Over the years we have received our fair share of emails from patients seeking treatment for their TMJ. In many of these emails, the sender will describe to us osteoarthritis of the jaw that came as a result of a traumatic injury such as a jaw dislocation during a hockey game or a dislocation or a fractured jaw from an accident. Some will write that their TMJ problems developed when they had some wisdom teeth removed. Others will suggest that TMJ came upon them slowly as a degenerative joint disease. This article will focus on the later, the connection of degenerative TMJ and degenerative cervical disc disease.
When TMJ has its root in cervical spine disorders
TMJ can develop from a combination of slow moving inter-related factors, sometimes starting with poor head posture that contributes to the stretching and weakening of the cervical spine ligaments and lateral TMJ ligaments. As a result of these degenerative changes, the lower jaw slips forward and creates a worsening of the patient’s problems. Like the people I described above, who had an acute event that began their TMJ problems, people who develop TMJ over time can also experience loud popping or the clicking of bones rubbing together in the loosened joint, accompanied by pain and stiffness as the muscles tighten, trying to compensate for the instigating laxity.
Many people with TMJ have a neck problem.
There is a lot of research connecting TMJ to neck pain and cervical spine instability. This research agrees with what we have seen in our clinical practice. Many people with TMJ have a neck problem.
In January 2020,(1) researchers in Switzerland announced that they were embarking on a study to assess the evidence of association of cervical spine signs and symptoms with temporomandibular disorders. They noted “the association of cervical spine impairments (in relation to neck posture, cervical spine mobility, muscle tenderness, muscle activity and neck disability) with temporomandibular disorders has been widely discussed in the literature. Clarification of this relationship is important for health professionals to better assess and treat temporomandibular disorders.”
In our more than 25 years experience in helping patients with TMJ, we have seen many patients that needed a better assessment of their TMJ pain.
When TMJ makes neck pain worse, when neck pain makes TMJ worse
We see a lot of patients where traditional TMJ treatments such as night appliances, bite guards, pain medications, et al, did not provide relief. The question is why? Sometimes, after an examination of the patient’s head, jaw and neck, we find that many of these patients have a cause and effect relationship where their neck pain and neck instability is causing and affecting a worsening of their TMJ problems. Their neck is hurting their jaw.
In these patients we find that pain can be traced to soft tissue damage and weakness in the back of the skull, the cervical vertebrae facet joints, the cervical neck ligaments, and the cervical neck muscles. The idea of cervical neck problems causing TMJ problems are not a new idea. In a study published in the journal Clinical Oral Investigations (2) researchers found that 31 consecutive patients with symptoms of TMJ indicated stability problems at the C0-C3 vertebral levels and tender points in the muscles of the cervical spine.
In 2003 study found that instability in the cervical spine impacted TMJ problems.(3) The researchers of this study found that in many TMJ patients the right and left masticatory muscles were so badly imbalanced that they were causing the cervical spine to become displaced and distorted the patient’s posture.
In 2016, researchers added (4) to this line of study by studying whether neck strengthen exercises would relive jaw pain in patients with temporomandibular
Why are the cervical neck muscles not more full explored when treating patients with TMJ?
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References:
1 Balthazard P, Hasler V, Goldman D, Grondin F. Association of cervical spine signs and symptoms with temporomandibular disorders in adults: a systematic review protocol [published online ahead of print, 2020 Jan 8]. JBI Database System Rev Implement Rep. 2020;10.11124/JBISRIR-D-19-00107. doi:10.11124/JBISRIR-D-19-00107
2 De Laat A, Meuleman H, Stevens A, Verbeke G. Correlation between cervical spine and temporomandibular disorders. Clinical oral investigations. 1998 Aug 1;2(2):54-7.
3. Shimazaki T, Motoyoshi M, Hosoi K, Namura S. The effect of occlusal alteration and masticatory imbalance on the cervical spine. The European Journal of Orthodontics. 2003 Oct 1;25(5):457-63
4 Calixtre LB, Grüninger BL, Haik MN, Alburquerque-Sendín F, Oliveira AB. Effects of cervical mobilization and exercise on pain, movement and function in subjects with temporomandibular disorders: a single group pre-post test. J Appl Oral Sci. 2016;24(3):188-97.
5 Fougeront N, Fleiter B. Temporomandibular disorder and comorbid neck pain: facts and hypotheses regarding pain-induced and rehabilitation-induced motor activity changes. Canadian journal of physiology and pharmacology. 2018 Aug 1;96(11):1051-9.
6 Lee IS, Kim SY. Effectiveness of manual therapy and cervical spine stretching exercises on pain and disability in myofascial temporomandibular disorders accompanied by headaches: a single-center cohort study. BMC Sports Science, Medicine and Rehabilitation. 2023 Dec;15(1):1-1.
7 Greene CS, Manfredini D. Transitioning to Chronic TMD Pain: A Combination of Patient Vulnerabilities and Iatrogenesis. J Oral Rehabil. 2021 May 9. doi: 10.1111/joor.13180. Epub ahead of print. PMID: 33966303.