Correcting Asymmetry & Joint Compression in TMJ ...€¦ · Craniomandibular Complex TMJ Mastery Principles, Applications and Disc Displacement A 2-day workshop focusing on intra-oral

Correcting Asymmetry & Joint Compression

in TMJ Dysfunction

John W. Corry, RMT

[email protected]

� Mastery is a lifelong process in which focus is given to

a specific subject in order to cultivate expertise.

� Ironically, the process is often humbling as each

revelation leads to many more inquiries.

� Introduction; Why address TMJ Dysfunction?

� A review of the Craniomandibular Complex� Cranial bones

� Muscles of Mastication – our domain

� The role of occlusion

� Voice, breath and expression

� Assessing Symmetry; The foundations of proper function.

� Providing effective intra-oral access.

� Practice building and networking with other health care

providers; Dentists, Speech-Language Pathologists, Physiotherapists, Chiropractors, MD’s, etc

� TMJ hypertonicity is extremely prevalent!�72% of surveyed in March 2007 people clenched their teeth.

� Trauma, assault, MVC, and sport clients often have TMJ

issues overlooked by many different practitioners.

� TMJ dysfunction is often a silent contributor in cases of

headache, scoliosis, and MVC.

� TMJ dysfunction is frequently found in clients where stress and “busy mindedness” is present.

� TMJ work will open networking possibilities with Dentists, Speech-Language Pathologist, Chiropractors, voice coaches, etc.

� It is easy on therapists, and will therefore offset other techniques that are taxing.

� Dovetails well with other modalities; Myofascial Release, CranioSacral Therapy, etc.

� It is unique in the profession of Massage Therapy! Therefore it provides an edge to networking and building a clientele.

Three Main Components:1. Cranial bones – remember

they move!

2. TMJ’s, Articular Disc & the

muscles of mastication

3. Occlusion (how the teeth fit

together)

Stages of opening showing

condylar hinge and then glide

forward

� The mandibular fossa of the Temporal bone

� Craniosacral Therapy informs us that their symmetrical position and movement is integral to proper TMJ function

Asymmetrical hypertonicity of the Medial Pterygoid muscles will influence the Sphenoid’s balance along

the mid-sagittal plane.

Temporalis Muscle; “has been almost completely

overlooked.” J. Upledger

Masseter muscle;

The Power Chewer

Medial Pterygoid:

The Function chewer

Lateral Pterygoid; Conjoined twins with opposing function

Muscle Action Insertion

Inferior Lateral Pterygoid Opens; condyle forward &

down

Neck of condyle

Superior Lateral Pterygoid During Closing (chewing

or “Power Stroke”)

(anterior pull on Articular

Disc matching Retrodiscal

Lamina) 1

30% to 40% to Articular

Disc, remaining 70% to

neck of condyle

1: Okeson, Jeffrey P: Management of Temporomandibular Disorders and

Occlusion, 5th Edition: Lexington, Kentucky,2003

To order 6th edition:

http://www.us.elsevierhealth.com/product.jsp?isbn=9780323046145

Anterior & Posterior bellies

� Along with the Inferior Lateral Pterygoid the Digastric muscles open the mouth.

� Fulcrum around the hyoid bone, which connects it to voice issues!

� Attachment to mastoid process makes it another influence on the temporal bone symmetry!

� Shown as #2; the articular

disc sits on “top” of the

condyle providing important

guidance during opening

and closing

� Like vertebral discs, its job

is to take up a prescribed

amount of space – forces of

clenching and grinding lead

to diminished space and

contributes to anterior disc

displacement.

� The hypertonic Medial Pterygoid m. lying over the inferior alveolar nerve can be a site of soft tissue nerve compression – mimicking tooth ache where the nerve is employed.

� Caution; cases of Trigeminal Neuralgia show up as TMJ Dysfunction –refer to MD for meds!

A relaxed jaw:

“lips closed – teeth open”

� A complex subject in the

domain of Dentistry

� Malocclusion often sited as

a primary contributor to

TMJ Dysfunction and

related headaches

� Until recently, many years

of Orthodontic applications

negated the awareness that

the cranial bones move!

Treating the mandibular sling;

� decrease/resolve hypertonicity

� restore joint space

Great view from beneath!

� Mandibular Sling; the

Masseter m. and the Medial

Pterygoid m. wrap around

the ramus of the mandible

with fascial continuity.

� Like the humerus, the

mandible is suspended by

soft tissue and is therefore

primarily affected by soft

tissue injury or dysfunction.

� While palpating active opening and closing ask,

“Which side is delayed?”

� No more tracking the mandibular wobbles!!

� The condyle that is delayed has accumulated more

compressive joint forces – clenching, grinding, trauma,

etc.

◦ The delayed side has been under-employed

◦ The other side has been over-employed – pain, tenderness, etc

◦ Similar to SI

Knowing which side is delayed

creates a treatment plan;

informs MT which muscles need work to

restore symmetry and joint space!

Motion Palpation of TMJ’s opening

and closing , “Which side is delayed?”.

“How To” . . . provide treatment for TMJ Dysfunction could never be taught effectively without live

instruction!

Proceed to a few visual

demonstrations.

Masseter muscle & Medial Pterygoid muscle

Wearing Nitrile glove

� Reaching across to contra-

lateral masseter m. allows

pad of thumb to explore

intra-orally.

� Outside fingers complete a

myofascial approach

� Incremental; 20 to 40

second intervals of access,

repeat right and left

� Effectiveness is achieved

by repetition – not

duration!

� First, find the ridge at the front of the mandible; Pterygomandibular Raphe

� Have the client rest their teeth on your finger –un-employ the muscle.

� Wait – 3 to 5 seconds!

� Gag reflex lives there, allow client to become familiar with contact.

Reaching the red line is full

access – then treatment begins.

� Proceed medially from hard

bone to soft tissue – YOUR

THERE!

� Flex your DIP joint to find

and engage superficial

resistance in the tissue –

count aloud for client,

“5,4,3,2, 1 and I’m out”

� Repeat left and right to

accumulate release.

� Effectiveness is achieved by

repetition, not duration!

Proceed to de-compress the joint

space – “invites” the articular disc to

return to rightful position.

� By pushing downwards on

the rear lower molar, with a

slight lift to the chin, the

condyle can be gently

tractioned .

� N.B. The client must rest

their teeth on your thumb as

any employment of

masticating muscles will

sabotage the line of traction.

Downwards on the molar, slight lift to the chin.

� The outside hand palpates

the TMJ to feel the joint

space opening.

� This determines the amount

of decompression force

needed from client to client.

� Engage decompression

force, stop a moment, then

re-engage.

� Our goals are to decrease hypertonicity in the

masticatory muscles, and restore joint space.

� Accessing the Masseter m. is easy, but mastering the

access of the Medial Pterygoid m. is the Gold Star!

� Treating both is addressing the Mandibular Sling – this

is unique to the profession of Massage Therapy!

� Remember – The Mandibular Sling is only a

component in the whole operation of the

Craniomandibular Complex

TMJ MasteryPrinciples, Applications and

Disc Displacement

A 2-day workshop focusing on

intra-oral techniques exploring masticatory dysfunction.

(7 CEU’s - CMTO)

John W. Corry, RMT

(519) 433-6156

[email protected]

“Feel free to contact me for further

discussion on this intriguing subject”.

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