I see a lot of patients that have temporomandibular dysfunction (TMD/TMJ). Many complain of pain in their face, jaw and neck as well as frequent headaches and difficulty chewing. But another very common complain is popping or clicking in the jaw. Even if you aren't experiencing pain, popping or clicking can be a sign of TMD.
So why does this clicking or popping happen? Before I can answer that, you need a little bit of background information.
The temporomandibular joint is a sliding hinge joint that connects the lower jaw (mandible) to the temporal bone of the skull (located in front of the ear on both sides of the head). Joints are the place that bones interact, usually allowing movement; the bones are covered with cartilage to keep bones from grinding against one another. The cartilage acts as a shock-absorbing disc to keep the movement smooth. This joint is flexible and allows movements such as up and down as well as side to side to chew, talk yawn, etc. These movements are also made possible by the muscles surrounding the joint such as the masseter (chewing) muscle.
Thanks to my Essential Anatomy app, I was able to draw on where the disc is below. It is depicted by a blue line. The red arrow is the direction the muscles pull the disc when unlocking the jaw.
TMJ dysfunctions are thought of as very common and can affect up to 33% of individuals in their lifetime. Women are more prone to having this disorder than men and it most commonly occurs between the ages of 20 and 40. Some causes include erosion or displacement of the disc, arthritis causing damage to the bone and/or cartilage, impact to the joint, as well as stresses like the grinding or clenching of your teeth and tightening of the jaw muscles.
Why does the clicking/popping happen?
Clicking is one of the earliest symptoms before TMD gets bad. Since the cartilage disc is near your eardrum, it's easier for you to hear it. Oftentimes the disc has slid forward and out of place. Compare the picture below to the picture above. The disc has moved forward. It is still in the joint but doesn't slide back when you close your jaw.
So how does it continue to progress after this stage? That's then when you get locking of your jaw. This happens when the disc has slid out of the groove of the jaw joint as pictured below.
Will it get better on its own?
Habits are usually the key components that drive this vicious cycle. If these habits aren't addressed, it will most likely continue to progress. But some interventions are better than others.
So what can be done about it?
There are many different ways to treat TMJ disorders. Some include mouth guards or bite adjustments by dentists. Some people are able to manage it on their own by adjusting their sleeping postures and eating habits. But the most effective and long-lasting seems to be physical therapy.
What do physical therapists do to treat TMJ disorders?
The first thing a PT should do is reduce inflammation of a dislocated TMJ with ice. Most often when patients are wanting to get their jaw treated, it is because they are in a great deal of pain. It is rare that we see someone seek treatment in early stages. So getting the patient out of immediate pain and inflammation allows the therapist to work on such a sensitive area.
Manual techniques on the neck, as well as neuromuscular re-education, are important to realign the head on the top of a stable spine. The disc in the TMJ can be reset and that's when the stabilization techniques need to be implemented.
Muscle pain and/or poor habits can cause the jaw to stray to one side, resulting in an improper bite. Jaw stabilization and strengthening exercises can alleviate pain and correct the muscles that were imbalanced to create an even pull of the jaw and the disc.
You can see an example of one of these exercises below!
And there you have it! If you're dealing with this kind of clicking/popping, locking or pain and other interventions haven't helped, try to find a physical therapist that specializes in TMJ and jaw disorders!
Remember, we can and we will get better together!
Dr. Justin C. Lin