TMJ Dysfunction

Manny Kim, PT, DPT, PRC, CSC I K Integrative Physiotherapy
Rockville, Maryland


The temporomandibular joint (TMJ) or “jaw joint” is one of the most complex joints in the body.  Each TMJ houses an articular disc and must always function as a pair.  The disc divides the joint in two sections, each with its own synovial membrane. The disc allows for the complex movement of the TMJ and provides shock absorption between the mandibular condyle and mandibular fossa (of the temporal bone). Inflammation and/or compression within the joint often cause pain.  Common symptoms of TMJ dysfunction include headaches and neck pain in addition to pain with chewing and restricted mobility of the joint itself.  The TMJ complex is part of our integrated postural system which involves many systems in the body working together to sustain an upright posture for movement and stability.  In fact, many research studies on the stomatognathic system demonstrate the bidirectional relationship between our bite and our posture. Some common causes of temporomandibular joint dysfunction (TMD) include trauma, bruxism, sleep apnea, malocclusion, poor posture, abnormal breathing mechanics, cranial distortion, systemic inflammation, and asymmetry in the body (scoliosis). Standard treatment for TMD often involves treating hypertonic muscles of the jaw and working with a dentist to provide an oral appliance to capture proper bite and decompress the TMJ.

Fascial Counterstrain Treatment

Fascial Counterstrain is a whole body, multi system approach to pain and dysfunction.  We are essentially working with and not fighting the nervous system.  A thorough examination investigates all the anatomy in the TMJ complex (cranial/cervical/mandibular complex) such as tendons, ligaments, nerves, circulatory vessels, muscles, joint capsules, and even bones.  Using the Counterstrain cranial scan, a skilled practitioner will assess these structures within the TMJ complex as well as throughout the body.  Once the primary system and location is identified, diagnostic tenderpoints, are found to confirm the exact anatomical structure that is in dysfunction causing the area to be inflamed and hypertonic/restricted.  Treating the the tenderpoint is done by a precise glide and/or positioning of the body to literally “reset” the reflex that is holding the tissue in a protective state.   These protective reflexes are caused by trauma such as injury or inflammation and can be found in any anatomical structure.   Below are some examples of common findings when treating TMD with Counterstrain: The TMJ capsules can be dysfunctional secondary to spasm of spinal ligaments in the neck. Each temporal bone may be literally twisted differently on each side causing an imbalance in the position of the mandibular fossa producing abnormal TMJ mechanics. Limited blood flow from arterial dysfunction can impair healing around the TMJ. Reflexive dysfunction in nerves such as the trigeminal nerve (mandibular branch controls muscles of mastication) and facial nerve (providing sensory feedback from the face) are often involved in TMD.  Venous/lymphatic dysfunction is common with those who have chronic TMD. Sometimes it is necessary to treat the lymphatic duct, which is in the thorax, to help drain the jaw complex.  The epidural veins in the spine may need treatment, which will improve drainage of the entire cranium, thereby helping alleviate maxillary sinus pressure.  Restoring balance in the autonomic nervous system is necessary to take someone out of sympathetic dystrophy, which is common in patients who are in chronic pain/dysfunction. A complex joint dysfunction requires a treatment approach that is capable of addressing the complexity of multi system involvement.  Working with a skilled Fascial Counterstrain practitioner is therefore vital to understanding and resolving the puzzle of TMJ dysfunction.