February 2025 - Fit and Flow Physiotherapy

The temporo-mandibular joint (TMJ) refers to the two joints located on either side of your face that connect your jaw to your skull. Pain in this area can stem from muscle tension, joint inflammation, or structural damage to the cartilage and bones of the joint.

Treatment options may include soft tissue release, gentle joint manipulation, or strengthening exercises for the muscles surrounding your neck and face. Occasionally TMJ pain will require imaging and specialist referral for surgery or orthodontic braces to help support the joint.

Symptoms of TMJ pain and dysfunction

TMJ pain can manifest as an ache in the jaw or face and may also lead to headaches. Dysfunction of the TMJ can result in clicking or locking of the jaw, often occurring while eating or chewing, but it can also happen upon waking or at rest.

Stiffness or dysfunction in this joint may limit jaw movement, making it feel as though you can’t fully open your mouth. Additionally, you might experience the sensation that your teeth are misaligned or don’t come together properly when chewing.

Causes of pain

TMJ dysfunction can result from tension in the muscles surrounding the jaw, including those involved in chewing and moving the mouth, as well as neck and shoulder muscles that connect to the base of the skull. The alignment of your head and neck can influence the position of the jaw and the effectiveness of these muscles. Consequently, posture can play a significant role in TMJ-related issues.

Stress

Stress can lead to tension in the muscles around the neck and shoulders, negatively impacting posture and jaw function. Grinding your teeth or clenching your jaw is often a sign of stress, leading to overuse of the jaw muscles and resulting in pain.

Posture

i. Sleeping

Sleeping posture can contribute to jaw dysfunction. For instance, sleeping on your stomach can place your neck and jaw in an unfavorable position, causing stiffness and pain over time.

ii. Sitting

Sitting posture also plays a role; when your head is positioned forward on your neck—common in slumped postures—it can create tension in the muscles under the jaw, leading to discomfort.

ii. Exercising

Additionally, exercise posture can affect jaw health in several ways. Maintaining tension in your jaw or clenching your teeth during workouts can lead to muscle overuse and fatigue, resulting in jaw pain. Poor movement patterns can also increase strain on your shoulders and neck, which can further contribute to tension and discomfort in the jaw.

Structural causes

Damage to the cartilage ring within the joint can lead to clicking and locking. This damage may be degenerative, resulting from years of teeth grinding, poor posture, or genetic factors, or it could stem from an acute injury, such as a blow to the jaw or biting down on something hard.

Arthritis in the TMJ can also result in stiffness, pain, or clicking. While the incidence of arthritis is largely influenced by genetics, poor joint function over time can accelerate the degeneration process.

Physio treatment

Physiotherapists employ various techniques to alleviate TMJ pain. These may include soft tissue massage for the muscles around the neck and jaw, and occasionally the shoulders, if they contribute to jaw tension. Specific jaw releases can be applied if one side is tighter than the other. If motor control issues are contributing to jaw pain, physiotherapists will provide targeted exercises to improve strength and movement in the jaw.

Posture in the head, neck, and shoulders plays a significant role in jaw pain. For instance, rounded shoulders or a slumped posture can increase tension in the muscles that connect to the base of the skull and jaw. Physiotherapists can identify poor postures and prescribe exercises to strengthen the relevant muscles and correct these patterns. They are also skilled in assessing your workspace and recommending modifications to improve your posture. For desk-related jobs, reviewing your desk setup, chair, monitor, and devices can help alleviate posture-related tension. For physically demanding jobs, evaluating your working postures, tools, and movement patterns can ensure your body is positioned favorably to prevent muscle fatigue, tension, and jaw pain.

If sleep posture is identified as a contributing factor to TMJ pain, adjustments to your sleep position, along with the use of specialized pillows or mattresses, may help manage discomfort.

TMJ specialists, dentists, or orthodontists may recommend braces to improve jaw alignment, reducing undue stress on the jaw and alleviating the effects of teeth grinding. In some cases, Botox injections may be suggested to decrease muscle activity around the jaw that contributes to pain, while surgery might be necessary if the cartilage needs to be repaired, removed, or replaced.

Psychologists can assist with stress management, which may help reduce instances of teeth grinding and jaw clenching.

TMJ pain can arise from a variety of causes and therefore require specific assessment and a targeted treatment approach. If you feel you are experiencing TMJ pain, make an appointment with us today.

Leading up to her pregnancy, Emma enjoyed training Crossfit 4 x week as well as trail running on the weekends.
Emma’s twin girls are now 2 years old, she is back in the gym 3 times a week and training for a half marathon

We spoke to Emma about her Exercise and activity before and during pregnancy and how she approached her postpartum rehab after giving birth.

What were your activity levels in the lead up to pregnancy and what was your activity like during?

I’ve always been very active, I did gymnastics when I was younger and have trained in the gym for the last 15 years. In the lead up to pregnancy I’d been doing Crossfit for about 4 years. I trained 3-4 times a week in the gym and would run trails or with a run club 1-2 times a week. I also saw a PT every few weeks for technique advice and strength with some lifting.

When I found out I was pregnant I was already rehabbing a hip injury and needing to heavily modify crossfit workouts. I decided for this reason to stop crossfit and focus on my PT program in the gym. I know plenty of people who have done crossfit throughout their pregnancies, and there’s no contraindications of doing so while you’re pregnant, but I made the decision to stop so that I could focus on quality movement and training based on how my body felt.

It turns out that I was so sick during my first trimester that I didn’t train much at all anyway. I managed to get out to walk my dog around the block once a day and that was it.

During my second trimester I was able to get to the gym about twice a week. My PT had written me a pregnancy program to follow and I did what I was comfortable with, and what I felt like doing on the day. My training goals during this time were to move my body, so I didn’t place any great pressure on myself to train hard or get my programs done.

During my third trimester my training slowed down again. Carrying twins was taking its toll, and I needed to rest a lot during the day. Walking was causing pelvic pain, I tried some pregnancy yoga classes online but these did not feel comfortable though my pelvis or ribs and I was needing to modify so much in the gym that I felt it was no longer worth the energy of going. I felt during this time that swimming was the only type of exercise I could manage, and I really enjoyed this. I could get my heart rate up without fatiguing myself too much or causing pain, and I felt like the buoyancy of the water taking pressure off my joints felt really good. So I swam about once a week towards the end of my pregnancy.

For someone who is used to training high intensities most days of the week, this period of reduced activity was initially very challenging mentally. But over time I got good at listening to my body and it felt good being able to let go of the pressure I put on myself to train everyday, and to train intuitively based on how I felt.

How long after birth did you start exercising?

The girls were born via planned cesarean, so I took my postpartum recovery very slowly.
I did nothing for the first 4 weeks except think about feeding and looking after the girls.
My mum was in the house to do all the washing and cleaning and she would push the pram for me when we went out for walks – which consisted of walking 15 minutes to get coffee then walking back.

After 4 weeks I started to feel more mobile and the pain from the surgery had reduced, so at this stage I started to work on my pelvic floor activation lying on my back. This is all I did for 4 weeks – practising pelvic floor activation, endurance and relaxation. I slowly began to add some leg movements in, and as I got more mobile I started to add in some gentle thoracic stretches.

From about 8 weeks on I had a small home routine that I would try to complete 3-4 times a week while the girls napped. As anyone with babies knows this (mostly) didn’t go to plan, but I did what I could, when I could, and relied on the consistency of doing at lease one thing everyday to help with progress.

The program involved some body weight squats, low level core exercises and some banded rowing for my upper body. I started to add lunges in, slowly increased my walks and started to add in some small hills.

I didn’t put pressure on myself at this stage, I moved because it felt good to have some control back of my body. I was also starting to notice aches in my lower back from feeding, holding and rocking the babies, so I wanted to prioritise strength to avoid an injury or further pain.

At about 4 months postpartum I was starting to feel like I had a bit more freedom and energy to leave the house, and I felt I’d built enough basic strength to start some exercises in the gym.
At this stage I wrote myself a postpartum gym program involving some basic machine exercises and light compound movements such as squats and deadlifts, bench presses and rowing, and completed this in the gym 2 times a week. I had great support from my sister who would train with me on those two days, and a lovely, supportive environment to train in (Anytime Caringbah).

I planned the next 6 months of training out in 8 weeks blocks, with the goal of returning to crossfit 1 year after giving birth. I completed this program consistently 2-3 times a week.

Running wasn’t a priority for me but when I reached 1 year postpartum I felt like getting outdoors and going for a run once a week balanced my training out. I started with 1 min intervals and built over 3 months until I could run 30 minutes without discomfort or issues.

My twins are 2 years old now, and I am back doing crossfit 2-3 times a week and running once a week on the weekends.

What were some struggles you found when returning to exercise?

Because I planned my training well and took my time returning to exercise, I found that my physical capacity wasn’t an issue. I was able to return comfortably without injury or issues.
The challenge was more about finding the time during the week to train. Juggling babies with work schedules, either finding gyms with creches or training very early or very late in the day, and the lack of sleep affecting training quality and recovery was the biggest challenge.

I again had to let go of pressures I put on myself to get to the gym and had to accept that some sessions may not go to plan, if they happen at all!
I was still able to progress and reach my goals, I had to learn patience and trusting the process.

Would you do anything differently?

I was quite proud of how I managed my rehab, I felt like I was equally able to enjoy newborn life and watching my girls grow while simultaneously taking time to look after myself and build my body back again.

I had stages where I worried if my body would ever be able to do the things it used to do again, but knowing now that for the most part it will and that it just takes time, maybe next time I’d take even longer to get back.

It’s amazing how capable the body is of adapting to change, I have a new appreciation for it and these days enjoy training to nurture it rather than smash it.
I hope to pass on these healthy exercise and activity habits to my girls and hope to be active myself throughout their lifetime.

If you’re looking to get back to activity after childbirth, or interested in a postpartum gym or running program, our Physios specialise in women’s health conditions, pre and postpartum rehab and strength and conditioning programs.
Get in contact with the clinic today to make an appointment.