Temporomandibular disorders (TMD) refer to a group of conditions affecting the jaw joint—the temporomandibular joint (TMJ)—and the muscles that control jaw movement. These conditions can cause persistent clicking, locking, or discomfort that interferes with eating, speaking, and sleeping. While many people reach for over-the-counter medications or dental guards as a first step, current evidence highlights conservative physical interventions, particularly therapeutic exercise, as a highly effective management strategy.
At Union Health Network, our clinical interest in conservative TMJ management focuses on identifying the mechanical and muscular factors contributing to your symptoms. By understanding the research behind jaw movement, patients can take an active role in their recovery.
What the Current Evidence Says About TMJ Exercise
For decades, the standard approach to jaw pain was often rest or stabilization with dental splints. However, modern systematic reviews have shifted the focus toward active rehabilitation. Research published in the journal Physical Therapy suggests that exercise therapy is not only effective for reducing pain but is often superior to no treatment or placebo interventions for both muscular (myofascial) and joint-related TMD (Armijo-Olivo et al., 2016).
A separate meta-analysis found that therapeutic exercise significantly improves the range of motion for those with restricted jaw opening (Zhang et al., 2020). The evidence suggests that exercise works by improving blood flow to the jaw muscles, desensitizing the nervous system to pain, and restoring the normal 'tracking' or coordination of the joint as it opens and closes.
Factors That Contribute to Jaw Dysfunction
Several factors can disrupt how the TMJ functions, making exercise a necessary part of the solution:
Muscle Coordination Issues: Sometimes the muscles on one side of the jaw pull more forcefully than the other, causing the jaw to 'deviate' or zigzag when you open your mouth. *
Postural Influence: The position of the head and neck (the cervical spine) directly affects the resting tension of the jaw muscles. A forward-head posture can put undue strain on the connective tissues of the TMJ. *
Bruxism and Tension: Constant clenching or grinding can fatigue the muscles, leading to localized 'trigger points' that benefit from gentle stretching and relaxation exercises. *
Joint Hypermobility or Hypomobility: The jaw joint may move too much (leading to clicking) or too little (leading to stiffness). Exercises are tailored to address whichever extreme a patient is experiencing.
What a Musculoskeletal TMJ Assessment Includes
Before starting any exercise routine, a thorough clinical assessment is necessary to ensure the movements are appropriate for your specific clinical presentation. An assessment with a clinician like Dr. Shahab Entezami may include:
Gait and Posture Analysis: Observing how the head sits on the shoulders and how the neck moves. 2.
Palpation: Checking for tenderness in the masseter, temporalis, and suboccipital muscles. 3.
Range of Motion Testing: Measuring how many millimeters you can comfortably open your jaw and checking for lateral (side-to-side) movement. 4.
Joint Sound Evaluation: Identifying whether clicks or pops occur at the beginning, middle, or end of the opening cycle. 5.
Cervical Spine Screen: Since the neck and jaw share nerve pathways, the clinician will assess the upper neck joints for stiffness or referred pain.
Evidence-Based Conservative Management Options
Once an assessment is complete, management often involves a multimodal approach. Treatment may include:
Patient Education: Understanding that TMD is often a manageable musculoskeletal condition rather than a permanent structural failure. *
Manual Therapy: Intra-oral and extra-oral muscle release techniques or joint mobilizations to improve movement quality. *
Acupuncture: Some patients find relief through neuro-functional acupuncture, which targets the nerves and muscles associated with the jaw. *
Therapeutic Exercise: The cornerstone of long-term improvement, focusing on the three pillars: coordination, relaxation, and posture.
Evidence-Supported Self-Management and Exercises
While every program should be individualized, several types of exercises are frequently supported by clinical research:
1. The Rocabado 6x6 Routine
Developed by Dr. Mariano Rocabado, this is one of the most well-known protocols for TMD. It involves six specific exercises performed six times each, six times a day. These movements focus on resting tongue position, controlled jaw opening, and rhythmic stabilization to teach the jaw muscles how to work without overstraining the joint.
2. Jaw Coordination (Mirror Drills)
Patients are often asked to open their mouths while watching in a mirror. If the jaw shifts to the left or right, the goal is to use slow, controlled movements to keep the chin in a straight vertical line. This 're-trains' the brain to coordinate the muscles symmetrically.
3. Postural Correction
Since the neck and jaw are linked, exercises like 'chin tucks' can help reduce the load on the TMJ. By bringing the head into a more neutral alignment over the shoulders, the tension in the muscles under the chin (suprahyoids) is often reduced.
4. Controlled Relaxation
Learning to keep the 'teeth apart and lips together' is a simple but effective cognitive-behavioral exercise. This helps break the habit of daytime clenching and allows the jaw muscles to rest in a neutral position.
When Should You See a Different Professional?
While most cases of jaw pain respond well to conservative musculoskeletal care, some situations require a referral to a dentist or a physician. A clinical assessment may lead to a referral if:
There is evidence of significant tooth wear or a sudden change in your dental 'bite' (occlusion). *
Symptoms are accompanied by persistent fever, unexplained swelling, or severe ear discharge. *
The jaw is 'locked' and cannot be moved even with gentle assistance. *
There is a history of significant trauma (like a fracture) that has not been imaged.
In many cases, your chiropractor can work alongside your dentist to provide a comprehensive care plan that addresses both the structural dental needs and the functional muscular needs of the jaw.
Frequently Asked Questions
Can exercise make my TMJ clicking go away? In some cases, improving the coordination of the muscles can reduce or eliminate the clicking sound. However, even if the sound remains, exercise is often successful in making the movement pain-free and preventing the joint from 'locking.'
How long does it take for exercises to work? Results vary depending on the individual and the chronicity of the symptoms. Some patients notice improvements in tension within a few weeks, while significant changes in range of motion or chronic pain may take 6 to 12 weeks of consistent practice.
Is it okay to exercise if my jaw is clicking? Generally, yes, as long as the exercises do not cause an increase in sharp pain. If a movement causes the joint to lock or causes significant discomfort, the exercise should be modified by a clinician.
References
- Armijo-Olivo, S., et al. "Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis." Physical Therapy, 2016. PubMed
- Zhang, Y., et al. "The effectiveness of exercise therapy on pain and motion in patients with temporomandibular disorders: A systematic review." Journal of Oral Rehabilitation, 2020. PubMed
- National Institute of Dental and Craniofacial Research (NIDCR). "TMJ (Temporomandibular Disorders)." NIH, 2023. Official Link
- Hall, G.C., et al. "The Effectiveness of Postural Training and Jaw Exercises in the Management of TMJ Disorders." Journal of Bodywork and Movement Therapies, 2018. [DOI: 10.1016/j.jbmt.2018.01.011]
If jaw, back or joint symptoms are affecting your daily activities, a clinical assessment may help clarify the possible contributing factors and appropriate care options. Union Health Network is accepting new patients in Richmond Hill.