Steve Kraus


What is TMD?

Temporomandibular disorder (TMD) involves the muscles of mastication and temporomandibular joint(s) (TMJ). TMD is a musculoskeletal problem, affecting up to 25% of the general population. In the absence of trauma, the etiology of TMD is unknown. However, the vast majority of patients respond well to a cost effective, conservative and reversible treatment approach.

 Common symptoms of TMD

  • jaw pain with chewing, talking and yawning
  • clicking with jaw movement
  • intermittent locking on opening or closing
  • limited mouth opening that can be mild, moderate or severe
  • ear symptoms (ear pain, fullness and tinnitus)
  • headache (temporalis area)

TMD and Cervical Spine Pain

A common comorbidity associated with TMD is neck pain.  Neck pain also referred to as cervical spine disorder (CSD), involves the muscles, facet joints, discs and nerves of the cervical spine. In the TMD population, CSD is often overlooked as a source for headache, facial and ear pains. A common headache that originates from the cervical spine is a cervicogenic headache. Cervicogenic headache is located at the base of the head extending to the temporal, frontal, and ocular areas. Cervicogenic headache can mimic a migraine headache. Cervicogenic headache may consist of ipsilateral blurring and reduced vision, a “migraine” phenomenon like nausea, loss of appetite, photophobia, dizziness, ear pain / tinnitus (cervicogenic somatosensory ear symptoms) and may even be vomiting. Neck pain proceeds the onset of migraine 70% of the time, neck pain is a trigger for migraine and neck pain has been suggested to be an etiology for migraine.

TMD and Cervical Spine Treatment

Physical therapists with proper training offer an evidence-based treatment for temporomandibular and cervical spine disorders. Treatments may include but not limited to patient education, behavioral modification, therapeutic exercise, modalities and manual therapy to include joint mobilization, manipulation and dry needling. Treatments offered by a physical therapist achieve satisfactory reduction or elimination of symptoms with improved function of the jaw and neck in the vast majority of patients.  An oral appliance provided by the dentist may be necessary to manage sleep bruxism. In 5% of the patients diagnosed with a disc displacement that are not responding to physical therapy or an oral appliance, these patients will need to consult with an oral surgeon. The physical therapist works closely with the oral surgeon to assure necessary post op management is provided for the patient.

During the initial evaluation and treatment session, treatment objectives, frequency and duration of treatment will be covered by the physical therapist. Communication between the physical therapist and the dentist, oral surgeon and / or physician will be expected.

TMD symptoms share similar symptoms with other common comorbidities that may require input from other healthcare professionals. Patients may need to be seen by an ophthalmologist (oculofacial pain), dentist (otalgia), ENT (sinusitis and allergies) and/or neurologist (migraine).