Let’s Break It Down Part 2- Demystifying a TMJ Diagnosis
By far the most common “TMJ” concern I see in my office is actually MUSCLE MYALGIA. So many times people come into the office thinking they have a problem with their joint when what they really have is muscle soreness. Unlike some of the other muscles in the body, it is IMPOSSIBLE to stop using the muscles in your head and neck that help you bring your teeth together. Every time you swallow, your teeth come together to make that happen. Every human swallows between 500-700 times a day. Each time, the jaw muscles contract. So NO MOVEMENT IS NOT POSSIBLE. However, a normal amount of function in the muscles (to swallow, speak, and chew) rarely results in dysfunction or pain, but a large number of people have what is called PARAFUNCTION. The word parafunction essentially means abnormal function. Here is where this gets confusing for most people- abnormal function (or clenching) in my world does not mean squeezing or gritting your teeth together like you’re angry. That action does count as parafunction, but did you know that even holding your teeth together at rest is clenching!?!? Check yourself right now as you’re reading this- are your teeth together? Are they touching at all? I just checked myself, and guess what? I’m clenching. Do that enough throughout the day and night and eventually the muscles fatigue just like every other part of your body would.
The most common example I use for most patients is that if you were to hold a dumbbell all throughout the night in the same position without relaxing, when you wake up in the morning how sore would your bicep be? Because of the contraction in that muscle for such a long period of time, the next day it would be hard to wash your hair or even pick something up that is light. It also might be hard to even move your arm and wouldn’t take much effort or work for that muscle to fatigue. Your jaw muscles are the same way. Hold your teeth together all night and only a little bit of movement in the morning (chewing your breakfast, or even light function) and those muscles will fatigue easily and feel sore.
So how do we know? Is it muscle or is it joint? One of the first things I look for in an exam is where is the pain coming from? If someone points to right in front of their ear canal that usually indicates more of a joint discomfort. But most of the time people actually point to their cheek. You can tell sometimes if you touch the spot that is sore, hold and squeeze your teeth together and you can feel the spot stiffen or even a little muscle knot there. Typically there is pain on function and less pain at rest. There can be limitations in the range of motion (you can’t open as far as normal), but often times you can push your jaw open with pressure (joint dysfunction, especially without reduction, you typically cannot push yourself open, its a hard stop).
Treatment for muscle soreness can sometimes include splint therapy. Sometimes temporarily, sometimes long term- it truly depends on the patient. Sometimes we use muscle relaxers or botox to calm the muscle down. Other things that can help- massage therapy, warm heat, rest (soft diet), postural therapy (working on lips together, teeth apart), mindful meditation (especially before bed).
People ask all the time, why am I clenching? And while we haven’t been able to fully answer that question there are some theories we might consider. Many times SSRI medications, such as Prozac/Lexapro, etc antidepressants, can lead to increased parafunction especially at night. Usually the clenching begins within the first 2-3 weeks of beginning the therapy or an increase in dosage (although it may take longer for a patient to notice soreness). Patients are often unaware that this is a side effect of treatment and it doesn’t make sense to them that a medication designed to relax you would lead to increased clenching. We don’t generally take patients off of a medication to manage this. We work on habit reduction, postural modification and other treatment modalities we can use to decrease the impact of clenching.
Increased stress or a life change can lead to bruxism (clenching) which can lead to muscle soreness. Even “good” change- like moving to a new town, starting a new job, or getting married can lead to increased clenching. There are some theories, although it’s still debatable at this point, that sleep disordered breathing (obstructive sleep apnea, or upper airway resistance) can lead to clenching. The verdict is still out on this one, but anecdotally I see the two show up together frequently in my practice.
Generally between a thorough history and clinical chairside exam, an experienced clinician can help determine whether your pain is coming from your joint, your muscles or both!! It is important to remember that oftentimes there is a combination of the two. Targeting the right source of pain and determining what habits and issues may contributing to ongoing discomfort is the key to finding relief. If you are unsure of how to manage your discomfort, please call us so that you can be evaluated and we can help get you on the path to healing.