What are different types of TMJ exercises I can do to alleviate my pain?

In the interest of preventing recurrent TMD pain over the long-term, the practitioner may recommend several exercises and/or lifestyle modifications for the patient. The patient may be encouraged to partake in a habit-reversal program or undergo lifestyle counseling, cognitive behavioral therapy for stress management, progressive relaxation, hypnosis, and/or biofeedback. Working with the patient, the practitioner would structure a custom treatment plan based on the patient’s individual condition and overall lifestyle.  

In patients with myofascial pain, recent studies have evaluated the use of CBT in addition to standard care. The studies have concluded that when used in conjunction with standard care, undertaking specific exercises of the jaw and undergoing CBT demonstrated better results than standard care alone. This may be because CBT teaches patients to reduce the emotional distress associated with pain. Physical therapy is a less invasive treatment that can help alleviate the severity of musculoskeletal pain and restore normal function by altering sensory input, reducing inflammation, and coordinating and strengthening muscle activities. Manual therapy has been shown to reduce pain in most patients over the long-term. Popular therapies include posture training, exercise, and mobilization. 

The primary objective of posture training is to minimize unexpected activity of the head, neck, shoulder, and tongue muscles. Increased cervical and shoulder muscle activity may exacerbate the symptoms of TMJ. Patients are also advised to avoid biting their fingernails, biting their front teeth, biting on their lower lip, and/or clenching their teeth together. A TMJ patient undergoing posture training would be instructed to keep the mandible in a relaxed rest position with the teeth separated, except while eating, swallowing, and speaking. Further studies are being undertaken to quantify the relationship between posture training and the alleviation of TMJ symptoms.

As with other muscles throughout the body, active exercise is vital to the development and maintenance of the normal function of the temporomandibular joint. Patients suffering from TMJ disorders are instructed to avoid activities that may injure the synovial joints along with stretching and relaxing the cervical and masticatory muscles. Over time, exercise will mobilize and stabilize the TMJs, increase muscle strength, and reduce joint clicking. The three most commonly recommend types of exercise are isotonic exercises to increase the range of motion, isometric exercises to improve muscular strength and function, and repetitive exercises to establish coordinated muscle function. 

TMJ patients may also benefit from mobilization techniques to increase the range of motion and alleviate pain resulting from muscle contracture. This may involve repeated manipulation of the appropriate muscle by the practitioner at varying speeds and amplitudes. To enhance the effects of mobilization, the patient must undergo muscle relaxation in conjunction with mobilization. To relax the muscles, the patient may be exposed to heat, cold, ultrasound, and/or electric stimulation.

To treat patients with acute disc displacement, the therapist may manipulate the mandible by gripping the mandible firmly with the thumbs on the occlusal surfaces of the posterior teeth. A firm and controlled force is applied to the mandible in a downward, forward, and inward direction. In addition to exercises, the practitioner may recommend orthopedic appliance therapy and/or relaxation therapy for the patient. 

To encourage patients to continue following the recommend physical therapy regimen even after physical therapy is over, it is important to give them a long-term outlook on pain management. Most patients will not feel motivated to exercise if it increases TMJ pain, so it is important to emphasize pain relief before commencing physical therapy. Once the patient has reached the goals of physical therapy treatment, the therapist will recommend some maintenance level of exercise that the patient will continue throughout their lifetime.