TMJ And
Brain Therapy
© 2005 Dr. Barry R. Gillespie
The temporomandibular joint (TMJ) is the most important
joint in the body.
Without it, we would have trouble talking, chewing, swallowing,
kissing, and other necessary life functions. This article
will explore why the TMJ becomes very important for us with
our touch therapies.
Evaluating A Client For TMJ
When evaluating a client for TMJ, you want to check for any
popping, clicking, or cracking in the joints themselves.
This can be palpated by placing your fingertips in front
of the ears over the head of the mandibular condyles, while
the client is opening and closing her mouth. This noise usually
indicates that the lateral pterygoid muscles are not functioning
correctly.
When these muscles contract, the jaw will open. Anatomically,
the lateral pterygoid muscle has an upper head that inserts
into the articular disc (the cushion between the mandible
and the cranium) and a lower head that inserts into the head
of the mandibilar condyle.
When the jaw opens, both should contract together in sync.
If they don’t, this disc may momentarily slip and cause
a noise that we hear clinically. If there has been chronic
damage to the disc, the noise will probably not stop, even
with your best efforts in therapy.
Key Muscles For The TMJ Client
The lateral pterygoids and masseters are key muscles for
the TMJ client. The former can be very hot upon palpation;
the latter can be very knotty from years of clenching and/or
grinding the teeth.
I will show the client how to massage these muscles on her
own.
When she opens her mouth, it should be vertically straight,
not zigzagged. She should be able to put 3 fingers (about
52 millimeters) in her mouth with an average opening. When
you look in the mouth, the dentition should be intact. A client
with missing teeth, tilted teeth, and dentures may tend to
have a collapsed or over-closed bite and can be more prone
to TMJ problems.
Clenching And/Or Grinding Teeth
The biggest factor that creates a TMJ problem is the clenching
and/or grinding of the teeth.
During the 1980s and 1990s I was on the Board of Directors
of The American Academy of Craniofacial Pain. We sponsored
two large meetings every year discussing TMJ subjects. Usually
at each one a psychologist would talk about the non-physical
aspects of TMJ.
For years I privately asked the wisest experts in the field
why people clench and/or grind their teeth.
No one knew the answer.
Clenching the teeth can place a tremendous amount of pressure
on the brain and its cycle of motion. With most structural
problems, situations like car and other accidents happen
to people. But since clients do this to themselves; they
have no one else to blame.
The Power Of The TMJ
A great exercise to show the power of the TMJ is to feel
a client’s brain motion. While you are following that
very slow, long brain cycle, ask the client to clench her
teeth. For most people the brain will immediately stop. The
lights will go out!
When you have the client release and relax her jaw, the brain
will continue its motion from that point in its cycle. The
lights will go on again!
The TMJ has the incredible power to turn the craniosacral
mechanism on and off. The anatomical rationale is that the
mandibular condyles can put abnormal stress on the temporal
bones in the joint area, causing them and the brain to restrict
its motion.
Dental Work And The Sacrum
A second exercise is to palpate the sacrum moving in flexion
and extension. When the client clenches, most sacrums will
similarly come to a dead stop. When the client relaxes her
jaw, the sacrum will continue its motion.
This shows you how dental work can directly affect the pelvic
structures. It also gives scientific rationale for a client
who is clenching or grinding his teeth all night and wakes
up with lower back pain for no apparent reason.
The Perfect Height
For A TMJ Appliance
A third exercise involves the use of tongue depressors.
For the above client who clenched her teeth and her brain
restricted, now ask her to clench on two tongue blades, each
placed over her left and right lower molars. The brain will
respond nicely for most people. This represents the average
height of a TMJ appliance (about 1.5 mm). If you raise the
bite two sticks on each side, the brain will probably restrict
again because it is too high.
When the dentist makes the lower TMJ appliance, it has to
be at a perfect height. You will need to check it to make
sure it is in concert with the moving brain.
You can do all of the craniosacral, fascial, muscle, and
TMJ therapy in the world – if the appliance is not working
correctly, all that therapy can be for naught.
Remember that we want a lower TMJ appliance because an upper
one may jam the maxillary bones, the craniosacral mechanism,
and the motion of the brain. There is only one goal for the
TMJ appliance that you should have in your mind: when the
client now clenches her teeth, the brain should still retain
its beautiful motion.
Any massage therapist who does structural therapy needs
to be aware of the importance of the TMJ. As you see clients
with this problem, you will need to work with a brain friendly
dentist who can fit a TMJ appliance and do restorative dentistry.
When you integrate the TMJ into your modalities, you will
find that you will be a more effective therapist with more
consistent results. © 2005
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