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As a result of a tremendous exposure to stress, the development of
temporomandibular joint (TMJ) disorders has reached pandemic
proportions. TMJ sufferers experience high-intensity headaches,
difficulty with chewing, painful joint clicking and popping, and other
symptoms. With the progression of the pathology, individuals may even
develop sleep disorders.
TMJ Anatomy: The
TMJ is formed by the temporal and mandibular bones. Attached to the
mandibular condyle is a fibrocartilage meniscus or articular disk,
which allows the mandible to move smoothly. The masticatory muscles
(temporalis, masseter, lateral pterygoid, and medial pterygoid) are
responsible for movement and stabilization of the TMJ.
Bruxism:
Due to stress, people often develop bruxism. Bruxism is a pathological
clenching and grinding of teeth that usually occurs during sleep.
Bruxism is caused by the hyperactive contraction of the masticatory
muscles. Imagine any other muscles in our support and movement system
kept under tight contraction for seven hours. Pathological hypertonus
in these muscles will be formed, followed by restriction of range of
motion, trigger point development, and other symptoms. With time,
hypertonic condition in the masticatory muscles leads to the
development of osteoarthritis in the TMJ, including negative effects on
the articular meniscus. In such a case, the above-mentioned TMJ
pathology starts producing severe headaches and painful "clicks."
Massage therapy and Post-Isometric Relaxation Techniques for TMJ Disorders:
Massage therapy should be focused toward the reduction of tension in
the masticatory muscles, releasing tension in fascia, and elimination
of trigger points. Post-isometric relaxation is an extremely important
tool for the restoration of the range of motion. Massage therapy steps
for TMJ:
Client is first positioned face down on the stomach
1. With the tips of the fingers, bilaterally, in circular motion, massage the neck area for 41/2 to 5 minutes.
2. Place the tips of the fingers around
the occipital bone. Under gradually increasing pressure, perform
massage on the insertion of the cervical muscles into the skull for
31/2 to 4 minutes.
3. Place both fists on top of the
trapezius. Under gradually increasing pressure, perform massage on top
of the trapezius for 30 seconds to 1 minute.
4. Ask the client to relax his/her jaw
to the extent possible. With the top of the fingers, bilaterally,
massage all the masticatory muscles for 5 to 7 minutes.
Client is then positioned face up on the back
5.
Ask client to open his/her mouth as wide as possible. Place the thumb
on the chin. With the other hand's fingertips, perform massage on the
masticatory muscles underneath, stretching for 5 to 7 minutes. Massage
each side separately, spending no more than 3 to 4 minutes on the
unaffected side.
6. Ask client to open mouth approximately 15 degrees. Place both thumbs
on the chin. Ask the client to close the mouth while you provide
resistance. Hold the masticatory muscles under isometric tension, for
approximately 30 seconds.
7. With exhalation, passively stretch all masticatory muscles.
8. Repeat steps six and seven twice more.
9. Trigger point therapy must be applied to every localization found.
Mechanisms of Trigger-Point Therapy:
A trigger point is a localization of pain. It can be found in muscles,
periosteum, tendon attachment points to bone, as well as near
muscle-tendon junctions. Even given the fact that most typical trigger
points are developed in the middle of the muscle belly, at the place of
nerve-muscle junction, I recommend two ways for discovery of trigger
points: First, ask the patient to point to the exact localization of
pain (trigger point); second, at the time of performing kneading and
myofascial tissue release, ask your client to let you know if they feel
a sharper level of pain under your fingers, which will be the trigger
point.
The main mechanism of trigger point therapy is
ischemic compression. Automatically, we can assume that in the area of
the trigger point, arterial blood supply is significantly decreased. By
gradually compressing the trigger point and reaching the threshold of
pain, we additionally decrease this blood supply to the point. After 10
seconds of this ischemic compression, we ask our client to report their
ability to tolerate additional compression (please do not overdo this
pressure; stop at a pressure that your client indicates is sufficient,
and do not increase it.
Do not increase the pressure if muscles demonstrate protective
contraction to the pain sensation.) After 20 additional seconds of
compression, quickly withdraw your fingers. While performing ischemic
compression of trigger points, arterial blood will accumulate around
the compressed point. With the fast withdrawal, arterial blood will
rush to the area of the trigger point, and a vasodilation reflex will
be awakened.
Mechanism of Post-Isometric Relaxation:
One of the factors responsible for the restriction of range of motion
is an energetic unbalance inside of the muscles, which is expressed in
the form of different tension levels in the fibers of the same muscle.
Imagine that in the same muscle, a portion of the fibers is in
pathological hypertonus and the rest is in normal tonus. Every movement
will increasingly overload the contracted part of the fibers.
This, of course, will cause a higher level of pathological accumulation
of tension. At the time of isometric contraction, the fibers of the
muscle are actively stretched, which leads to a balancing of the tonus
between different fibers in the muscle. After 30 seconds of isometric
tension following post-isometric relaxation (stretching), Golgi organs
are activated, which in turn will contribute to normal tonus in
muscles. In such a case, the muscle will be able to produce adequate
energy during contraction and relaxation. The above-mentioned positive
changes in muscular tissue will help to restore normal range of motion.
Full-Body Stress-Management Massage:
As mentioned before, stress is the main cause of the development of
bruxism and TMJ disorders; therefore, it is very important to those who
suffer from TMJ disorders (in addition to the protocol which I offer
you in this article) to receive full-body stress-management massage.
From my experience, the phenomenon of bruxism can be reduced within
five full-body stress-management massage treatments given on a weekly
basis. Elimination of bruxism is an extremely important factor that
will allow the masticatory muscles to be restored to normal metabolism
and prevent re-accumulation of tension in the muscles.
Boris Prilutsky, MA Beverly Hills, California www.ippt.com (310) 836-8811
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