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There seems to be a lot of confusion
among massage therapists about TMJ and
the approaches for treating it. I am
going to discuss the basis of TMJ, and
the necessary components of successfully
applying massage techniques to treat
this syndrome.
First the basis: the core distortion pattern found in everyone I
have ever seen in over 25 years of
practice. This distortion includes
rotated iliums and shoulders, and an
imbalance of the cervical spine and
cranium. The entire body is involved in
this core distortion. However, for
purposes of understanding TMJ, we will
have a clearer picture if we look at the
components of the core distortion
pattern.
The cranium has bones that relate to the bones of the pelvis. Of
specific importance here are the
sphenoid, occiput, temporals, zygomas,
maxilla, palatines and palate. There is
a direct relationship between the iliums
of the pelvis and the temporals and
greater wings of the sphenoid - if the
greater wings of the sphenoid and
temporals are rotated anteriorly on one
side, then the ilium on that same side
will also be rotated anteriorly.
There is also a direct relationship between the occiput and sacrum
- the direction in which the occiput is
tipped is the same direction of tippage
seen in the sacrum. Key in cranial
motion is a flexion/extension movement
of the occiput and the sphenoid. When
the cranium moves evenly into
flexion/extension without tippage or
rotation, then the iliums and sacrum are
level and offer a balanced support for
the body. When the flexion/extension
motion of the sphenoid and occiput is
torqued, an uneven movement of the
cranium in flexion/extension is created,
which results in a torquing of the ilium
and sacrum mirroring what takes place in
the cranium. While this is technical, it
is important to recognize this since
this is the primary torsion found in the
core distortion pattern and in TMJ
Syndrome.
Additionally, when this torsion exists between the sphenoid and
occiput, the other facial bones involved
with TMJ - the mandible, maxilla,
palatines, palate and zygomas - are also
in this torsion distortion. Using
kinesiology for muscle testing, this can
be verified. If TMJ is present, the
muscle test will be weak, as will
additional tests involving the structure
of the pelvis. Consequently, it is easy
to see that the TMJ Syndrome is
synonymous with the core distortion of
the entire body, and that the pelvis and
the cranium need to be brought back into
balance in order to effectively treat
TMJ.
Another consideration is the curvature of the neck, which is also a
result of this distortion, and the
imbalance found here helps support and
lock up the dysfunctional TMJ pattern.
So the TMJ syndrome needs to be looked
at as a structural balance problem with
the TMJ being a distortion that is a
result of the core distortion of the
full body. Now for the fun...
Treating TMJ Syndrome
As you can see from the discussion above, TMJ distortion
stems from the imbalance of the pelvis,
spine and cranium.
So when seeking long-term correction of
TMJ problems, one needs to treat this
entire distortion pattern. If massage
and Cranial/Structural techniques (not
to be confused with craniosacral
techniques) are applied only to the
cranium, then the distortion in the rest
of the body will bring the distortion
back into the cranium and the TMJ, and
you'll be back where you started. If,
however, there is a balancing of the
pelvis, a reduction of the scoliotic
curve caused by the imbalanced pelvis, a
reduction of the reverse curvature of
the neck, and a balancing of the
cranium, then the positive changes to
the TMJ will be able to be maintained
long-term leading to happy clients.
Recently, when working with a dentist who had a severe TMJ problem
complicated by extensive dental
correction, the changes in the balancing
of the jaw were so profound after the
torsion in the cranium was released and
the core distortion throughout her body
had been released, that she had to go
back into braces to bring her bite back
into alignment. However, her TMJ
symptoms disappeared!
TMJ problems are often accompanied by many emotional blockages that
have become chronic, and often manifest
as a thickening and tightening of the
soft tissue. They can exist throughout
the structure, but especially in the
pelvis, abdomen, thorax, neck, and jaw.
These emotional blockages can, and often
do, resist soft tissue changes that are
necessary to balance the structure. It
is important for the client to be able
to release the trapped emotional energy
so the chronically tightened soft tissue
can relax and release the old core
distortion holding pattern.
When balancing the core distortion pattern and working with TMJ, I
prefer to integrate a number of
techniques. First, I will initiate the
torsion release throughout the core
distortion pattern by using
Cranial/Structural techniques. Then,
once the torsion is released from the
cranium, the soft tissue of the entire
body starts to unwind and release, which
greatly facilitates the balancing of the
structure. There are usually many areas
where this unwinding of the structure is
limited due to the myofascial holding
pattern, adhesions and scar tissue.
Releasing the torsion in the cranium allows a balancing of the
bones in the cranium, and consequently a
balancing in the TMJ. I have found that
in balancing the cranium using
Cranial/Structural techniques, many of
the TMJ problems will be profoundly
minimized or disappear entirely with
minimal work in the actual muscles that
are directly related to the TMJ - i.e.
masseter, pterygoid, temporalis.
However before I will work with the muscles of the TMJ, I am going
to seek a balance between the pelvis and
the cervical spine, and release the
musculature of the neck and shoulder.
By doing this I will have maximum
results in a minimum amount of time when
actually working in the muscles of the
TMJ. This will usually take 3-4
sessions of balancing the structure,
including the neck, before doing deep
efficient work with the muscles
associated to the bones of the TMJ.
When addressing the cervical spine, I would work to release the
anterior muscles first, and then the
posterior muscles, and concentrate more
on the SCM and scalenes because they
tend to hold the neck in a distorted
curvature. Often much more work is
necessary on the muscles of the anterior
neck than the muscles connected to the
bones of the TMJ, even though the pain
is felt in the area of the muscles of
the TMJ.
When working with the muscles directly associated with the TMJ, I
will check the cranium first using
kinesiology to be sure that optimum
balance and mobilization of the cranial
motion is present. Then, after treating
the anterior neck and posterior neck, I
release the soft tissue over the scalp
and face. Now I will release the
masseter and its attachments
externally. I will then work with the
musculature inferior to the mandible,
paying special attention to the tissue
around the angle of the mandible, to
where it attaches in the back of the
TMJ. After having released both sides
of the mandible, I will now work
intraorally on the masseter including
the attachments on both sides. At this
point the pterygoids are about the only
muscles affecting the TMJ that have not
been addressed. Since they are located
at the back of the mandible, releasing
them tends to be uncomfortable for many
clients. However, by releasing
everything else first, there will be no
resistance from the other musculature of
the mandible that would diminish the
release of the pterygoid. Consequently,
the amount of time and pressure
necessary to fully mobilize and balance
the TMJ by working on the pterygoids
will be minimized.
It is important not to try to do too
much in any one session when working
with TMJ because clients will have a
significant shift throughout their
structure, and the structural shift
needs time to integrate as it balances.
Additionally, TMJ problems are often at
the top of client’s lists as far as
being painful, so it’s necessary to be
mindful of always working within their
pain threshold.
Don
McCann, founder Structural Energetic
Therapy |
