#massagetherapy

My Jaw Locks & Clicks! What's Going On?

One of the most common jaw complaints is clicking and locking, often associated with pain in the jaw, face, head and down the neck. This can often be caused by an anterior disc displacement, something we see frequently in the clinic.

But what is an anterior disc displacement and what can we do about it? Before we dive into that question, let’s back it up and talk about the anatomy of the temporo-mandibular joint.

The Anatomy of the TMJ

The temporo-mandibular joint (aka the TMJ) is what attaches the mandible (aka the jaw bone) to the skull. It is located just in front of the ear and, if you place your hands on either side of your face just in front of your ears, you can feel that jaw moving forward and back as you open and close your jaw.

The TMJ is a synovial joint between the temporal bone of the skull and the condyle of the mandible. Between the condyle and the temporal bone is a donut-shaped fibrous disc that is essential for proper opening and closing of the jaw. This disc is partially held in place by the retro-discal tissue, a network of loose connective tissue, blood vessels and nerves attaching the back of the disc to the bone behind it, just in front of the ear canal.

Anterior Disc Displacements

One of the most common causes of temporo-mandibular dysfunction (aka TMD) is when the disc becomes displaced, typically anterior in the joint and away from the ear canal. When this occurs, the retro-discal tissue in the back gets stretched and is unable to hold the disc back in its normal position.

Common symptoms of anterior disc displacements include:

  • pain in the TMJ with chewing, yawning & talking

  • pain in and around the ear

  • headaches

  • a reproducible click in the TMJ, with or without pain

  • decreased range of motion with opening

When a disc moves anteriorly in the joint, it may click or block jaw movements but this isn’t guaranteed. Every person’s anatomy is different: jaw condyle shapes, depth of the socket, size of the disc, amount of retro-discal tissue and all the other factors that make a person unique can play into their TMD and experience of pain.

Treating a Disc Displacement

A few things to know first:

  1. One third of asymptomatic people have at least one displaced TMJ disc. It’s really common to have a disc issue and not be bothered by it at all!

  2. Discs will not (typically) relocate back to where they were. Instead, your body heals and creates a “pseudo-disc” from the now-stretched retro-discal tissue to act as the original disc.

  3. When that disc moves forward, it can often block the opening of the TMJ. Over time, the disc remodels to be less donut-shaped and more wedge-shaped so the condyle of the jaw can easily slide over it.

Acute Disc Displacements

Remember how I said just up there that discs won’t relocate?

If the injury has occurred in the past 3 days, we can sometimes (and I stress SOMETIMES) get the disc to relocate. It has to be before the retro-discal tissue has stretched too much. Our therapists who treat TMD can attempt a specific maneuver to try and get that disc back to where it was.

Outside this 72 hour window, we are looking at healing and remodeling the disc.

Chronic Disc Displacements

We have a whole tool-box of therapy techniques to help with disc displacements in the TMJ. These include:

  • Manual therapy of the TMJ - we use specific techniques to increase the range of motion of the jaw and help the disc remodel into the wedge shape we’re looking for.

  • Soft tissue techniques (including IMS and massage) of the surrounding muscles - with a disc displacement, these muscles (for instance, the temporalis and masseter) are often clenching or working hard to compensate for the TMD, leading to increased pain and headaches.

  • Neck assessment & treatment - when the TMJ is irritated, up to 70% of people also have neck pain. As a part of TMD treatment, the neck needs to be evaluated and treated accordingly.

  • Exercises - the right exercise for you and your TMD is so important. The right exercise helps discs remodel, muscles relax and pain reduce. We spend a lot of time with you to make sure you are doing the correct exercise with the correct technique.

Top Five Tips in Dealing with a Disc Displacement

Finally, we live by these principles of managing disc displacements:

  1. Don’t test it!! You will be tempted - does it still click? Is it still stuck? - but we beg you to resist this temptation. Let your disc heal. The more you poke it, the longer it’ll take to heal.

  2. Avoid hard/crunchy/chewy foods for the first 6-8 weeks after a disc displacement. We promise you can eat your favourite food soon but avoid those types of foods initially.

  3. Support your jaw when yawning. If you have the urge to yawn and really open your jaw, place a hand under your chin so you have something to push against and limit how much your jaw actually opens.

  4. Sleep is so important for healing & pain control. We know that under 6.5 hours of sleep per night increases your experience of pain. We also know that you heal when you sleep. So make sure you’re getting enough sleep, with a good pillow supporting your head!

  5. Posture also play a huge role. Make sure your computer is set up properly so you aren’t sitting in a head forward posture, putting more inappropriate muscular forces through your jaw. (Need some tips on computer set up? Read our blog!)

If you are dealing with a disc displacement, TMD or headaches, book with one of our TMJ therapists online, by email or calling us at (778) 630-8800.

Questions I Get Asked the Most as an RMT (Registered Massage Therapist) 

Our fabulous RMT Gabrielle De Winter joined us in January of this year. An instructor at the West Coast College of Massage Therapy, she has pursued further training in jaw pain, also known as temporomandibular joint dysfunction. In this short question and answer blog, Gabrielle answers the questions she most frequently gets as an RMT.

Gabrielle’s Most Frequently Asked Questions 

Do you get free massages? 

Only from my husband! Most RMTs are independent contractors that don’t have built in extended medical benefits through their union (in fact we don’t have a union) or through their workplace. Some RMTs will work out exchanges with other RMTs they know. Mostly, we will need to book in with a practitioner to get a massage, just like everyone else. 

Do your hands get sore? 

Sometimes! But if you’re in an appointment with me as your therapist, I’m more concerned about how your body is feeling and not thinking of my own. 

Can massage help migraines and headaches?

 Yes! Tension headaches are typically muscular in origin and respond well to massage. I have a particular interest in treating tension headaches with massage. I did a study in school where we found tension-like headaches can be reduced significantly with massage.

Migraine headaches are a little trickier - sometimes massage can help calm down the nervous system. Migraines are usually multi-faceted and if you haven’t tried massage, it may be worth a go.

If you come in for massage related to headaches, I’ll ask you a lot of questions around your activities, if you’ve seen your dentist or optometrist lately, if you have balance issues… From there, we will figure out the best course of action with massage therapy.

Is massage painful?

 It doesn’t have to be! I want to work within your comfort level and what’s safe and effective.

What if I fall asleep and snore?

If I notice that you’re falling asleep, I’ll ask if you’re okay with me working on you while you’re asleep. If that’s fine, great! If not, I’ll make sure you stay awake while I’m working on you.

But this happens all the time! We are engaging with the autonomic system and if the goal is relaxation, people definitely sometimes fall asleep.

Is it okay to ask for more or less pressure?

Absolutely! We will discuss this on our first visit - what kind of pressure you’re comfortable with. While we are in the treatment, if you decide the pressure level needs to change, we can adjust as we go.

Are my muscles tight? 

Muscles can be “tight” but we can use better words to help us better describe what is happening. What feels “tight” is often a muscle which has been shortened, lengthened, or aggravated. 

What most patients think of as “tight” is a shortened muscle. Muscles cross joint(s) that they act on which as a result can limit their range of motion if they are shorter than usual. In order for me to see if a muscle is short, I would perform a muscle length test, which involves bringing the insertions points of a muscle away from each other so I can see if a shortened muscle is decreasing a joint(s) range or movement. 

Muscles could also be felt as “tight” if they are in a lengthened position. Much like a rubber band stretched out. This happens often to desk workers who sit for long periods of times with their shoulders rotated forward. In order for their shoulders to be forward, the muscles that bring the shoulders back will lengthen to allow that opposite position of the shoulder blades to happen. Some of the muscles between the shoulder blades, namely the rhomboids and the middle fibres of trapezius in this desk worker scenario tend to become lengthened and weak overtime. 

Muscles can be aggravated or carry extra tone for a number of reasons. Common reasons are injury, overuse or poor posture. When a muscle gets aggravated, it may react by feeling tight, stiff, or sore. A few ways to avoid having constantly aggravated muscles include regular stretching, strength training, and of course a massage with your favourite RMT. 

Are you looking for a massage? You can book with Gabrielle online, by emailing us or giving us a call at (778) 630-8800.

Meet Gabrielle!

We are so happy to introduce one of our newest additions to the team, Gabrielle De Winter! Gabrielle (pronounced GABE-ree-ELLE) is a registered massage therapist, graduating valedictorian of her class from the West Coast College of Massage Therapy in 2017. Learn more about Gabrielle below!

What is something totally random that people won’t know about you? I LOVE panda bears!

When did you decide you wanted to be an RMT? Oh that’s a complicated one. I thought about it when I was 17 years old and visited the school. At the time I didn’t feel ready for all the touching of strangers! I knew that I wanted to eventually, though.

Which sports are you into? Basketball, martial arts, swimming, rock climbing and archery.

Where did you grow up? I grew up in Richmond, BC.  

What is your favourite orthopaedic condition to treat? Tension headaches!

What makes you happiest? Simple things like finishing a long hike, drinking a warm drink by the fire, or holding the hand of a loved one.  

LIGHTNING ROUND!!!!!

Cats or dogs? Dogs

Favourite food? Fresh steamed mussels in a white wine and cream sauce with a fresh baguette.

Favourite dessert: Pie, any and every type (except for cow pies)

Favourite Junk food: Green Tea Pocky or Cream Dill kettle chips (I can’t decide)

Beach or mountains: Beach

Favourite colour: Peach

Favourite music: Experimental Rock/ Rock Electronica (think Radiohead, Björk, Portishead)

Favorite day of the week? Thursday

Nickname? Gabe, Gabies, Panache, Gabriella poompe paya, Sweetie- kins and Sweetie- Pie. If you forget my name, just say , “chocolate” and I’ll turn around.

Would you rather be able to speak every language in the world or be able to talk to animals? Every language in the world.

Favorite holiday? Christmas

How long does it take you to get ready? 30 minutes

Invisibility or super strength? Super Strength

Is it wrong for a vegetarian to eat animal crackers? HAHA no

Dawn or dusk? DAWN

Do you snore? I think I do on the RARE occasion. I’m a light sleeper and I’ve woken myself up.  

Place you most want to travel? Belgium

Last Halloween costume? Tiger

Favorite number? 4

Have you ever worn socks with sandals? NEVER

Would you rather cuddle with a baby panda or a baby penguin? PANDA

Would you want to live forever?  Yes

What's for dinner tonight? A salad with all the nuts and bolts