·         Arousal

·         The Brain

·         Exercise

·         Indoor Air Pollution

·         Muscle Tension

·         Nutrition

·         Posture

·         Sensory Processing

·         Sleep

·         Other Suggestions


Research Topics


My Theories

Former Theories



The Cause of Internet and TV Addiction?


Temporomandibular Disorders (TMD)

Note: TMD is sometimes referred to as TMJ symdrome.


·        What Are TMDs?

·        Symptoms

·        Causes

·        Risk Factors

·        Treatment

·          What is Physical Therapy?

·          Methods of Physical Therapy

·          Treatment Plan

·          Prevention

·          Posture

·          Stretching

·           Warning

·           Introduction

·           Guidelines

·           Stretching the Jaw

·           Stretching the Neck

·          Exercise

·          Biofeedback

·        TMD and Hyperacusis


What are TMDs?

"Today, researchers generally agree that temporomandibular disorders fall into three main categories:

·         myofascial pain, the most common form of TMD, which is discomfort or pain in the muscles that control jaw function and the neck and shoulder muscles;

·         internal derangement of the joint, meaning a dislocated jaw or displaced disc, or injury to the condyle;

·         degenerative joint disease, such as osteoarthritis or rheumatoid arthritis in the jaw joint."

NIDR: What are Temporomandibular Disorders?



·           TMJ/TMD and Facial Pain



·        "We know that severe injury to the jaw or temporomandibular joint can cause TMD. A heavy blow, for example, can fracture the bones of the joint or damage the disc, disrupting the smooth motion of the jaw and causing pain or locking. Arthritis in the jaw joint may also result from injury…

·        Some suggest, for example, that a bad bite (malocclusion) can trigger TMD, but recent research disputes that view.

·        Orthodontic treatment, such as braces and the use of headgear, has also been blamed for some forms of TMD, but studies now show that this is unlikely.

·        And there is no scientific proof that gum chewing causes clicking sounds in the jaw joint, or that jaw clicking leads to serious TMJ problems. In fact, jaw clicking is fairly common in the general population. If there are no other symptoms, such as pain or locking, jaw clicking usually does not need treatment."

NIDR: What Causes TMD?


"Injury to the jaw, temporomandibular joint, or muscles of the head and neck – such as from a heavy blow or whiplash – can cause TMD.

Other possible causes include:

·        Grinding or clenching the teeth, which puts a lot of pressure on the TMJ

·        Dislocation of the soft cushion or disc between the ball and socket

·        Presence of osteoarthritis or rheumatoid arthritis in the TMJ

·        Stress, which can cause a person to tighten facial and jaw muscles or clench the teeth"

WebMD: Temporomandibular Disorders (TMD)


Risk Factors

Chewing-Side Preference

·           Laterality: Change in Chewing-Side Preference May Cause TMD



"Stress and tension may awaken a (quiet) asymptomatic TMD, aggravate or intensify an existing temporomandibular condition. However, in order for stress to effect TMD there must be an underlying physical predisposition for the disorder to cause TMD. If a patient has healthy dental occlusion, muscle and jaw function, stress would not cause TMD, but would likely produce effects elsewhere in the body."

TMJ/TMD and Facial Pain



Conservative and Reversible Treatments

"The key words to keep in mind about TMD treatment are 'conservative' and 'reversible.' Conservative treatments are as simple as possible and are used most often because most patients do not have severe, degenerative TMD. Conservative treatments do not invade the tissues of the face, jaw or joint. Reversible treatments do not cause permanent, or irreversible, changes in the structure or position of the jaw or teeth."

NIDR: Treatment


Self-Care Practices

"Because most TMD problems are temporary and do not get worse, simple treatment is all that is usually needed to relieve discomfort. Self-care practices, for example, eating soft foods, applying heat or ice packs, and avoiding extreme jaw movements (such as wide yawning, loud singing and gum chewing) are useful in easing TMD symptoms. Learning special techniques for relaxing and reducing stress may also help patients deal with pain that often comes with TMD problems."

NIDR: Treatment


Improper Treatment

"All too often patients are classified as 'chronic pain patients' and their complaints pigeonholed as stress or psychological disorders. These patients may be relegated to treatment only with medication and counseling, with no treatment of the physical cause of their illness. A valid analysis of each patient is essential to give fair weight to the physical vs. psychological status before that patient is told, in essence, "it's all in your head."

TMJ/TMD and Facial Pain


Early Treatment, Progression

"Early appropriate treatment of a TMD may avoid the progression to a chronic pain state, much less easily resolved."

TMJ/TMD and Facial Pain


Physical Therapy

What is Physical Therapy?

"Other conservative, reversible treatments include physical therapy you can do at home, which focuses on gentle muscle stretching and relaxing exercises, and short-term use of muscle-relaxing and anti-inflammatory drugs."

NIDR: Treatment


 Methods of Physical Therapy

"Treatment goals for TMD addressed by physical therapy are to relieve pain, decrease muscle spasm in the masticatory and/or cervical musculature, decrease intra-articular inflammation or tendonitis, restore normal mandibular function and motion without restriction, normalize ROM, and manage the problem to a level of tolerance, since there is no 'cure' for TMD (1,4). Modalities implemented to address these treatment goals are

·          Heat in the form of a moist heat pack or ultrasound/phonophoresis,

·          Cryotherapy in the form of an ice pack or a fluoromethane vapocoolant spray,

·          Electrotherapy such as transcutaneous electrical nerve stimulation (TENS) or electrical stimulation (E-stim)/iontophoresis, and

·          Manual techniques such as soft tissue mobilization (STM)/massage, joint mobilization/distraction, or cervical traction (4)."

University of Delaware Physical Therapy: TMJ Dysfunction


Treatment Plan

"TMJ dysfunction is a complex disorder involving many aspects of physical therapy. Because not all 'TMJ patients' have the same clinical presentation, it is very important for the therapist to establish the cause of the patient's affliction. Once established, the therapist can create a better plan of care for the patient."

University of Delaware Physical Therapy: TMJ Dysfunction



"Although it is important for patients to be treated for TMJ dysfunctions, it is just as important for them to be educated on how to better take care of themselves so that they may relieve their own pain, and prevent a further reoccurrence of symptoms. Physical therapists are not always able to see their patients as many times as they may like, so it is often times necessary to set them up with a good home rehabilitation program in between visits and after their physical therapy has been completed."

University of Delaware Physical Therapy: TMJ Dysfunction


"A common presentation of TMJ dysfunction is hypermobility of the joint. Although there are dozens of other diagnoses involving TMJ dysfunction, hypermobility is perhaps the most prevalent mechanical disorder, and thus warrants discussion of treatment.(6)
     Once a diagnosis of hypermobility is established and modalities have been applied, patient education must be addressed. Some points for the patient to remember include:

· No chewing gum, ice, or fingernails.

· No clenching teeth, or clenching cigars or pipes between teeth.

· No wide jaw opening when eating; no eating tough, chewy, or crunchy foods.

· No wide jaw opening when talking, singing, or yawning.

All of the above actions could potentially cause further injury to the hypermobile TMJ.(1,3,7,10)"

University of Delaware Physical Therapy: TMJ Dysfunction



"The next thing that should be addressed is the patient's posture. A major cause of many patients' TMJ dysfunctions is the way they carry their heads.(11) When the head is protruded, the jaw (especially when chewing) is placed in an awkward position that strains the masticatory muscles.(7) Postural awareness should be broken down into three components: standing, sitting, and sleeping.

·          Standing should be assessed, and focus should be placed on

These exercises promote standing up straight and retraction of the head, neck, and shoulders.

·          Sitting should be assessed next, especially in patients who work behind desks or drive regularly. Focus should be placed on

  • maintaining lumbar lordosis [lumbar curve],
  • chair arm rests, and
  • proper desk height (shoulders should be flexed 25 degrees [moving the upper arm upward to the front] and abducted 15 to 20 degrees [moving the upper arm up to the side away from the body]).

·           Finally, sleeping posture should be assessed, focusing on

  • Maintaining cervical lordosis [supporting the curve of the neck] (with a cervical pillow) and
  • Decreasing lumbar lordosis [lumbar curve] (with a pillow under the knees).

Although patient comfort needs to be taken into account, the supine sleeping position [sleeping on your back] is preferable.(4) Sleeping prone [sleeping on your stomach] puts the cervical [neck] spine in a rotated and extended position, putting stress on the joints, muscles, and ligaments of the spine and leading to trauma of the TMJ.(1,4)"

University of Delaware Physical Therapy: TMJ Dysfunction



Stretching: Warning

"Those with dislocating jaws should not do these [jaw] exercises. Please consult your doctor for further advice."

Coventry Pain Clinic: Treatment - Exercises - Head, Neck, Shoulder, Arms


Stretching: Introduction

"The patient should then be taught some stretching to relieve the strain on the neck and masticatory [chewing] muscles.(1) Stretches should include a Masseter / Temporalis stretch, a Sternocleidomastoid stretch, an Upper Trapezius stretch, and Posterior Cervical muscle stretches."

University of Delaware Physical Therapy: TMJ Dysfunction


Stretching: Guidelines

"All of these stretches should be

·          Performed bilaterally [on left and right sides of the body] (with the exception of the Temporalis / Masseter stretch) and

Done at least 3 times per day."

University of Delaware Physical Therapy: TMJ Dysfunction


Stretching: Stretching the Jaw

Note: Those with dislocating jaws should not do these [jaw] exercises. Please consult your doctor for further advice

"If you can comfortably get three or more knuckles between your front teeth [try one or two first, see instructions on linked page], you have good jaw opening and do not need to do this exercise."

Coventry Pain Clinic: Treatment - Exercises - Head, Neck, Shoulder, Arms


"The Masseter and Temporalis muscles can be stretched by having the patient pull the jaw forward, down and to the side opposite the involved joint."

University of Delaware Physical Therapy: TMJ Dysfunction


Stretching: Stretching the Neck

·          "The Sternocleidomastoids can be stretched by having the patient extend the head, bending it to the side opposite the muscle, and turning the head to the same side as the muscle.

·          The Upper Trapezius can be stretched by having the patient tilt the head to one side, while turning the face to the other side.

·          The Posterior Cervical muscles can be stretched by having the patient flex the head and neck on the chest. Flexion with rotation to both sides should also be done to stretch other posterior cervical muscles.(14)"

University of Delaware Physical Therapy: TMJ Dysfunction



Note: Please consult your doctor before attempting these exercises.

"In addition to stretching and postural adjustments, a home exercise program needs to be established. The Southside approach is a three-part program that incorporates awareness, control, and stabilization, and seems to be quite effective.

·          The first part is done to balance the upper quarter of the body through awareness of RTTPB. RTTPB stands for

and promotes a comfortable, relaxed jaw position that can be properly exercised.

·          The second part is

  • done in a state of RTTPB and
  • involves control of rotation and translation of the TMJ [temporomandibular joint].

With the tongue on the roof of the mouth (to ensure pure rotation) the mouth is passively, then actively opened. After proper rotation has been established with exercises, the patient can progress to opening the mouth passively, then actively without the tongue touching the roof of the mouth.

·          The final part

  • involves mandibular stabilization, and again
  • should be performed in RTTPB.

With the jaw in the neutral position, the patient pushes on the jaw with his/her index finger to the

  • right,
  • left,
  • up,
  • inward,
  • diagonally back and to the right, and diagonally back and to the left

while isometrically resisting the force applied.

The patient progresses with this exercise by repeating the steps with the jaw

  • One knuckle width apart, then
  • Two knuckle widths apart.

(This exercise can be done while the patient is performing the rotation and translation exercises).(14)"

University of Delaware Physical Therapy: TMJ Dysfunction



"A final method that a therapist can use to rehabilitate patients is through the use of Biofeedback, or 'Jaw awareness.' Biofeedback is a means of behavior modification that teaches the patient voluntary self-regulation and awareness of muscle tone and tension. This is usually done using Electromyographic (EMG) feedback, where an EMG machine amplifies minute muscle action potentials to let the patient know when the muscle is over-active.(7) The patient attempts to lower the signal and 'learns' what the relaxed state should feel like.(11) Biofeedback can be used on the masticatory [chewing] muscles, as well as cervical [neck] postural muscles to decrease muscle guarding and fatigue, to retrain postural muscles, and to enable the patient to become familiar with the 'feeling' of low levels of muscle activity.(7)"

University of Delaware Physical Therapy: TMJ Dysfunction


TMD and Hyperacusis

·           Hearing: Hyperacusis: What is Hyperacusis



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