WHY DOES MY JAW HURT? TMJ Pain: Where It Comes From and How To Treat It

Have you ever heard the acronym “TMJ” thrown around? Maybe you’ve had a friend complaining about “having TMJ”? What they probably mean is that they’re having TMJ pain. In actuality everyone has two Temporomandibular Joints (TMJs)--but some people experience specific issues within those joints.

What is TMJ and why does my jaw hurt?

The Temporomandibular Joint is what attaches the jaw bone (mandible) to the rest of your skull (temporal bone). The chronic pain associated with the TMJ is called temporomandibular joint dysfunction (ironically, it’s a mouthful).

Temporomandibular Joint Dysfunction or TMD is a dysfunction or abnormal function of the joint that makes up your jaw.

A few common symptoms include:

• Jaw pain

• Headaches

• Neck pain

• Ear Pain

• Difficulty opening mouth fully

What about other types of pain? How does my jaw cause pain elsewhere?

How does pain originating in your jaw present in so many other areas? You can thank a concept called ‘referred pain’. Referred pain occurs when the interconnecting network of nerves in an area sends pain signals to the brain. Sometimes when these signals are sent the brain interprets them and spans them across different anatomy structures adjacent regions from the origin of the pain itself. It’s kind of like when your Amazon package shows up four houses down on your neighbor’s porch: all the right systems were there, it just didn’t quite make it.

That might sound like complex medical jargon but you’re probably already familiar with referred pain. The most common example of referred pain is an individual experiencing a heart attack. The origin of the issue is in the cardiac muscle of the heart, but oftentimes a tell-tale sign is the pain and numbness that goes down the left arm.

While TMD is less life threatening it’s still a very real pain that interferes with everyday life. Pain from your TMJ can orient all around your head, face and neck. Common referred pain sites include forehead, behind or around the eye, at the base of the skull, throughout the neck and even the ear.

Another common and painful issue with the TMJ is the inability to open the jaw fully. Remember when you were a kid and one of your friends would double-dog dare you to try to fit your whole fist in your mouth? Turns out, that’s a pretty good practice for determining mouth range. We use a “three knuckle” test to assess if the range of the opening of your mouth is normal or limited.

How did I get TMD?

In most cases, there’s not a traumatic incident or specific time that your TMD or TMJ- associated pain began. Often, the pain accumulates from habitual patterns overtime. For example, we tend to clench our teeth subconsciously when we’re stressed. Some of us only chew food or gum on one side of our mouth. When we have habits that stress one side more than another the muscles on that side can get tight and locked up just like a shoulder or knee. In some cases the TMJ can even get stuck and lock either in a “closed” or an “open” position.

How do I get rid of it?

Much like your TMD or TMJ related pain didn’t happen due to a single event, there’s not a single “one-size fits-all” solution either. It’s often a combination of several tactics implemented over time that bring you relief.

As a chiropractor, I treat TMJ pain and TMD issues with a range of techniques. These include manual therapy, dry-needling, stretching techniques, and adjustments to the neck and TMJ itself. A large part of treatment will include addressing the behaviors, habits or other factors contributing to the origin of pain. We can treat the pain all day and all year, but if we never address the source of the pain it will continually come back each time you get stressed out at work or have a bad night of sleep and grind your teeth.

On your own, there are a few method and tactics you can implement to break the habits causing your pain:

1. Try the “Resting Jaw Position”

   1. Lips together (no mouth breathing)

   2. Teeth slightly apart (no clenching)

   3. Tongue gently resting at roof of mouth (this is called digastric activity)

2. Chew on both sides of your mouth

   1. Next time you’re eating food or chewing gum, consciously think about where you’re chewing. If you’re favoring one side, start actively involving both sides of your mouth.

   2. Consider switching to mints if you’re a gum-chewer.

3. Avoid oral parafunctional activities (that’s a fancy way of saying “activities other than breathing or chewing)

   1. Avoid chewing on pens, your nails and even gum

4. Avoid sleeping on your stomach

   1. The position forces your jaw into clenching

5. Stress management techniques

   1. This could be a whole article within itself but I’ll keep it brief -- if you are in a stressful time because of work, finances, etc, find healthy ways to deal with and manage stress

   2. This could include: dedicating more time to sleep, seeing a therapist or counselor for stress management, exercising regularly, etc.

6. Create physical reminders

   1. It might seem silly but I recommend putting a post-it note on your computer or workspace that reminds you to “stop clenching.”

   2. You could also set an alarm or reminder for yourself on your phone to prompt you to stop clenching throughout the day

TMD and TMJ pain will not go away overnight. It will take some on-going practice and yes, even some daily reminders-- to consciously stop the habits that develop and exacerbate your pain. Also, if you want to sound like the smartest person in your friend group you can let everyone know that saying “TMJ joint” is like saying “the ATM machine” -- it’s redundant :)

Are Standing Desks Worth The Hype?

Have you heard the quote ‘sitting is the new smoking’? It seems like an odd comparison at first until you consider how many hours a day Americans spend sitting--surely that can’t be good for us, right?

The problem with sitting

Let’s look at a typical, pre-COVID day: You get in your car to sit during your 30+ minute commute. You then sit at your desk for hours on end and get back in your car to reverse the commute. You get home, exhausted from work and slump on your couch for the evening to recoup from your mentally taxing day. Does that routine sound familiar? Even if your “commute” is from your bedroom to your living room or home-office right now, you’re still spending much of the day in the sitting position.

Many of us have jobs that lock us inside with computer monitors at a desk for many hours. On one hand, you could make a drastic job change to another industry that keeps you on your feet more often. That’s likely not an option for most of us. The good news is, we can make some modifications to our habits within the current parameters we’re working within.

Silver bullet: standing desk?

Most of us are aware that sitting for long periods of time isn’t great for our bodies. Lo and behold a solution: the standing desk! If sitting is the new smoking, I’ll just work all day while standing. Problem solved…? I wish it were that easy.

Here’s the issue: sitting with poor posture can cause low back, neck and shoulder pain. Standing with bad posture can yield the exact same issues. If you had bad posture while sitting, it’s natural to repeat those patterns when standing.

For those of you with standing desks, do any of these look familiar?

• Shifting hip to one side

• Bending forward due to the desk being too low

• Rounding the shoulders, and jutting the head & neck forward

• Elevated shoulders due to desk being too high

• Locking out the knees

How to transition yourself to a standing desk

Bottom line: you’ll bring the habits you’ve developed from sitting all day into standing all day as well. When you’ve grown accustomed to sitting all day and then immediately transition into standing instead your muscles and joints do not have the endurance, strength, capacity, or stamina to tolerate hours of standing. So how do you adjust to your new standing desk without exacerbating bad habits or pain?

The most practical approach is to mix up and change positions throughout the day. Being locked into stagnant postures can be detrimental to us when we don’t deviate from them often. I recommend having a hybrid sit-stand desk which allows you to easily toggle between good ergonomics (a fancy word for your efficiency in your working environment) for sitting and standing alike. A few practical tips on adjusting properly to your standing desk:

1. Proper set-up and fit

   1. You should be able to have your feet slightly under the desk without craning your neck to reach your workspace/computer. Think of the pain you might experience when you’re washing a lot of dishes -- we want to avoid that.

   2. To determine the ideal height for your standing desk, bend your elbows to 90 degree angles. Measure from the floor up to your hands. This should be the height to have your standing desk at to avoid undue strain.

Elbows at a relaxed, 90 degree angle.

2. Strategies for adjusting to a standing work model

1. Set a goal of standing for 1 hour each day, and gauge the difference. Try this for a couple days and then increase to 1.5 hours, 2 hours, up to 4-5 hours each day of your ~8 hour work day.

2. Try adopting an every-other-hour rule where you switch between sitting and standing. Maybe you start your morning email read-through while standing and then tackle answering those emails while sitting.

3. Experiment with taking at least one meeting while walking around if you’re able.

4. Use a 15-20 minute “on” and a 40-45 minute “off” approach. Stand for 15-20 minutes at the top of each hour and then sit the remaining 40-45 min.

3. Options for your stance at your standing desk

1. Captain Morgan - Keep one foot stable on the ground bearing about 70% body weight while your other leg is propped up on a box or other object. Switch feet as necessary. Make sure you don’t “lock out” your knee on your balance leg-- We don't want to start a new knee issue :)

2. Split/scissor stance- In this position, one foot is stepping forward while the other is stepping back. It’s almost like stopping in mid walking stride. Switch front foot as needed.

3. Straight up - In this standard position feet are about hip width apart. Keep a soft bend in the knees, weight evenly distributed in both legs, and between your heels and toes.

4. Wide stance - Similar to the Straight-Up...but wider. Stand with your feet a bit wider than shoulder-width apart with weight evenly distributed. Depending on how wide your stance is (determined by how comfortable it is for you) you may need to lower your standing desk slightly to accommodate your loss in height.

B

A

D

C

Find a strategy that works and don’t be afraid to experiment with work rhythm and flow.

The upside of standing up

One thing I personally notice when working at a standing desk is that I naturally “fidget” more... and that’s a good thing. I find myself naturally flowing through all of the different standing positions listed above. By cycling through these different positions I allow my body to respond to indicators that I’m starting to feel tired or stiff. When you use this shifting practice you’re training your body to move throughout the day without missing a beat in answering your emails.This increased movement is half the benefit of the standing desk. You’re also increasing blood flow--always a good thing--and even creating a slight increase in metabolic demands (i.e. more calories burned--but no, this doesn’t count as your workout for the week).

So...is a standing desk worth it? Like with most things--only if you use it correctly.

Resources and product recommendations:

1. This study for Just Stand as well as the coordinating CDC research provides tons of helpful data around standing desks and sitting issues.

2. Want to dig more into how bad sitting all day can be for you? This resource compares the sitting/smoking dynamic.

3. Some recommended products for sit/stand conversion:

   1. FlexiSpot - $299

   2. Vari - $295

   3. WayFair - $86

   4. https://www.upliftdesk.com/uplift-v2-laminate-standing-desk/ $589

If you’re experiencing chronic pain that’s heightened when you’re standing or sitting all day, book a consultation with me for an assessment on your posture and habits. The easiest way to book with me is to contact the Carolina Sports Clinic front desk.

Disclaimer:The content in this post is for general educational and entertainment purposes. Every human body is different and unique and may require a custom approach or modification. This content should not be seen as medical or health advice. You should not self-diagnose, please see me or another licensed practitioner for individual healthcare needs.

Why Eliminating Pain is a Lifestyle Change, Not a Quick Fix

How many times have you heard someone casually say, “I have a bad back--it flares up pretty often” or “I’ve had low back pain for 15 years”? While it may feel “common” to have back pain, it’s not normal or good--and you don’t end up with that kind of chronic pain overnight.

When my patients come to see me, I walk them through some questions that help me understand their day-to-day lifestyle. Why? The best predictor of low back pain is previously experienced low back pain.

The bad habit of back pain

My patients want to understand where their pain came from especially if there wasn’t a big event that triggered the pain (like a car accident or a particularly hellacious CrossFit workout). The reality is, most cases of low back pain are not caused by a single instance outside of specific trauma. Typically, pain is caused by a habit of movement that an individual uses to carry out their normal activities throughout the day. The problem is that the path of least resistance for the body to complete a given task-- such as bending down to tie your shoes-- may not be the most biomechanically advantageous.

Let me give an example: when you bend down to tie your shoes how do you do it? Do you think to yourself, “Self, let’s do this right. Bend at the hips, soft knees, push the butt back while keeping the back nice and straight. Engage the hamstrings.” My guess is, you probably don’t. Instead, you create a shortcut like rounding your back to get to your shoes as quickly as possible. We get away with the “shortcut” for a while because the body is incredible at adapting to stresses placed on it. But after a while the cumulative effect of taking these small shortcuts everyday lead to an exhaustion and break down of whatever piece of anatomy has been pulling the most weight in the group project titled “tie the shoes”. And to be clear in this analogy--that’s usually your lower back.

How do I fix it?

Eventually this pain gets to be so impactful on your everyday function that you come see a chiropractor, physical therapist, or the like. After a couple treatments the pain begins diminishing. The natural cycle of inflammation has passed and you go back to your normal activities. The body was given a break from its shortcuts and then it got some well-needed attention to get worked on. The catch is that this was just a bandaid. If the movement habits remain unchanged in everyday life, it will be just a matter of time before the same issue resurfaces again--and often with a vengeance. This becomes a vicious cycle of “flare-ups” throughout the year.

The good news is, there’s a different way to treat your pain other than repeating this pain-temporary relief-pain cycle.

Address the inflammation

To begin addressing your inflammation start with a visit to a chiropractor or physical therapist to allow the natural inflammation to pass. Usually this takes about 3 days if we don’t continue to irritate it. Your practitioner might give you an adjustment, some rehab and mobility work and a set of simple exercise or movement patterns to repeat at home.

Modify your patterns

Then the next step is to modify our autopilot movement patterns. Each time we bend forward to tie our shoes we pick the scab. What if we use a different method to achieve the same result? Instead of bending down from a standing position you might prop your foot onto a chair. Maybe you drop into the bottom position of a lunge. Both of these alternatives shift the emphasis of stress from the low back into more of a hip dominant movement. The hips were made to have a large range of motion--the low back is not. Now all body parts stay happier because we varied the process. Less stress is put on one specific thing and instead is dispersed throughout the body. It may feel laborious or foreign at first but moving in a conscious way overtime is one of the best ways to correct bad habits and replace them with healthy movements (and, in turn, less pain!)

If we don’t change the activities that got us in pain in the first place, we are doomed to end up back in the same place down the road. Break the mold by moving mindfully instead of gravitating back to more of the same habits.

Suggested low back maintenance exercises

Below are some of my favorite go-to’s for low back pain. Each video offers an explanation of the movement and its benefit.

Disclaimer:The content in this post is for general educational and entertainment purposes. Every human body is different and unique and may require a custom approach or modification. This content should not be seen as medical or health advice. You should not self-diagnose, please see me or another licensed practitioner for individual healthcare needs.