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5 Simple Steps to Jaw Pain Relief: A Whole Body Approach to TMJ Jaw Pain

publication date: Jul 16, 2018
 | 
author/source: Tracy Laval

 

 

by Tracy Laval, BFA, RMT, CST-T, DOMP

 

INTRODUCTION

 

     It’s 7:30 am Monday morning. Julia wakes up with an aching pain in her jaw and her neck is stiff. It’s hard to get out of bed knowing she has another day of pain ahead of her. This has been happening for years. The pain ebbs and flows in intensity but it never goes away.

     She skips the bagel for breakfast,as much as she wants to eat it. She decides that it’s not worth the pain. The chewy bread sends electrical shocks of pain in her ear, cheek and jaw. Instead she sticks to soft foods like yogurt. At lunch she leaves the carrots and nuts on her plate for the same reason. Almonds were once her favorite food. Julia is frustrated with the constant pain and has begun feeling limited in her food choices.

     This article was written for people like Julia as a way to teach you simple and practical ways to heal your jaw pain. In this article I focus on how stress activates tension in your jaw and how to calm your body’s response to stress. Reducing your stress and building resilience in your nervous system to better manage your stress response is essential so that your body is less reactive and therefore less tense. This approach is often overlooked.  

     As a Craniosacral therapist I have heard this story many times from the clients who have come to me seeking pain relief for their jaw. I’m passionate about TMJ issues because I also had jaw pain for years. It’s what lead me to become a Craniosacral therapist. I needed to find a gentle solution for the pain in my face. My jaw pain is now gone. It returns from time to time when I am stressed. When that happens I use these 5 simple steps to help calm my nervous system; the tension and pain melts away as my nervous system switches gears.

 

Your TMJ

     A simple joint on either side of your face allows your jaw to move. These joints are called your temporomandibular joints (or TMJ for short). Without these joints you wouldn’t be able to open or close your jaw or move it side to side. All of these motions are necessary for you to use your mouth to breathe, eat, and drink.

     You also use your TMJ to move your jaw to communicate, thereby expressing your thoughts and emotions through speech, sounds, and facial expressions. The ability to express yourself helps you to feel understood and connected to others. Speaking and social connections helps our brain to work at its highest level.

     The human jaw is the largest and strongest bone of your face. (1) It is designed to work efficiently, smoothly, and with great strength. Pound for pound, your jaw is stronger than a gorilla’s.(2) Together the two masseter muscles (the main muscles used in chewing) can bite up to 150 pounds, making it the strongest muscle in the human body relative to its size. (3)

 

Osteopathy, your nervous system and your TMJ

     The approach of this article is based on the osteopathic principle that your body operates as a unit. Osteopathy is a holistic approach to health care that recognizes that your entire body is interconnected.  Body parts and systems are all intertwined and designed to all work harmoniously together.

     Each body part will directly and indirectly affect many of its neighboring parts and systems in your body. Because your whole body is interconnected we can treat your TMJ problems directly at the joint or indirectly by working with any of the many systems with which it is interconnected.  Both approaches work well. In this article we will use the indirect approach by working through your nervous system to improve your jaw function.

     Your nervous system is spread throughout your entire body. It is made up of your brain, spinal cord, nerves, and the corresponding senses.  It constantly responds to stimuli inside and outside of your body so that you are in a safe, healthy, and functional state of balance. To do this your nervous system takes in information, processes it, and then sends a signal to your muscles telling them how much tension they should have. Because all muscles work together and affect each other, tension in the human body is precisely calibrated; it isn’t random.  When you have excessive muscle tension there is a reason for it. It’s important your TMJs work well because they are the most used joints in your body. In one day, your TMJs move 2000-3000 times (4).

 

 

STRESS, PROTECTION, PAIN, AND YOUR JAW

 

Stress and your muscles

     Your jaw tightens in response to stress because your nervous system tells it to. Your nervous system is especially attentive to signals of stress in your surroundings. In each moment your body is scanning for anything that might threaten your wellbeing. This is an ancient stress response mechanism that’s designed to keep you alive and increase your chances of survival. 

     A stress response is how your body behaves under stress. It happens automatically, without you having to think about it. Your body chooses the most sophisticated response first and if that doesn't work it makes the next best choice, which is less sophisticated. Your body will take into account your past experiences, meaning how successful these strategies worked for you in the past, as it makes its decision in a split second.

     For example, when you hear an unexpected sound you will automatically raise your head and turn toward the sound or you will automatically duck and cover, bringing your head toward your body like a turtle. These are immediate and predictable movements.  We all do them.

 

 Your jaw tightens in response to stress

because your nervous system tells it to.

 

     It may surprise you to know that humans are innately social creatures. We have evolved successfully because we use relationship strategies to solve our problems. Under stress your brain’s first choice is to use social strategies. Examples of social strategies include working cooperatively together, communicating, using facial expressions, eye contact, and positive tones of voice. If that doesn’t work your brain chooses a fight or flight strategy. Fighting strategies combine energy (usually anger) with movement, to move your body towards the threat. Annoyance, irritation, and agitation are variations or fighting strategies. Flight, or running away, moves your body away from the problem. Anxiety is a form of the flight response. Under extreme distress your body will choose freeze as a last resort.  This is a strategy that shuts down most of your body systems, to make it appear you are dead, so that the thing threatening you loses interest. In the animal world most animals don’t eat dead prey. Fainting, shutting down emotionally, and spacing out are all variations of freeze.(5)

     What does this have to do with the pain in your jaw, you may be asking? Under stress your brain orders the muscles of your face and neck to tense up to ultimately protect yourself.  That tension in your jaw is used to brace yourself or to defend yourself, physically and emotionally. That’s why we want to look at the role stress is playing in your jaw pain.

     Notice if spikes of stress are making your jaw pain worse. Ask yourself: how much stress am I under? Am I chronically stressed or does it come and go? Rate your current stress levels on a scale from 0-10.  Zero is the lowest amount of stress and ten is the highest. Give yourself a number. What number would you give yourself today, this week and this past month? Rate all three. What would be your ideal number?  What are you working towards?

 

Jaw pain is an intelligent response

     Think of your jaw pain as an engine light that goes off in your car. It’s a warning signal. It’s designed to alert you that something needs your attention. The louder the alarm (in this case: more pain), the more urgent the need for action. Your body may be using pain in your jaw to get your attention. Your body needs you to do something. It’s just like when you feel thirsty; it's your cue to drink water.

The key to solving your jaw pain problem is to understand what is causing it. Start by asking yourself these questions:  

  • how long have I had jaw pain (days, months, years)?
  • did this pain come on suddenly or gradually?
  • what was happening in my life around the time this pain started?
  • overall is it getting better or worse?

     The next time you feel pain in your jaw start to notice what time of day it is. Is it first thing in the morning when you wake up, during the day while you are at work, or does it creep up over the day and you feel it by the end of your workday? Notice where you are, who you are with, what you are doing, and what you are generally thinking and feeling.  

     Ask yourself: if is it something physical that you are doing that is aggravating your jaw (like poor posture as you drop your head forward driving or working on the computer)?  Is it mental (are you under a tight deadline or feeling pressured)? Or is it emotional (is there tension at work, at home or with a friend between you and your spouse or children)?  It’s possible it is all three. We know that the body, mind, and emotions are all interconnected. By asking yourself these questions and becoming aware of the circumstances surrounding you during the times you have pain, it will help you better understand what your body needs you to do to shut off that pain signal.

 

What this all has to do with jaw pain

     Ongoing physical, mental and emotional stress causes ongoing tensing,clenching, and bracing. This creates abnormally high tension surrounding your jaw which causes compression, decreased blood flow and pain. To counteract this constant, ongoing, threatening input, your body needs to feel safe physically, mentally and emotionally so that your nervous system can reset. That’s what the next section will help you do. 

 

SELF HELP: 5 Simple Steps for Jaw Pain Relief

     Below are 5 simple and practical ways to calm your nervous system to reduce the tension in your jaw by deactivating your defensive responses. I use this same approach regularly in my clinic where I specialize in TMJ jaw pain. I give these correctives to my clients in my clinic and I do them myself daily.  They are effective and easy to use and a great place to start.

 

1.       Slowly alternate breathing in and out of your nostrils:

     Why? Stretching out your exhale slows down your heart rate. This calms your nervous system. Slowing your breathing has the fastest affect on calming your nervous system. Alternating your breath out of each nostril has the added benefit of linking your left brain with your right brain for better communication and balance in your nervous system.

     Instructions: Set a gentle alarm for 11 mins (I use my phone). Close your eyes.  Close your mouth.  Breathe in and out through your nose.  With one hand raised to your nose, press your thumb into the side of your right nostril, just below the bone halfway down your nose.  Inhale through your left nostril, breathing slowly and deeply.  At the end of the inhale press your ring finger from the same hand into the side of the left nostril and remove your thumb. Exhale slowly from the right nostril.  Stay in this position and inhale through the right nostril. At the end of the inhale press your thumb into the side of your right nostril and exhale from the left nostril.  Repeat until your alarm rings indicating you to stop.  Do this daily.  Do it when you first wake up or whenever you want a clear head for thinking or more energy (like after lunch or late afternoon).  You might find it energizing.

2.       Laying Down Chair:

     Why? Because this relaxes your psoas muscle which is deeply connected to your nervous system.  If it is chronically tight it will have an agitating effect on your nervous system and trigger your flight or fight stress response. 

     Instructions: Lay on the floor on your back in front of a chair with the seat facing you,(or footstool or couch).  Bend your hips and knees to 90 degrees each so that your calves are resting on the seat of the chair.  Allow the chair to support your lower legs completely, checking to see that you aren’t using your leg muscles or hip muscles to hold your legs up.  Allow your leg and hip muscles to relax and for your belly to become soft (you are aiming for your belly to feel like it’s made of honey or jelly).   This relaxes your nervous system.  Rest here for 20 mins.  Do daily anytime (before bed or a meal is best).  It will help your sleep and digestion.

3.       Back your chin up

     Why?  Because your head position affects the amount of jaw tension you have. Your jaw muscles contract to help your neck muscles hold your head up against the downward pull of gravity. When your chin is forward, away from the centre of your body, this strains and compresses the area at the top of your neck where vital nerves and blood supply feed your brain reducing blood flow and nerve function.  

     It’s also a tremendous amount of work for your body to balance your head out in front of your body, suspended against the downward pull of gravity.  Your head weighs around 12 pounds.  For every inch your head moves forward away from your midline it adds an extra 10 pounds.  For every inch!  How many inches is your head forward when you are looking at your phone, at your computer or driving?  It’s normal to get drawn into what we are doing but it’s not ideal for your body so we constantly need to correct this habit.

    You’ll need a regular reminder to pick your head up and move it back.  Your muscles have become weak. You’ll need to build strength in the muscles at the top of the neck and you’ll need to revitalize the area at the top of your neck, creating a better environment for blood flow. You can do all this by simply moving your head back in line with the rest of your body. Movement creates lubrication for your joints. It helps them move more easily and smoothly.

     Instructions: Set an alarm for the top of the hour for each of your waking hours.  I use an app called Simple Habit.  I’m sure there are others.  When the alarm goes off bring your chin back towards your body.   Then return your chin forward over your body as far as it will comfortably go (this is a small movement overall).  Then back your chin up towards your body as far as it will go.  Repeat 10 times .  Chin forward and chin back count as 1 time. 

     Move within a comfortable range of motion.  The movement is small and mindful.  This is a sensitive area. Go slower than you think.

     If you have had the habit (and weakness) of dropping your chin forward, the top of your neck can feel rusty, thick, boggy, stiff, or dry.  Be gentle.  You’ll feel yourself move more easily as this area gets revitalized. When I first started doing this movement I felt like the top of my neck was rusty and that I was moving flakes of rust off with each movement.  In a few days, with regular movement and mindful correction, my head moves much more smoothly on my neck and I’m able to move my neck farther in both directions (again this is a small motion). Slowly my neck is starting to feel longer like I’m working out the rust between the top few vertebrae (bones of the neck).  Move gently, patiently and work within a pain free range of motion. Don’t rush this process.

 

4.  Write down anything in your life that annoys you, or is bothering you then do something about it

     Why?   Your nervous system likes when you take action to solve your problem, especially if you are prone to chronic fight/flight stress response.  That response is all about movement and taking action. The action you take (no matter how small or big) is completing a biological process that signals to your nervous system to reset.  The action could be small, like move your desk out from under that annoying air conditioner, or saying no when you don’t want to do something or it could be big like having that difficult conversation, or making a big decision like moving or changing jobs.

     If this is hard for you, practice taking little actions every day.  It’s like training a muscle.  The more you do it the easier it becomes, and it actually becomes energizing.  I used to think I was a procrastinator until one day I realized I felt overwhelmed.  If I did something about my situation, like make a phone call (which is hard for me) then I felt much better.  I could finally relax.  It was my body’s way of sending me a signal that I needed to take action to change my environment for a better feeling inside of my body.  This is the point of this corrective.

     Instructions: In a journal make 4 columns (work, home, health, finances).   Under work could think about your relationship with your boss, your colleagues, the physical environment, the vibe, the work you do, where your workstation is.  At home you could include your house, your husband/partner, your kids, your pets, your neighbours, and your neighbourhood.  Under health you can list your physical health, mental health, emotional health.  Finances you can list your income and expenses.  You get the idea.  List stuff that’s relevant to you.

     Under each title write down anything that bothers you or doesn’t feel right for you.  Include all the small stuff that annoys you and frustrates you and also include the big stuff. The point is to identify what doesn’t feel right for you.  It doesn’t matter that it’s ok for someone else.  Just because it feels right for someone else doesn’t mean it feels right for you.  Don’t try to talk yourself out of or into something that doesn’t feel right for you. The point is if it doesn’t feel right for you, your body will interpret the stress as a threat and initiate a stress response which mean clenching and grinding your teeth, over activating the muscles of your jaw which causes you pain.

     Circle anything that bothers you from the above list that is within your control. There is always something you can do the make your life feel better for you. Take action daily to improve the environment of your life.

5.  Cuddle with a loved one

     Why? Laying in stillness is our body’s most vulnerable time.  Your body needs reassurance and reminders that it’s safe to lay in stillness.  It needs to feel a sense of security and safety to sleep deeply. When we lay together in stillness with a loved one (partner, pet or child), especially with our naked skin touching their naked skin it stimulates the release of the hormone oxytocin which is involved in social bonding and love. For children and babies, laying in stillness with a parent makes them feel protected.  Increasing a feeling of being safe decreases your body's need for defensive behaviors.

     Instructions:  Lay together with a pet, partner, child or loved one.  If you live alone and you don’t have a pet, surround one side of your body with pillows. You can be awake or fall asleep.  If you are awake resist the urge to look at your phone or any other electronic device. Being still, present and responsive to each other is essential for your body to let go of the tension it holds to protect itself. Rest for 20-45 mins together.  Try it first thing in the am, in the middle of the day or at night while going to bed. I like to do this early in the morning. I usually fall asleep as I lay with my husband and wake up feeling deeply rested.

 

Encouragement and Final words

     It is my hope that by understanding more about how your nervous system works that you can help yourself get jaw pain relief in a gentle way. Your body is a sophisticated and dynamic living system, which means that nothing in your body ever stays the same.  Your state of health is constantly changing moment to moment. That means that in each present moment change is always possible.

     If you want a different response in your body you’ll need to make changes to your surroundings. Change is made easier by taking small, steady and repeated actions. Imagine the effect of going to the gym once per week versus 5 times per week. The person who goes more often sees and feels a tremendous change, more quickly. These 5 correctives, when applied regularly, add up to a big change in the way your body responds to stress.  You’ll feel more calm. You won’t be as hyper sensitive and reactive to stress. You’ll feel more in control and aware of your response. 

     In addition to the correctives, I also recommend you consult a skilled bodyworker in your area for customized one to one care. A bodyworker is a healthcare professional who uses their hands to detect and correct excessive tension.  A Craniosacral therapist is one example of a bodyworker who can gently release and balance any remaining tension in your jaw. Ask if they feel comfortable working in your mouth (not everyone does).

You can look for a Craniosacral therapist in your area https://www.upledger.com

     Keep in mind the advice here is general advice and is not meant to take the place of medical treatment.  Consult your medical doctor for medical treatment. 

 

References

  1. Tortora, Gerard J., Derrrickson, Bryan.  Principles of Anatomy and Physiology 11th Edition. Hobokan: John Wiley & Sons Inc, 2006. p. 207
  2. Wroe, S., Ferrara, T., McHenry, C., Curnoe, D., Chamoli, U. (2010). The craniomandibular mechanics of being human. Proceedings of the Royal Society of London, Series B, 277: 3579-3586
  3. Lippert, Lynn S.  Clincial Kinesiology and Anatomy 4th Edition. Philadelphia: F.A Davis Company, 2000.
  4. Biel, Andrew. Trail Guide to the Body Fourth Edition. Boulder:  Books of Discovery, 2010. p. 236
  5. Borges, Stephen W. Dana, Deb. Clinical Applications of the Polyvagal Theory.  The Emergence of Polyvagal-Informed Therapies. W.W. Norton & Company. New York. 2018. p
  6. Chitty, John.  Dancing with Yin & Yang. Boulder: Polarity Press, 2013. p135