Is the Jaw and /or neck causing Face Pain? Or is it a Medical or Dental problem?
February 17th, 2013
Any patient coming in for physiotherapy treatment of Headaches, face, neck and shoulder pain should be screened for TM Joint inflammation and dysfunction especially if they have ever been in a car accident or had a prior facial trauma
Jane in her late 40″s had been in two car accidents- 5 and 8 years ago. Since then she had chiropractic treatment for recurring neck pain. Her jaw had started to click in the last year and she was fitted for a night guard and told to take a course of anti inflamatories. More recently the dental hygenist had noticed on a recent visit to have her teeth cleaned, that she had extreme difficulty opening her mouth wide.
Arriving in my office I asked her to list her complaints with #1 being most severe. # 1 was Migraine headaches, #2 -neck pain, #3- Jaw locking #4- limited mouth opening #5- Back pain. (this was chronic)
I started my assessment by evaluating head alignment relating to the rest of her body and noticed she had a pronounced forward head posture. This can lead to a poor position of the tongue and changes in spinal alignment. Both significant in having good Jaw biomechanics. ( The tongue tip should be touching the palate in “m” sounding position).
She predominately breathed in the upper part of her chest and suffered from hay fever. This had not been confirmed by a doctor.She wondered over the years if the inability to breathe through her nose led to difficulties concentrating. Or was it menopause? Stress?
She had started yoga but reported that her balance was awful. (SEE NEXT BLOG HOW THE JAW IS A “BAROMETER OF BALANCE”)
However recently her jaw had started to click more on one side and she reported wiggling her mouth to get around something. That “something” is a disc shaped like a figure of eight fatter at each end and narrow in the middle. ( It facilitates the lower jaw to move on the skull during opening.)
I assessed her TM Joints, I made her aware that her jaw deviated to the right on opening and her mouth opening was limited to 30mm without pain and 40mm with pain.
Research shows that any dysfunction in the upper neck associated with poor jaw biomechanics can escalate TM joint problems if not treated.This was the case with Jane. Initially she had an Anterior disc with reduction which had progressed to an Anterior disc without reduction. The soft tissue ie: muscles, fascia and ligaments respond protectively causing pain
I improved her jaw mechanics which helped her posture and balance.
She reported that she could open her mouth wider,her balance had improved at yoga,her headaches gone and even her back pain had improved. This intrigued her!
In conjunction with my treatment I encouraged her to see other health professionals to check for the other possible causes of Face Pain.
1. Cranial nerves inflammation
2. Inflammatory Disease
5. Cardiac problems
6.. Infection in ear, gland, viral, septic joint
Happily it was a dysfunction of Right TM Joint, affecting the “Muscles in the face and neck/shoulder areas. The car accident and compensatory posture alignment possbly contributed to Upper cervical (neck) spine inflammation and increased Dural /fascial tension
In summary, I believe that Physiotherapists should screen the TM Joint as part of their assessment for complaints of Headaches, face, neck and shoulder pain. Especially if the client has ever been in a car accident or had a prior facial trauma.
Physiotherapists can play an important role in assessing if the jaw or any part of the musculoskeletal body is causing face pain and headaches
( TM Joint dysfunction is most prevalent in 20-40 year olds and female to male ratio 3:1)