TMJ/TMD Pain Management

TMD Muscle Spasm Protocol

The best way to maintain the health of your chewing muscles and temporomandibular joints is to think of them like any other muscle and joint: avoid overloading them and give them adequate rest and recovery. The following instructions will help reduce muscle spasm and will help unload the joints. The more diligently you follow these instructions, the more your muscles can relax and the more your joints can heal. These are also important to follow when you are recovering from a TMJ surgery. Once your muscles and joints feel better, do not suddenly stop this protocol. Instead, wean off slowly. If you stop abruptly, your muscles can experience a rebound spasm.

Soft diet

Chewing for your jaw is analogous to doing squats for your hips and knees. Essentially, chewing puts stress on both the jaw muscles and the jaw joints. Therefore, the softer your diet is, and the less forcefully you chew, the more your jaw muscles can rest, and your joint swelling can subside. Try to stick to a diet that consists of food that is easily mashed with your tongue, which means you don’t have to use much force to chew it. This is not forever, but you should not increase your chewing strength until your TMJ symptoms are gone.

Night guard

Night guards are quite misunderstood. They are not going to stop you from clenching. But they still provide great benefit for your jaw and jaw joints. The function of a night guard is twofold. First, it prevents the full force of the muscle contraction during nighttime clenching or grinding. So, the muscle spasm is attenuated. But the second function is more important. A properly made night guard separates the teeth enough so that the joint does not become compressed during maximal contraction. It essentially unloads the joints, protecting them while you sleep from the compressive forces of those clenching muscles. To effectively protect your joints, the night guard must be constructed of a hard plastic material. Most patients will benefit from wearing a night guard at night. The night guard should feel snug, but not uncomfortable. If you wear retainers, you can wear a night guard in place of either your upper or lower retainer, and it will double as a retainer. Unfortunately, patients undergoing active orthodontics must wait until they complete treatment to wear a night guard, as the teeth are actively moving.

Warm Compresses

Many people instinctively use ice packs for their TMJ pain. However, ice causes muscle contraction, and will not facilitate muscle relaxation. Instead, use warm compresses on your masseter and temporalis muscles (see illustration on right). Warmth helps muscles relax. You can use microwaveable gel packs sold at pharmacies or on Amazon, or you can put a wet washcloth in the microwave. Use whatever is most convenient for you. The more you apply heat to your tense muscles, the more they will relax. Do this at least once a day, but more is better. Just be careful not to burn your skin.

Massage

Another thing that helps muscles relax is regular massage. You can do this yourself or go for professional massage therapy, but the most important thing here is frequency and consistency. Massage your temporalis and masseter muscles by using your index and middle fingers to slowly rub the muscles in a circular motion. They may feel sore, and in that case, don’t push too hard. It should not hurt. Do this self-massage at least 2-3 times daily, for about 30-60 seconds each time. Try not to clench the muscles as you are doing this.

Stretching

Like any other muscle in the body, stretching the masseter and temporalis muscles will help them relax and avoid injury. You can work with a physical therapist for some extra help, but the major work will be done by you, throughout the day. You should do these stretches 10-20 times daily. Do the exercises slowly and smoothly. Do not make any fast or jerky movements. You can do these exercises while sitting or standing. When doing these exercises, you should feel a gentle stretch. They should not cause pain. If an exercise is causing pain or discomfort, try doing it more gently.

How to stretch yourself

Put your middle finger on your bottom teeth. Put your thumb from the same hand on your top teeth, as in the illustration to the right. This is more effective than other methods because this position of your fingers gives you leverage. Open your mouth as wide as you can. Push your fingers gently against your teeth to give extra resistance. Push until you feel a gentle stretch, but no pain. Hold this stretch for 10 seconds, then relax. Take 1 full breath between each repetition. Repeat this stretch 10-20 times daily. If your muscles are in spasm, this stretch is helpful to relax and elongate contracted muscles. If you are recovering from TMJ surgery, this stretch is very important to prevent the formation of scar tissue inside the joint.

There is a very helpful device called the OraStretch® press system by CranioRehab, that can make stretching much easier. If you feel that stretching on your own is difficult, our doctors can prescribe this device for you.

Physical therapy

Some patients will benefit from extra formal physical therapy sessions. It should be a glorified massage and stretch session. It should not be a workout for your jaw and should not hurt. If your doctor sends you for physical therapy, do not stop your daily routine of all of the above. It should be in addition to all that you do on your own.

Muscle relaxants

Your doctor may prescribe you a medication that relaxes these muscles. Take the medication as prescribed. It is usually best to take the medication at bedtime, so that it can work while you sleep, but it should wear off by morning, so you don’t feel tired. You can experiment with the time of evening that you take the medication so that the duration of effect works for you. If you do not feel relief, or if you feel too drowsy in the morning, discuss this with your doctor. A different muscle relaxant may work better for you. An important rule when it comes to muscle relaxants is, do not take it only when you are symptomatic. It must be taken on a regular, daily basis to be effective. Once you feel better, and your muscles are no longer in spasm, you will be instructed to wean yourself off of it slowly, by cutting the pill in half for a week or so, and then perhaps taking one every other night, etc. If you stop taking the full dose abruptly, you may experience rebound muscle spasm.

NSAIDs or steroids

Your doctor may also give you medication that reduces swelling. This is specifically for swelling inside your joint that may be causing pain. If you have been instructed to take a medication like this, take it exactly as prescribed, or it will not work effectively.

Botox

Botox is a powerful toxin that causes temporary muscle weakness. While it is most popularly used for skin wrinkles and other cosmetic purposes, it can be a very helpful adjunct to fighting your painful muscle spasm, or to get you to stop clenching or grinding with your jaw muscles. It is injected directly into the masseter and temporalis muscles. It should be used in conjunction with some, or all of the modalities described above, never in place of them. Its effects begin to take effect within the first 3 days, the effects peak at about 3-4 weeks post injection, and the effects last about 3 months, and some patients require several courses of the injections of the to have lasting effects. Botox can be a miracle drug for patients experiencing stubborn muscle spasm. The only downside is that it is an expensive medication, and it is generally not covered by insurance. You will have to pay upfront for it, and you will likely not be reimbursed for it by your insurance company.

Stress-relieving activities

This one should be obvious, but it is the most difficult task of all. Many people manifest their stress from everyday life in their jaw, neck, head, and back muscles. So, while we cannot avoid stress, it is encouraged to implement stress-relieving activities in your routine on a regular basis, to help to try to dissipate some of the stress. Some examples of this are walking, meditation, yoga, reading or watching a movie, journaling, talking to friends who make you laugh, or even talking to a therapist. Try to pay attention to your jaw habits during the day and try consciously not to clench your jaw when you’re stressed or out of habit.