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TMJ Hypermobility & Proprioception

A man's face with a slight smile viewed from just below the eyes, with the caption above it "TMJ Hypermobility & Proprioception"

While jaw problems come in all shapes and sizes, hypermobility issues are one of the most common. The jaw, also called the temporomandibular joint or the TMJ, is a complex joint. It is unique compared to the other joints in our body because the jaw bone (the mandible) connects between the right and the left sides of our body. That means that what happens on one side, inevitably effects the other.

Regardless of whether the jaw is stiff on one side (hypomobility) or loose on one side (hypermobility), the other side will also pay the price. Focusing on hypermobility, gf the jaw is loose on one or both sides, it creates some problems for us. People will often report popping, clicking, pain, locking of the jaw, and muscle tension problems such as clenching or grinding their teeth. In some cases, it can even lead to ear ringing. (See Can TMJ Treatment Cure My Tinnitus?)

In this post we'll discuss an overview of:

How Hypermobility Effects The Jaw

So how can all that happen from a few loose ligaments in the jaw? Many of the nerves that help our body to sense position are located in the ligaments. If the ligaments are loose, the instability presents our bodies with a choice. Either our muscles have to work harder to try and stabilize the joint, or the joint will move in an uncoordinated way.

If the muscles are working overtime, they can develop painful trigger point. Trigger points occur when the tissue swells and there is a build up of chemical irritants like lactic acid. Most muscles are not designed to work all the time. Overuse of some muscles in the jaw that are close to the ear can also contribute to ear ringing. In fact, most people who experience clicking in their jaw can feel the pop inside their ear if they put their finger into the ear canal while opening and closing their mouth.

When the joint moves in an uncoordinated way, we run the risk of compressing or pulling on the nearby nerves as the joint moves. There is also a disc in the joint that can catch, resulting in a clicking sound. If the joint is mobile enough, it may slip out of place and then pop back in. Formally, doctors call this is a subluxation. If the joint is even more mobile, in extreme cases, the joint can dislocate entirely.

Most true dislocations of the jaw happen as a result of trauma to the face. This is different than when a person experiences lock jaw. Most cases of lock jaw occur when the position of the jaw is shifted, preventing the disc from sliding smoothly between the joint surfaces. If the disc gets stuck in the middle, the jaw can't open and close normally.

As you can see, the jaw is a complex joint, and there are a variety of different problems that can occur. If you're concerned your jaw may be hypermobile, it's best to work with a physical therapist who specializes in treating TMJ problems. Unfortunately, there is not a national directory at this time to help you find PTs who have an interest in treating patients with jaw problems. It is also unfortunate that many call center employees that are trained to try and improve patient confidence in the company's services will schedule the patient an appointment without really knowing if the therapist specializes in TMJ problems or not. Even some therapists with minimal experience treating the TMJ will claim to be able to treat jaw problems simply because they want your business. For tips on how to find a competent PT, check out Choosing a PT for TMD.

Proprioceptive Exercises

After your PT has ruled out structural problems, if they determine that hypermobility is the issue, they may talk to you about improving the coordination of your jaw. Proprioception is a medical term for the body's ability to sense it's position in space. For example, if you sit with your eyes closed and raise your hand in the air, you can feel where your hand is without having to look at it. That position sense is called proprioception.

This is important if you want to help your body control the movement of the jaw with your muscles. The goal is to teach your muscles to work together to prevent subluxations, reduce poor coordination of movement that affects the disc (leading to popping/clicking), and reduce irritation of the nerves that can occur with uncoordinated movements.

Basic proprioceptive jaw exercises can be done at home without much equipment. The most basic movement our jaw performs is to open and close. When a PT watches a patient perform this movement, they are looking to see if the person opens their mouth straight up and down. When people with hypermobility open their mouth, it often wobbles slightly to the right or left without them realizing it.

If you aren't trained to see this, it's easy to miss. It may help to perform the movement slowly while watching in the mirror or utilize a slow-motion video recording to watch the movement.

It's important though that the patient can see the abnormal movement. It's difficult to correct something that you can't recognize occurring. Once you are aware of the atypical movement pattern, you can begin working to correct it.

When trying to build new movement habits, it's best to start slow. When moving slowly, the brain has more time to think and react to feedback and make adjustments. The goal is to perform intentional and controlled movements.

Typically it's best to start with a lot of feedback to make sure that you are doing the movement correctly. We can check ourselves by using visual feedback from our eyes in a mirror, tactile feedback from our hands touching our face, and auditory feedback from the sounds the TMJ does or doesn't make.

Knowing your learning style can be helpful here. It may be easier for you to learn with one form of feedback or another. Likewise, as you start to progress to doing the movements without the added feedback, some forms may be harder to give up than others.

If you aren't a visual person, sometimes tactile feedback is more helpful. The same movement of opening and closing the mouth can be performed with your finger held to your lips as though you are saying "Shhh!" and telling someone to be quiet or keep a secret. When opening and closing the mouth in this position, the feeling of your lips gliding up and down against your finger can give you feedback about if you are moving in a straight line.

The hands and the lips have more sensory nerve endings than the jaw itself. Taking time to specifically focus on jaw movement is often necessary despite the fact we move and use our jaw to eat and talk every day.

When we are using the jaw to eat, we are often more focused on the taste of what we're eating than how our mouth is moving. When using the jaw to talk, we are more focused on what we are saying than how the jaw is moving. Distraction frequently keeps us from learning to move our jaws in a smooth and coordinated way.

Some patients find that if they can learn to coordinate the movement of their jaw well while opening and closing, their pain and clicking/popping improve significantly. There are several proprioceptive exercises that a skilled PT can teach you to coordinate your jaw movement better for your unique needs. There are also a variety of muscle energy techniques, joint mobilizations, and lifestyle habit changes that can improve jaw problems.

TMJ Hypermobility and Ehlers Danlos Syndrome

When the TMJ isn't the only part of the body that is hypermobile, there is an added layer of complexity to address. For people with Ehlers Danlos Syndrome (EDS), they often experience hypermobility in the neck, ribs, and shoulders which can all contribute to TMJ problems.

The jaw does not exist in a vacuum, it is attached to a whole person. The muscles on the front and sides of the neck attach to the jaw. Some of those muscles also attach to the ribs, and shoulders on the other end.

Moving past the muscular component, the jaw and the neck are structurally related. If you think of the jaw like a swinging door that opens and closes, the upper cervical spine in the neck serves as the door hinges. If there are alignment and instability problems in the neck, it can keep the door from swinging properly.

A collage of a woman pressing her fingers to her jaw muscles, a door on it's hinge, an anatomy mannequin with the msucles of the shoulder, neck and face, and a set of invisilne dental appliances

Aside from financial motivation, that is part of why many PTs who don't specialize in jaw problems will still take patients with jaw problems. They are hopeful that treating the neck will improve the jaw problems by association. While this is true if the neck is in fact involved, ideally, it's best to find a therapist who can treat both issues. For a person with EDS, while the neck may be partially to blame, the ligaments in the jaw itself are most likely also loose and will need specific treatment as well.

Beyond joint structure, people with some types of Ehlers Danlos Syndrome also experience a high and narrow palate, and dental crowding which can also contribute to problems with the TMJ. In some cases, working with a dentist and/or orthodontist that are accustomed to treating TMJ patients is necessary.

It's also important to recognize that the stress of living with complex chronic illness can affect a person mentally, financially, and physically. When under high levels of stress some people begin to clench their teeth subconsciously and will complain of waking with jaw pain from clenching and grinding in their sleep.

There are even more challenges to good management of TMJ problems in people with EDS who have other conditions like dysautonomia, and Mast Cell Activation Syndrome (MCAS), which occur more commonly in people with EDS.

A physical therapist performing a thorough evaluation will consider all of these factors and more to provide optimal patient care for a person with EDS and TMJ hypermobility problems.

This article is for introductory educational purposes only and is not intended as a replacement for individual medical advice. You are encouraged to schedule an evaluation appointment to obtain personalized recommendations from a licensed healthcare provider before starting a new exercise program. Click here to book online if you are interested in scheduling and evaluation with a TMJ specialty therapist.

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