseters, the classic finger stripping works fine. My two favorites are using the base of my palm just below the zygomatic arch, working the tissue down and around, and combining that with a Floating Joint-type following of any joint movement. I use this move in virtually every treatment; with TMJ I spend more time and pay more attention.
- Finger stripping and palm circles work fine on temporalis; again take more time with TMJ and absolutely include the ears. Work them thoroughly within the client’s comfort zone. A Floating Joint technique for the ears is to pull straight out on them, feel the connection between them through connective tissue, and look for balance.
- The classic ‘pinching’ of the SCM’s between the therapist’s thumb and side of the index finger is probably the most effective technique. Shorten the SCM by rotating the head away from the one you are working, and flex the head. Add mobilizations as the tone of the muscle softens. (Note: if head mobilizations make the client dizzy or nauseous, the eustachian tubes are congested – I have never seen it otherwise. Hold the head still or leave it still on the table while you work the lateral neck muscles. I always suggest the client ices the side of the neck post-Tx, or do it during Tx.)
- Pec minor very often doesn’t get the massage attention it deserves, especially in female clients. After working pec major, address pec minor thoroughly. Finger stripping is fine: I also like using the base of my palm and working both same side and contra-laterally. Mobilize the entire shoulder while you work into pec minor; you can put one hand under the shoulder blade while working into the muscle with the other. Come at pec minor from as many directions and angles as you can think of.
Beyond these, rib cage work and mobilizations are always a good idea. Any relaxation techniques will be absolutely indicated, as long as they get a parasympathetic response from the client, so pay attention to his/her reactions. Floating Joint of the head, arms, and shoulders should work great.
As always, thanks for reading, love to hear from you.