Dry Needling for TMJ
Unlocking Relief for TMJ with Dry Needling
Key Points:
TMJ disorders cause significant jaw pain and discomfort, affecting daily activities.
Dry needling presents a promising TMJ treatment by offering pain relief and restored jaw function.
Research supports the efficacy of dry needling for TMJ symptoms.
Understanding TMJ and exploring dry needling can offer new hope for sufferers.
Temporomandibular Joint (TMJ) disorders are more than just a pain in the jaw; they represent a complex health challenge affecting millions worldwide. Characterized by pain, discomfort, and limited movement, TMJ disorders can severely impact one's quality of life. In the quest for effective treatments, one innovative approach stands out: dry needling for TMJ. This article delves into what TMJ is, its symptoms, and how dry needling offers a beacon of hope for those seeking relief.
What is TMJ?
The Temporomandibular Joint (TMJ) connects the jawbone to the skull, enabling you to talk, chew, and yawn.
The temporomandibular joint (TMJ) is a complex structure that facilitates movement of the jaw. It connects the jawbone to the skull and allows up to open and close our mouths, chew, talk, and yawn. It is positioned in front of the ears, and one TMJ is found on each side of the jaw, identifiable by the palpable movement experienced when opening the mouth.
The temporomandibular joint is made up of several key components:
Mandibular Condyles: These are the rounded protrusions on the top of the mandible (lower jaw) that fit into the temporal bone of the skull.
Articular Disc: This is a thin, oval-shaped piece of cartilage that sits between the condyle and the temporal bone, allowing smooth movement.
Temporal Bone: This bone forms part of the side of the skull and houses the TMJ.
Ligaments: Several ligaments surround the TMJ, providing support and limiting the range of motion to prevent dislocation.
Muscles: Various muscles contribute to the movement and function of the TMJ. The primary ones include:
Masseter: This muscle elevates the jaw to close the mouth.
Temporalis: It assists in elevating the jaw and moving it backward.
Pterygoid Muscles: The medial and lateral pterygoid muscles work together to open the jaw, move it forward, and side-to-side.
Together, these structures allow for the complex movements required for chewing, speaking, and facial expressions.
What is TMD?
Temporomandibular disorders (TMDs) encompass over 30 conditions that lead to discomfort and dysfunction in the jaw joint and the muscles managing jaw movements. While “TMJ” denotes the joint itself, “TMDs” refers to the array of disorders affecting this area. Causes vary widely, from genetics and arthritis to jaw injury and habitual grinding or clenching of teeth.
Types of TMJ Disorders
TMDs are categorized into three primary groups:
Joint Disorders: This category includes issues with the joint's disc, among other disorders.
Muscular Disorders: These involve the masticatory muscles responsible for chewing.
TMJ Headaches: Headaches that are linked to a TMD.
A person may experience multiple TMDs concurrently, presenting a complex diagnostic and treatment scenario.
Causes of TMJ Pain
While direct injury to the jaw or TMJ can precipitate some TMDs, the origins of many disorders remain elusive. Emerging research points to a blend of genetic factors, psychological stress, and individual pain perception as potential contributors. Additionally, gender differences in TMJ structure could influence the prevalence of TMDs, which are notably higher in women than in men. Contrary to previous beliefs, there is no conclusive evidence linking orthodontic treatments or "bad bites" to the onset of TMDs.
TMJ Symptoms
Although joint sounds like clicking are common and typically benign, certain symptoms can indicate a TMD:
Pain: The most frequent symptom, pain can be felt in the jaw joint, chewing muscles, face, or neck.
Jaw Stiffness: A feeling of tightness in the jaw muscles.
Limited Movement: Difficulty opening the mouth fully, chewing, or jaw locking.
Painful Jaw Noises: Clicking, popping, or grating sounds in the jaw joint that cause discomfort.
Ear-related Symptoms: Ringing in the ears, diminished hearing, or dizziness.
Dental Misalignment: A noticeable change in how the upper and lower teeth align.
It's important to distinguish between normal TMJ sounds and those indicative of a TMD, which may require medical evaluation and intervention.
TMJ and Orofacial Pain
Orofacial pain, affecting the tissues of the oral cavity and face, is a significant condition that ranks as the second most common type of orofacial discomfort, with about one-third of individuals experiencing symptoms in their facial and masticatory muscles. This pain is often linked with temporomandibular joint dysfunction (TMD), which impacts chewing muscles and surrounding areas, with a yearly incidence rate of almost 4% in the United States. Myofascial pain associated with TMD is believed to stem from trigger points (TP) in the muscles, identifiable by their hypersensitivity and the localized pain they produce, which can also limit motion and function of the jaw.
To address myofascial pain, various non-invasive treatments are employed, aimed at deactivating these trigger points. These include methods like ischemic compression, passive stretching, and others like ultrasound and cognitive behavioral therapy. Among the interventions, dry needling (DN) emerges as a minimally invasive alternative, utilizing sterile needles to directly stimulate the trigger points, thus offering relief from neuromuscular pain and improving movement impairments.
Dry Needling for TMJ
Dry needling, a modern treatment modality, involves inserting thin acupuncture needles into specific muscles and trigger points points to relieve pain and improve function. For TMJ sufferers, dry needling targets muscles around the jaw, neck, and sometimes the broader facial region to reduce tension and alleviate discomfort.
Depending on who you ask, dry needling may be considered an acupuncture style or a physical therapy technique. Either way it involves using acupuncture needles to deactivate trigger points.
The Science Behind Dry Needling for TMJ
Emerging research underscores the potential of dry needling in treating TMJ disorders. Studies have shown that dry needling can significantly reduce muscle tension and pain, offering an effective, non-surgical option for TMJ relief. One study (see below) highlighted reduced pain intensity and improved jaw function in participants undergoing dry needling therapy.
Muscles in TMJ Pain
TMJ pain, a common condition affecting the jaw's functionality and comfort, often involves several muscles, each contributing to the complex interplay of movements and sensations. These muscles, prone to developing trigger points, can refer pain to the jaw and surrounding areas, complicating temporomandibular joint disorders (TMD). Understanding the roles and potential impact of these muscles is crucial in addressing TMJ pain effectively.
Masseter: One of the primary muscles enabling jaw closure, the masseter, can develop trigger points that contribute significantly to TMJ pain. Its role in elevating the jaw makes it a frequent site for tension and discomfort.
Temporalis: This fan-shaped muscle, extending over the temple and assisting in jaw elevation and retraction, can harbor trigger points that radiate pain to the jaw, contributing to TMJ discomfort.
Pterygoid Muscles: Comprising the medial and lateral pterygoids, these muscles are integral to opening the jaw, and moving it forward and side-to-side. Trigger points in these muscles can lead to a range of TMJ symptoms, including pain and limited movement.
Upper Trapezius: Although not directly connected to jaw movement, the upper trapezius muscle can influence TMJ pain through its anatomical and functional connections to the neck and shoulders. Tension in this muscle can refer pain to the jaw area.
Sternocleidomastoid (SCM): This muscle, running along the neck's side, plays a pivotal role in head movement. Trigger points in the SCM can refer pain to the jaw, adding another layer to the complexity of TMJ pain.
Additional muscles that may refer pain to the jaw include the digastric muscle, which assists in opening the mouth, and the cervical muscles, which support the head and neck. These muscles can develop trigger points or tension, contributing to the overall experience of TMJ pain.
Addressing TMJ pain often involves a comprehensive approach, considering the involvement of these muscles and employing therapies such as dry needling, traditional acupuncture, massage, and physical therapy to alleviate discomfort and restore function.
Dry Needling for TMJ Research
The use of dry needling (DN) and acupuncture for treating orofacial pain, particularly associated with Temporomandibular Joint (TMJ) dysfunction, has gained attention in recent years. Research exploring the effectiveness of this intervention offers insights that could revolutionize how TMJ and associated myofascial pain are managed.
One 2019 systematic review looked into the impacts of dry needling on orofacial pain originating from myofascial trigger points in individuals with TMJ dysfunction. This study highlighted that dry needling showed superiority over other interventions for short-term pain intensity relief and was more effective than sham therapy in improving pressure pain thresholds. However, the authors urged caution due to the very low quality of evidence and small effect sizes observed. They advocated for more robust randomized controlled trials to further validate dry needling's efficacy in this context.
Another double-blind randomized 2022 clinical trial examined the effectiveness of deep dry needling (DDN) as an initial treatment for TMJ disorders. Participants undergoing DDN on the masseter muscle exhibited significant improvements in pain reduction, muscle activity, and jaw function, including the symmetry of mouth opening and closing, increased range of mouth opening, and alterations in static jaw position. These results underscore the potential of DDN to serve as a foundational therapy for TMJ disorders, suggesting that addressing jaw trigger points can lead to considerable reductions in facial pain and enhancements in mandibular functionality.
A 2010 study examined the short-term impacts of dry needling on active myofascial trigger points (TrPs) in the masseter muscle of patients with temporomandibular disorders (TMD). Conducted on twelve female patients, it compared the effects of deep dry needling and sham dry needling interventions on pressure pain threshold (PPT) in the masseter muscle and mandibular condyle, as well as pain-free active jaw opening. Results indicated significant improvements in PPT levels and jaw opening in the group receiving deep dry needling as opposed to the sham treatment, suggesting that dry needling on masseter muscle TrPs could effectively enhance pain thresholds and jaw mobility in myofascial TMD patients.
These studies collectively suggest that dry needling, whether as a direct intervention or part of a broader treatment strategy, holds promise for individuals suffering from TMJ dysfunction and associated orofacial pain. However, both pieces of research underscore the necessity for further studies with rigorous methodologies to firmly establish dry needling's role and efficacy in treating TMJ disorders.
Real-life Impact
Consider the story of Alex, a long-time TMJ sufferer. After trying various treatments with little success, Alex turned to dry needling. The results were transformative, with significant pain reduction and improved jaw mobility. Alex's story is a testament to the potential of dry needling to change lives for those battling TMJ disorders.
Exploring Dry Needling Treatment for TMJ Pain
Despite its benefits, some may have reservations about dry needling, fearing discomfort or questioning its scientific basis. It's crucial to consult with a qualified practitioner who can provide a safe and effective treatment experience, addressing any concerns and tailoring the approach to individual needs. A licensed acupuncturist with dry needling training will be the best type of expert to look for since they primarily use needle therapy in all of their treatments.
For those exploring treatment options for TMJ, dry needling offers a compelling avenue worth considering, potentially unlocking a new level of comfort and quality of life.
Over to you
If you liked this article, please share with friends and family who may be interested in learning about dry needling for TMJ pain.
Sources:
Trinh, D. T., Tran, A. H., Nguyen, Q. T., Bui, M. M. P., Vuong, N. L. (2019). Dry needling for the treatment of orofacial pain of myofascial origin in patients with temporomandibular joint dysfunction: A systematic review. Journal of Alternative and Complementary Medicine, 23(3), 164–179. PMC6546838
Dib-Zakkour, J., Flores-Fraile, J., Montero-Martin, J., Dib-Zakkour, S., & Dib-Zaitun, I. (2022). Evaluation of the Effectiveness of Dry Needling in the Treatment of Myogenous Temporomandibular Joint Disorders. Medicina (Kaunas, Lithuania), 58(2), 256. https://doi.org/10.3390/medicina58020256
Itoh, K., Asai, S., Ohyabu, H., Imai, K., & Kitakoji, H. (2012). Effects of trigger point acupuncture treatment on temporomandibular disorders: a preliminary randomized clinical trial. Journal of acupuncture and meridian studies, 5(2), 57–62. https://doi.org/10.1016/j.jams.2012.01.013
Fernández-Carnero, J., La Touche, R., Ortega-Santiago, R., Galan-del-Rio, F., Pesquera, J., Ge, H.-Y., & Fernández-de-Las-Peñas, C. (2010). Short-term effects of dry needling of active myofascial trigger points in the masseter muscle in patients with temporomandibular disorders. [Abstract]. Retrieved from https://pubmed.ncbi.nlm.nih.gov/20213036/
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