Physio for the Head

Most people do not know that physiotherapy has been shown to be effective for a wide range of issues around the head including jaw pain, headaches and neck pain (1). Furthermore physiotherapy has also been proven to be effective in treating altered sensations like persistent itchiness, numbness and tingling and many more that are listed below (2). In a survey of members of the American Dental Association, physiotherapy was listed among the 10 most common treatments used, involving 10% to 17% of patients for jaw dysfunction (3). Often people overlook the symptoms by ignoring or taking painkillers, but it is important to seek a health professional who can identify the root of the problem and prevent reoccurrence.

Jaw = Tempomandibular Joint (TMJ)

TMJ issues have been categorised into the following;

Muscle disorders, including myofascial pain with and without limited mandibular opening.
Disk displacement with or without reduction or limited mandibular opening.
Arthralgia, arthritis, and arthrosis.

Physio has been shown to be highly effective for treating issues category 1 and has been shown to help with the treatment of category 2 and 3 (4).

Chronic TMJ problems also called Myofascial pain dysfunction syndrome of the TMJ, tends to effect females more than males, peak incidence between thirty to fifty year old. A team approach is needed with an assessment by a dentist to exclude any malocclusion problems, a doctor to rule out any potential serious underlying conditions and physiotherapy to assess with a view to manual therapy and exercise. There are many different causes which warrants a thorough examination, below are three of many muscles from which their trigger points may be causing your symptoms (5) as well as other structures that may be having an impact.

Sternocleidomastoid (SCM)

This two part muscle that runs from your sternum and clavicle up to your mastoid process can cause widespread issues. Many symptoms are associated with different trigger points throughout the muscles, below are the location and signs and symptoms related to them.

Referred pain-sternal branch: Deep eye pain, tongue pain when swallowing and headaches over the eye, behind the ear and in the top of the head. Linked to TMJ pain as well as pain at the back of the neck and top of the breastbone
Referred pain-clavicular branch: Cause of frontal headaches on the opposite side, deep earache, and a toothache in the back molars.
Balance problems-clavicular branch: Sensations of dizziness, nausea and prone to lurching and falling. Sometimes unexpectedly fainting may occur.
Auditory disturbances-clavicular branch: Unilateral deafness or hearing loss have been reported as well as tinnitus.
·Visual disturbances-sternal branch: Reports of dimmed, blurred and/or double vision. Reddening and excessive tearing of the eyes as well as drooping eyelid may occur.
·Systemic symptoms-both branches: Disturbed perception of the amount of weight carried in the hands, cold sweat on the forehead and excessive mucus in the sinuses, nasal cavities and throat.

Position of SCM trigger points and their areas of referred pain.

Having ruled other causes of these symptoms physiotherapy can help to alleviate these symptoms by performing techniques to reduce the tension in your SCM.

Masseter

This is the powerful muscle in your TMJ responsible for biting and chewing. Unfortunately, this muscle is prone to trigger points which can cause pain in several places. Its primary cause of pain is over the TMJ, causes increased muscle tension that restricts the jaw from opening. It can also cause pain in the upper and lower teeth and also a common cause of tooth hypersensitivity to heat, cold and touch. Masseter trigger points also linked to frontal face pain, under the eyes and over the eyebrows. Bags under the eyes, deep ear pain as well as unrelieving deep ear itch have all been linked with masseter trigger points. Thankfully these trigger points are easy to locate and are treatable by a physiotherapist.

Temporalis

Temporalis is a large, flat muscle that helps the masseter in chewing motion. Trigger points in this muscle causes headaches at the front and side of the head as well as a cause for teeth hypersensitivity and pain in the upper gums.

Upper Cervical Spine Referral

Your symptoms may sometimes be referred from your upper cervical spinal region including the trigeminal nerve. C1, C2 and C3 nerves all feed into the trigeminocervical nucleus in the brainstem. This region is where sensory nerve fibers in the descending tract of the trigeminal nerve interact with sensory fibers from the upper cervical roots. This functional convergence of upper cervical and trigeminal sensory pathways allows the bidirectional referral of painful sensations between the neck and trigeminal sensory receptive fields of the face and head (6). This means that any part of the head and upper neck can refer pain to any other part. It is important for your physio to carefully examine the patient’s TMJ and neck to ensure that all structures contributing to the condition are identified and treated.

So what does the evidence say?

Physical therapy was reported as almost always better than no treatment, with efficacy increasing in direct proportion to the amount of treatment received. In addition, those subjects who received more treatment modalities seemed to do better than those who received fewer modalities. Programs involving combinations of active exercises, manual therapy, postural correction, and relaxation techniques may decrease pain and impairment and increase TVO in the short term in people with TMD resulting from acute disk displacement, acute arthritis, or acute myofascial TMD. However, it is impossible to discern whether a combination program is more effective than providing the separate elements of the program as individual treatment techniques (4)(7).

Don't just take our word; our client's testimonial

When I first sought out Matt for treatment, I had been suffering from severe TMJ jaw pain and chronic neck and shoulder pain for 2 years. I was immediately comfortable with Matt and confident in his skills. Rather than merely address the pain itself, Matt address the causes of the pain. His approach is holistic and the treatments he uses are varied and highly effective and tailored specifically to my pain levels. He uses a combination of massage, stretching and muscle release, as well as dry needling and has set up a regime of stretching and exercises for me to do at home as well.

He is creative and thoughtful in his approach to my treatment, and highly flexible in what he does depending on my issues at the time. In addition, he is friendly and easy to talk to, which allows me to feel fully comfortable and relaxed in his presence. I've been seeing Matt now for two years and the progress I've made has been extremely positive. My jaw pain in particular has been reduced to such a manageable level that I often have days with no pain at all. My neck and shoulder pain has also been significantly reduced, and despite the stubborn nature of my issue, Matt continues to persist and is constantly finding new methods to further improve my overall physical well-being. I have been very happy with my results!

References

(1) Calixtre, L. B., Moreira, R. F. C., Franchini, G. H., Alburquerque-Sendin, F. and Oliveira, A. B. (2015) ‘Manual therapy for the management of pain and limited range of motion in subjects with signs and symptoms of temporomandibular disorder: a systematic review of randomised controlled trials’, Journal of Oral Rehabilitation, 42(11):847-861.

(2) Kalamir, A., Bonello, R., Graham, P., Vitiello, A. L. and Pollard, H. (2012) ‘Intraoral myofascial therapy for chronic myogenous temporomandibular disorder: a randomized controlled trial [with consumer summary]’, Journal of Manipulative and Physiological Therapeutics, 35(1):26-37.

(3) Glass, E. G., Glaros, A. G. and MsGlynn, F. D. (1993) 'Myofascial pain dysfunction: treatments used by ADA members', Cranio, 11(1):25–29.

(4) Medlicott, M. S. and Harris, S. R. (2006) 'A Systematic Review of the Effectiveness of Exercise, Manual Therapy, Electrotherapy, Relaxation Training, and Biofeedback in the Management of Temporomandibular Disorder', Physical Therapy, 86(7), 955-973.

(5) Travell, J., Simons, D. and Simons, L. (1999) Myofascial Pain and Dysfunction: The Trigger Point Manual, 2nd ed, Lippincott, Williams & Wilkins.

(6) Bogduk, N. (1992) ‘The Anatomical Basis for Cervicogenic Headache’, Journal of Manipulative Physical Therapy, 15:67-70.

(7) McNeely, M. L., Armijo Olivo, S. and Magee, D. J. (2006) 'A Systematic Review of the Effectiveness of Physical Therapy Interventions for Temporomandibular Disorders', Physical Therapy, 86(5), 710-725.

Can physio help my Jaw?