TMJ dysfunction- The possible origin of severe referred pain

The temporomandibular joint (TMJ) refers to the jaw joint. When dysfunction occurs in the jaw joint, it may cause symptoms that people could not associate to the jaw. This is because the pain caused by the TMJ dysfunction may refer pain to the other structures surrounding or away from the TMJ. However, early diagnosis with physiotherapy will prevent TMJ dysfunction from becoming chronic.

TMJ is the most frequently used joint in our body as it allows us to open and close the mouth at least 2000 times a day. Therefore, a dysfunction in the TMJ can cause pain that can debilitate our daily activities.

So what the common symptoms from TMJ?

• Severe headaches
• Dizziness
• Pain in the eyes or in the back of the eyes
• Earaches
• Ringing in the ears
• Pressure in the ears
• Hearing problems
• Stiff shoulder and neck muscles
• Tooth ache
• Difficultly swallowing
• Frequent sore throats

When the TMJ is injured, muscles, ligaments, tendons, nerves and blood vessels can get injured simultaneously. The nerves send out and receive information from these structures. Irritation of the nerve can cause pain felt far from the originating problem. This phenomenon is also known as “referred pain”.

Another cause of referred pain from the jaw is the “trigger point”. A trigger point is an irritable spot in a muscle that is locked into a painful spasm. Normally, when a muscle is working, its fibers act like little pumps, contracting and relaxing to circulate blood through the muscle. In a trigger point, the muscle fibers hold their contraction, which leads to blood flow decrease. This causes the tissue to have lesser oxygen intake and more accumulation of muscle waste products. The trigger point responds to this, sending out more pain signals in the affected area and connected areas leading to a no ending cycle of continuous muscle contraction and lack of blood flow.

The main goal of the physiotherapy is to identify the source of the symptoms, aiming to reduce the pain and regaining normal function of the TMJ with manual therapy and exercises.