The Cause and Cure for TMJ Disorders That Went Viral

The article by Dr. Larsen or MSK Neurology has been viewed hundreds of thousands of times across platforms and commented on by almost a thousand people. As far as TMJ posts go, we'd consider that viral. However, the article is very very long, so we wanted to condense it for you. The proposed solution is at the end by the way. 

Here's his YouTube video breaking it down, and the article below if you ever want it for reference.

https://www.youtube.com/watch?v=lWZTgOox0PY

https://mskneurology.com/true-cause-solution-temporomandibular-dysfunction-tmd/

But here's the gist.

TMJ Disorders effect up to a third of the population, with around 5% having symptoms severe enough to seek treatment.

Symptoms range from jaw pain and tension, to headaches, ear pain and tinnitus, trouble sleeping, up to depression.

And the fact is, that there is NO consensus on the cause for TMD. Partly because the disorder is so multifaceted, all that is known are correlations with things like teeth grinding, estrogen levels, as well as stress or anxiety levels. However these reasons cannot be argued to be the actual cause for TMJ Disorders. This is why treatment is so ineffective right now. Because doctors don't even know why it happens. 

But basically, the author argues that the true reason for TMD symptom development is because of improper lower jaw positioning. Specifically, the postural tendency to have the lower jaw fully retracted (down and back) as shown as opposed to its proper position of being slightly protracted (forward and up).

Full video of screenshots here (https://www.youtube.com/watch?v=PVxlL_lMces&t=97s) 

That means that proper position is NOT to have your molars fully contacting each other at all times. There should be a slight separation there when you jaw is resting.

What is the cause for this improper jaw posture?

The cause for this resting position can be attributed to several things.

One as mentioned in the video is improper tongue posture due to mouth breathing. If the tongue is not correctly positioned in its resting state at the roof of the mouth, the jaw will have a tendency to rest lower and farther back.

Another is due to active clenching. Many people want their back teeth to touch at resting position. Again, this maximally retracts the lower jaw.

The other possible reason is head posture. If the head is leaned too far forward as shown in this photo, the "hyoid" muscle that connects the lower jaw to the neck is in tension, therefore pulling the lower jaw down and back. 

So How Does This Affect the TMJ?

Taking a closer look at the TMJ, we can see how a maximally protracted jaw sits. As you can see, the condyle (or the "ball" joint of the jaw) sits too far back within the socket.

This allows for the muscle connected to the disc the condyle normally sits in to pull it out of place, since there isn't any resisting force from the condyle. Over time, as the disc gets pulled more out of place, the condyle is able to sit farther and father back.

So How Does This Cause My Symptoms?

Disc Displacement: 

When the condyle no longer normally sits within the articular disc, this called disc displacement. And there are 2 types, DD with reduction and without reduction.

Reduction basically just means whether the jaw joint slips into the disc as it opens. So DD with reduction has the famous jaw clicking or popping sound associated with TMJ Disorder. This is the condyle popping in and out of the articular disc. 

Once the ligament that connects the disc to the TMJ deteriorates further though, it is able to further slide forward. At this point, the jaw no longer slips into the disc during opening and closing, so the sounds cease to occur. Often pain kind of subsides at this stage as well, but we'll get into why in just a second.

However, movement is extremely limited at this point, and full jaw opening is blocked by the disc past ~30mm.

Jaw Pain:

The severe pain experienced due to TMJ Disorders is also explained. The main reason is due to the fact that there is a lot of nervous tissue behind the TMJ. In a normal resting position, this tissue isn't contacted. However, as disc displacement occurs, or with bad enough lower jaw posture, the ball of the TMJ sits far enough back in the socket to put pressure on this nervous tissue. Additionally if there is disc displacement WITH reduction, the asymmetric shape of the disc further pushes the condyle backwards into this tissue.

The reason that pain often subsides once disc displacement without reduction is reached is because the jaw joint has more space to sit behind the disc, which no longer pushes it into the nervous tissue.

Another reason for pain is frequent muscle spasms/muscle knots/pressure points that form in the TMJ muscles from the imbalance or overuse of the muscles.

Jaw Tension:

Normally caused by the muscle spasms/muscle knots/pressure points mentioned above.

Headaches:

The temporalis muscle found around your temples plays a large role in the retraction of your lower jaw. This means that improper posture in which it is constantly retracted and clenched puts undue pressure, causing a build up of muscle spasms/muscle knots/pressure points. These can normally be treated with heat and massage, but that may not be a permanent solution if the root cause is what we discussed in this article.

Ear Pain and Tinnitus: 

The nervous tissue discussed in the reasoning for jaw pain is actually located really close to the inner ear canal. The pressure put on these nerves may additionally compress nerves within the inner ear that have sound modulating roles, and obviously pain perception as well.

The Proposed Solution

The proposed solution is simple. From maximal retraction (when your jaw is farthest back and your molars are touching), move your jaw forward by around 2-4mm. And stay there. This is meant to be the new resting posture of your lower jaw.

The lips should be closed, and the tongue should be resting at the roof of the mouth.

You should not feel any tension in the front of the neck area like you would if you pushed your jaw even further. If you do feel that neck tension, remember to also work on your head posture as to not have it be leaned forward.

There is no exercise that will make this a natural feeling apart from simply changing the habit of your posture. It may take time for your muscles to get comfortable in this new position, so do not force it if you feel some getting tired. Also note that full retracting your jaw is fine when doing thins like eating since you need to "clench" to bite through food.

In theory, this should help if you have Bruxism as well. Since a full time change in resting position should translate into your resting position during sleep as well.

If you found this article interesting or informative, consider following us on instagram @mytmjrelief, and checking out the myTMJ Pen, a tool to work out painful muscle spasms and assist in at home PT exercises. Read some of our other blogs and check out our free TMJ exercise guides.