Jaw Pain and Temporomandibular Disorders (TMD): Symptoms, Diagnosis, and Treatment
Updated: Sep 8
Temporomandibular disorders (TMDs) are a diverse group of conditions affecting the jaw joints, the muscles that control jaw movement, and related structures. They may cause jaw or facial pain, restricted movement, locking, painful joint sounds, difficulty chewing, or headaches associated with jaw function.
TMDs rarely have one simple explanation. Joint health, muscle function, injury, clenching and other jaw behaviours, sleep, stress, pain sensitivity, and general health may interact differently from one person to another. Accurate diagnosis therefore depends on understanding the individual rather than treating every case of jaw pain in the same way.
This article explores TMJ anatomy and biomechanics, common TMD presentations, assessment and diagnosis, and conservative treatment options. It also considers how education, self-management, exercise, manual therapy, interdisciplinary care, and Motion Specific Release procedures may be incorporated into an individualized management plan.
Article Index:
Understanding TMD
The temporomandibular joints, or TMJs, connect the lower jaw to the skull. TMJ refers to the joint itself, while temporomandibular disorders, or TMDs, describe more than 30 conditions that can affect the jaw joints, the muscles used for chewing, and related structures.
TMDs affect approximately 5% of adults, although estimates vary according to the population and diagnostic criteria studied. They occur about twice as often in women as in men. Some episodes are brief and resolve with minimal care, while others become persistent and substantially affect eating, speaking, sleeping, work, and quality of life.
TMDs can be organized into three broad categories:
Joint-related disorders: These include disc displacement, joint inflammation, degenerative joint disease, subluxation, and other conditions affecting the TMJ.
Muscle-related disorders: These involve pain and dysfunction in the masticatory muscles and may include pain that spreads into the face, temple, ear region, or neck.
Headache attributed to TMD: In some cases, headache is influenced by jaw movement, function, or loading and can be reproduced during examination.
A person may have more than one type of TMD at the same time. Symptoms may also be influenced by injury, clenching, sleep disturbance, stress, pain sensitivity, and other health conditions. Neck pain commonly coexists with TMD, but cervical findings should not automatically be assumed to be the cause.
Understanding which tissues and factors are clinically relevant is essential because the diagnosis guides the treatment. A painful jaw joint, a sensitive chewing muscle, and an intermittent painless click are not the same problem and should not be managed as though they are.
TMJ Anatomy and Movement
The temporomandibular joint, or TMJ, connects the mandibular condyle of the lower jaw with the mandibular fossa and articular eminence of the temporal bone. There is one joint on each side, and both must coordinate whenever the jaw opens, closes, or moves from side to side.
The TMJ is often described as a modified hinge-and-gliding, or ginglymoarthrodial, synovial joint. Its movement combines rotation and translation:
Rotation: During the early part of opening, the mandibular condyle primarily rotates beneath the articular disc within the lower joint compartment.
Translation: As opening continues, the condyle and disc move forward and downward along the articular eminence within the upper joint compartment.
Combined movement: Rotation and translation overlap rather than occurring as two completely separate phases.
Side-to-side movement: During lateral excursion, the condyle on the side toward which the jaw moves primarily rotates and may shift slightly laterally. The opposite condyle translates forward, downward, and medially.
A biconcave articular disc lies between the mandibular condyle and temporal bone. The disc improves joint congruence and helps distribute forces during jaw movement. It divides the joint cavity into two compartments:
The superior, or discotemporal, compartment, where most translation occurs
The inferior, or discomandibular, compartment, where most rotation occurs
The disc is connected medially and laterally to the condyle by discal ligaments and blends with the joint capsule around its periphery. Posteriorly, it is continuous with vascular and nerve-rich retrodiscal tissues. Anteriorly, it blends with the capsule and may receive variable attachments from the superior head of the lateral pterygoid muscle.
Unlike most synovial joints, the articulating surfaces of the TMJ are covered primarily by dense fibrous connective tissue, often described as fibrocartilage, rather than hyaline cartilage. This tissue is adapted to the combination of movement and loading experienced by the joint.
These structures work together as a dynamic system. However, anatomical changes such as disc displacement, remodelling, or joint sounds do not necessarily indicate pain or require treatment. Their clinical importance depends on symptoms, function, examination findings, and, when appropriate, imaging.
Soft Tissue Anatomy
Muscles of Mastication
Four paired muscles produce most movements of the mandible:
Masseter
Temporalis
Medial pterygoid
Lateral pterygoid
These muscles work together rather than functioning in isolation. They elevate, lower, protrude, retract, and move the jaw from side to side while helping control the relationship between the mandibular condyle, articular disc, and temporal bone.
Painful temporomandibular disorders may involve the masticatory muscles, the temporomandibular joints, or both. Muscle-related pain can be local or spread into the jaw, temple, face, teeth, ear region, or neck. Because other dental, neurological, vascular, and medical conditions can produce symptoms in similar areas, tenderness alone does not establish the diagnosis.
During examination, an important finding is whether jaw movement, resisted testing, or standardized palpation reproduces the patient’s familiar pain, meaning pain that resembles the problem they normally experience.
The following anatomy is somewhat more technical and is included for students, clinicians, and readers who would like a deeper understanding of jaw function.
The Masseter
The masseter is a powerful jaw-closing muscle located along the side of the face. It has superficial and deep portions that differ slightly in fibre direction and function.
Origin: The zygomatic arch and adjacent zygomatic process of the maxilla
Insertion: Primarily the lateral surface of the mandibular ramus and angle, with deeper fibres extending toward the upper ramus and coronoid region
Action: Elevates the mandible to close the jaw. The superficial fibres can assist protrusion, while the deeper fibres may contribute to mandibular control and retrusion.
Innervation: The masseteric nerve, a branch of the mandibular division of the trigeminal nerve, or cranial nerve V3
The masseter is one of the principal muscles examined when muscle-related TMD is suspected. Sustained clenching, unfamiliar chewing demands, trauma, or altered jaw use may aggravate symptoms in some individuals.
Palpation can produce local, spreading, or referred pain. The clinically meaningful question is not simply whether the muscle is tender, but whether palpation reproduces the patient’s familiar symptoms. Masseter pain may be experienced in the cheek, jaw, preauricular region, or nearby teeth, but referral patterns vary and should not be treated as fixed diagnostic maps.
The Temporalis
The temporalis is a broad, fan-shaped muscle covering the temporal region of the skull. Its fibre direction allows different regions of the muscle to contribute to different aspects of mandibular control.
Origin: The temporal fossa and deep surface of the temporal fascia
Insertion: The coronoid process and anterior border of the mandibular ramus
Action: Elevates the mandible. Its posterior fibres also assist mandibular retrusion.
Innervation: The deep temporal nerves arising from the mandibular division of the trigeminal nerve, or cranial nerve V3
The temporalis is also included in standardized assessment for muscle-related TMD. Pain may be felt locally in the temple or may spread toward the forehead, eyebrow, jaw, or upper teeth. Symptoms may be influenced by clenching, grinding, chewing, trauma, sleep disturbance, or other factors that increase jaw-muscle demand.
Temple pain should not automatically be attributed to the temporalis. New or unusual temporal pain, particularly when accompanied by scalp tenderness, jaw fatigue during chewing, visual symptoms, fever, or systemic illness, requires prompt medical assessment to exclude conditions such as giant cell arteritis.
The Medial Pterygoid
The medial pterygoid is located on the inner surface of the mandibular ramus. Together with the masseter, it forms a muscular sling around the mandible.
Origin: The medial surface of the lateral pterygoid plate and adjoining portions of the palatine bone and maxilla
Insertion: The medial surface of the mandibular ramus and angle
Action: Bilateral contraction elevates the mandible and assists protrusion. Unilateral contraction contributes to movement of the jaw toward the opposite side.
Innervation: The nerve to the medial pterygoid, arising from the mandibular division of the trigeminal nerve, or cranial nerve V3
The medial pterygoid may contribute to pain during chewing, clenching, or opening the mouth. Because it lies deep within the jaw, assessment requires caution. Tenderness in this region is not specific to one structure and must be interpreted alongside the patient’s history, movement findings, and other examination results.
The Lateral Pterygoid
The lateral pterygoid is a deep muscle with an important but complex role in controlling the mandible and TMJ. It is commonly described as having superior and inferior heads, although its architecture and attachments vary between individuals.
Origin: The superior head arises primarily from the greater wing of the sphenoid. The inferior head arises from the lateral surface of the lateral pterygoid plate.
Insertion: Most fibres attach to the pterygoid fovea on the neck of the mandibular condyle. A variable portion of the superior head may also attach to the joint capsule and articular disc.
Action: The inferior head contributes to protrusion and assists jaw opening. Unilateral activation helps move the jaw toward the opposite side. The superior head is more active during closing, clenching, and controlled loading and may help coordinate the condyle-disc complex.
Innervation: The nerve to the lateral pterygoid, arising from the anterior division of the mandibular nerve, or cranial nerve V3
The lateral pterygoid should not be portrayed as a simple muscle that pulls the disc out of position. Disc displacement is multifactorial, and the muscle’s relationship with the disc, capsule, and condyle is anatomically variable.
Direct intraoral palpation also has important limitations. The muscle lies deep within the infratemporal fossa, and research indicates that pressure applied in the commonly described “lateral pterygoid area” may contact other tissues rather than reliably isolating the muscle. Findings from this region should therefore be interpreted cautiously and should not be used alone to diagnose lateral pterygoid dysfunction.
Anatomy Informs the Examination, but Does Not Determine the Diagnosis
The muscles of mastication are essential to jaw function, but TMD cannot usually be reduced to one tight muscle, one trigger point, or one altered movement pattern. Symptoms may reflect interactions among muscle capacity, joint health, oral behaviours, sleep, stress, pain sensitivity, previous injury, and general health.
Anatomy helps clinicians decide what to examine. Diagnosis depends on whether the history and examination findings form a coherent clinical pattern and whether other causes of facial or jaw pain have been appropriately considered.
Symptoms of Temporomandibular Disorders
TMD can affect the jaw joints, chewing muscles, or both. Symptoms may be present on one or both sides and often change with chewing, speaking, yawning, clenching, or other jaw movements.
Common symptoms include:
Pain or tenderness in the jaw, chewing muscles, temples, or immediately in front of the ear
Pain that spreads into the face, ear region, or neck
Pain or difficulty with chewing
Jaw stiffness or fatigue
Difficulty opening the mouth fully
Catching or locking when opening or closing the jaw
Painful clicking, popping, or grating within the jaw joint
Headache in the temple region that is affected by jaw movement or function
A change in how the upper and lower teeth meet
Joint Sounds Do Not Always Mean Something Is Wrong
Clicking or popping without pain or restricted movement is common and does not necessarily indicate a disorder requiring treatment. Joint sounds become more clinically relevant when accompanied by pain, locking, altered movement, or difficulty using the jaw.
Associated Symptoms Require Careful Evaluation
Some people with TMD also report ear pain, a sense of pressure or fullness in the ear, tinnitus, hearing changes, or dizziness. These symptoms can have several possible causes and should not automatically be attributed to the TMJ.
Clenching and grinding, collectively known as bruxism, may increase strain on the jaw in some people, but they are better considered potential contributing behaviours rather than symptoms that confirm TMD.
Tooth pain or sensitivity should first be assessed for dental causes. Facial pain can also arise from sinus disorders, headache conditions, nerve-related pain, infection, inflammatory disease, or other medical conditions. A careful history and clinical examination are therefore essential before concluding that symptoms originate from the jaw.
How TMD Is Diagnosed
There is no single test that diagnoses every temporomandibular disorder. Diagnosis usually begins with a detailed history and physical examination. The objective is to determine whether symptoms arise primarily from the jaw joints, the chewing muscles, or another condition that can produce similar facial or jaw pain.
The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) provide an evidence-based framework for assessing the most common pain-related and joint-related TMDs.
Understanding the Symptoms
The clinician may ask about:
Where the pain is located and whether it spreads elsewhere
When the symptoms began and whether they are improving, worsening, or fluctuating
Whether chewing, yawning, talking, clenching, or other jaw movements change the pain
Clicking, popping, grating, catching, or locking of the jaw
Difficulty opening the mouth, chewing, or eating certain foods
Headaches, ear symptoms, neck pain, or other pain conditions
Previous facial or jaw trauma
Arthritis, inflammatory disease, dental treatment, medications, and general health
Clenching, grinding, gum chewing, nail biting, or other repeated jaw behaviours
Sleep, stress, emotional distress, and the effect symptoms have on daily life
Stress and psychological distress are not red flags and do not mean the pain is imaginary. They may influence muscle activity, sleep, pain sensitivity, recovery, and the overall burden of persistent pain.
Physical Examination
A clinical examination may include:
Observation: Assessing facial symmetry, swelling, jaw position, and the pathway of the mandible during opening and closing.
Jaw movement: Measuring comfortable and maximum mouth opening, side-to-side movement, and forward movement of the jaw.
Joint assessment: Evaluating the TMJs for pain, movement restriction, clicking, popping, crepitus, or locking.
Muscle assessment: Applying controlled pressure to the masseter and temporalis muscles and, when indicated, other relevant structures.
Dental and oral assessment: Looking for dental disease, changes in the bite, oral lesions, and signs that another dental or medical condition may be responsible.
Neurological, ear, and cervical examination: Performing additional tests when symptoms suggest involvement beyond the jaw.
The key finding is not tenderness alone. For many pain-related TMD diagnoses, examination should reproduce the person’s familiar pain, meaning pain that resembles the complaint that brought them for assessment.
Tooth wear may suggest previous or ongoing grinding, but it cannot establish how frequently someone currently grinds their teeth. Similarly, jaw deviation, joint sounds, or postural findings do not diagnose TMD by themselves.
When Imaging May Be Needed
Imaging is not routinely required for every person with jaw pain. It may be considered when there has been trauma, significant locking or loss of movement, progressive changes in the bite, suspected arthritis or bone disease, neurological findings, unexplained swelling, or symptoms that do not respond as expected.
Different imaging methods provide different information:
Panoramic radiography provides a general view of the jaws and may help identify certain dental or bony abnormalities.
CT or cone-beam CT provides more detailed information about the bones of the TMJ.
MRI is best suited to evaluating the articular disc, joint fluid, bone marrow, and other soft tissues.
Imaging findings must be interpreted alongside the symptoms and clinical examination. Disc displacement and degenerative changes can occur in people without jaw pain and do not automatically explain the person’s symptoms.
Warning Signs Requiring Further Investigation
Jaw or facial pain should not automatically be diagnosed as TMD. Prompt medical or dental investigation may be required when symptoms include:
Fever, redness, marked swelling, drainage, or other signs of infection
A new or enlarging facial, oral, or neck mass
Unexplained weight loss, night sweats, or a history of cancer
Progressive facial numbness, weakness, altered sensation, or other neurological changes
Significant trauma or suspected fracture
A rapidly changing bite or progressively increasing facial asymmetry
A jaw that becomes locked open and cannot be closed
New headache, scalp tenderness, visual symptoms, or jaw fatigue with chewing in someone over 50, which can indicate giant cell arteritis
Jaw discomfort associated with exertion, chest pressure, shortness of breath, sweating, or nausea, which requires urgent medical assessment
A good diagnosis does more than identify painful structures. It determines whether the presentation fits a recognized TMD, considers contributing biological and psychosocial factors, and rules out dental, neurological, vascular, inflammatory, infectious, and other medical causes.
Want to Develop a More Systematic TMD Examination?
The upcoming MSR TMD course will guide practitioners through history-taking, red-flag screening, jaw movement assessment, muscle and joint examination, cervical considerations, and clinical interpretation.
TMD Diagnostic Videos
Available with an MSR Pro subscription
In this detailed clinical video, Dr. Mylonas demonstrates a structured assessment of jaw movement, muscle and joint-related pain, joint sounds, and relevant contributing regions.
Individual procedures should not be interpreted in isolation. Findings become more meaningful when they reproduce the patient’s familiar symptoms and correspond with the history, pattern of jaw function, and other examination findings.
Video chapters:
00:00 Introduction
00:20 Screening for red flags
00:55 Patient history
01:56 Observation
02:45 Jaw range of motion
05:08 Lateral excursion and movement pattern
05:40 Jaw protrusion
06:10 Resisted mouth opening
06:45 Resisted mouth closing
07:10 Clicking, popping, and crepitus
09:00 TMJ compression and symptom-provocation testing
09:42 Palpation of the muscles of mastication
11:00 Palpation and reproduction of familiar or referred pain
12:25 Cervical and thoracic spine evaluation
14:06 Postural observation
MSR Pro members: Sign in to access the complete examination video.
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Cervical Examination - Orthopaedic Testing
Jaw and neck symptoms frequently coexist, but this does not mean that every TMD originates in the cervical spine. A cervical examination may be appropriate when the patient also reports neck pain, headache, trauma, neurological symptoms, or symptoms influenced by neck movement.
In this video, Dr. Mylonas demonstrates cervical observation, palpation, range-of-motion assessment, and selected orthopaedic tests. The findings should be interpreted as part of the complete clinical picture rather than as proof that cervical dysfunction is causing the TMD.
Cranial Nerve Examination - 12 Cranial Nerves
A complete cranial nerve examination is not required for every uncomplicated TMD presentation. It becomes important when a patient reports facial numbness, altered sensation, weakness, visual or hearing changes, abnormal facial movement, unexplained asymmetry, or other symptoms suggesting neurological involvement.
This video demonstrates an examination of the 12 cranial nerves and provides a systematic way to screen sensory, motor, visual, auditory, vestibular, and reflex functions.
Abnormal cranial nerve findings are not typical features of routine TMD and may require medical, neurological, dental, or other specialist assessment.
Conditions That May Coexist With TMD
Temporomandibular disorders do not always occur in isolation. Some people also experience sleep disturbance, headaches, neck pain, tinnitus, psychological distress, or pain in other areas of the body.
These relationships are often complex and may work in both directions. The presence of two conditions does not prove that one caused the other or that treating the jaw will resolve every associated symptom.
Sleep Disturbance
Jaw pain can make it difficult to fall asleep or remain asleep. Poor-quality sleep may also increase pain sensitivity, reduce recovery, and make persistent symptoms more difficult to manage.
Sleep bruxism, insomnia, and obstructive sleep apnea are separate conditions. They may coexist with TMD, but one should not automatically be assumed to cause another.
Tinnitus and Other Ear Symptoms
Tinnitus, ear pain, pressure, and a sensation of fullness are reported more frequently by people with TMD. Some individuals notice that moving or clenching the jaw changes their tinnitus, suggesting a somatosensory influence.
However, an association does not establish that the TMJ caused the ear symptoms. Persistent tinnitus, hearing loss, dizziness, discharge, or significant ear pain may require medical or audiological assessment.
Neck Pain
Neck pain and cervical disability commonly coexist with TMD. The jaw and cervical regions interact during many everyday movements, and pain in either region can influence movement, muscle activity, and sensory processing.
This relationship does not mean that poor posture or a cervical “imbalance” caused the TMD. The cervical spine should be evaluated when neck symptoms, headaches, trauma, or movement-related findings make it clinically relevant.
Headaches
Headache disorders, including migraine and tension-type headache, commonly overlap with TMD. The DC/TMD also recognizes headache attributed to TMD, which is usually located in the temple region and is modified by jaw movement, function, or parafunctional activity.
Not every headache experienced by someone with TMD originates from the jaw. New, severe, progressive, or neurologically accompanied headaches require appropriate medical investigation.
Psychological Distress
Anxiety, depression, sustained stress, and pain-related fear are more common among people with persistent TMD pain. These factors can influence sleep, muscle activity, pain sensitivity, coping, and disability.
This does not mean that TMD is “all in the mind.” Pain is a biological experience influenced by physical, neurological, psychological, and social factors. Recognizing these influences can help create a more complete and individualized management plan.
Other Chronic Pain Conditions
Persistent TMD sometimes overlaps with other chronic pain conditions, including:
Migraine and other recurrent headaches
Neck or back pain
Fibromyalgia or widespread pain
Irritable bowel syndrome
Other persistent orofacial pain conditions
The presence of pain in several regions may indicate a more complex pain presentation requiring coordinated, multidisciplinary care.
Symptoms That Require Separate Evaluation
Some symptoms should not simply be classified as part of TMD:
Difficulty swallowing: Persistent or progressive swallowing difficulty can arise from neurological, muscular, structural, gastrointestinal, or other medical conditions and requires appropriate investigation.
Electric-shock facial pain: Brief, intense, shock-like episodes may indicate trigeminal neuralgia rather than TMD.
Facial numbness or weakness: These are not typical features of uncomplicated TMD and warrant neurological or medical assessment.
Upper-extremity numbness or vascular symptoms: Peripheral neuropathy and thoracic outlet syndrome are separate conditions and should not be attributed to jaw dysfunction without an independent diagnosis.
Looking at the Whole Person
The overlap between TMD, sleep, headache, neck pain, tinnitus, emotional distress, and other persistent pain conditions cannot be explained by one mechanism. Possible influences include shared nerve pathways, altered pain processing, sleep disruption, health behaviours, emotional stress, and the effects of living with ongoing pain.
A comprehensive assessment identifies which factors are relevant to the individual rather than assuming that every associated symptom originates from the jaw.
Multidisciplinary Care: Matching Treatment to the Person
TMD can involve joint pain, muscle pain, headaches, sleep disturbance, dental concerns, psychological distress, or other health conditions. No single profession addresses every possible contributor. When a presentation is complex, communication among the appropriate healthcare professionals can lead to a more coordinated and individualized plan.
Depending on the person’s findings, care may involve:
A dentist: To evaluate the teeth, bite, oral health, dental causes of pain, and whether an oral appliance is appropriate.
An orofacial pain specialist: To assess persistent or diagnostically complex jaw, facial, and headache presentations.
A chiropractor or physiotherapist: To address jaw and cervical function through education, exercise, movement-based rehabilitation, and appropriate manual therapy.
A physician or nurse practitioner: To investigate medical, inflammatory, neurological, infectious, or medication-related concerns.
A psychologist or behavioural health professional: To help with pain coping, stress, sleep, anxiety, depression, or behaviours that may aggravate symptoms.
An audiologist or ear, nose, and throat specialist: When tinnitus, hearing changes, dizziness, or persistent ear symptoms require further investigation.
A sleep professional: When insomnia, sleep bruxism, snoring, daytime sleepiness, or possible sleep apnea is clinically relevant.
Not every person with TMD requires all these services. Referral should be guided by the diagnosis, symptom complexity, response to care, and the patient’s individual needs and goals.
What About Night Guards and Occlusal Splints?
A dentist may recommend a night guard or occlusal splint for selected patients. These removable appliances fit over some or all of the teeth and can serve different purposes depending on their design.
An appliance may:
Protect the teeth from damage associated with clenching or grinding
Reduce jaw pain for some patients
Temporarily change how forces are distributed across the teeth and jaw
Provide information about how symptoms respond to altered jaw loading
A splint does not necessarily stop bruxism, reposition a displaced disc, or permanently correct the bite. Research on pain relief is mixed, and benefits vary among patients. In clinical guidelines for chronic TMD pain, reversible occlusal splints are not among the most strongly supported first-line treatments.
When an appliance is used, it should be professionally fitted, reversible, comfortable, and monitored for changes in symptoms or the bite. Devices designed to permanently alter the teeth, bite, or jaw position should generally be avoided as an initial treatment for TMD.
The best plan usually begins with conservative, reversible options and expands to multidisciplinary care when the clinical presentation requires it.
Selected MSR Protocols for TMD
Manual therapy may help reduce pain, improve comfortable jaw movement, and make it easier for some people to begin active rehabilitation. The appropriate technique depends on whether symptoms appear to arise primarily from the TMJ, the muscles of mastication, the cervical region, or a combination of factors.
Motion Specific Release is a treatment system developed by Dr. Brian Abelson, DC. It integrates joint mobilization, soft-tissue procedures, movement assessment, patient education, and functional exercise.
The following demonstrations show only a few of the techniques that may be incorporated into an individualized TMD treatment plan. They are not intended to represent a complete protocol or a universal treatment sequence.
Temporomandibular Joint
Available with an MSR Pro subscription
In this clinical demonstration, Dr. Abelson presents several gentle TMJ mobilization procedures. These techniques use specific hand contacts and controlled forces to assess and influence comfortable joint movement.
TMJ mobilization is not required for every person with TMD. The direction, force, duration, and suitability of treatment should be determined from the diagnosis, symptom irritability, joint mobility, and response to examination.
These procedures are intended for appropriately trained healthcare practitioners and should not be attempted as self-treatment.
MSR Pro members: Sign in to access the complete demonstration.
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Masseter Muscle Release
In this demonstration, Dr. Abelson applies a Motion Specific Release procedure to the masseter muscle. The masseter is commonly examined when jaw pain is affected by chewing, clenching, or resisted jaw closure.
The purpose of treatment is not simply to locate and eliminate a presumed “knot.” The clinician monitors tissue response, symptom reproduction, patient comfort, and changes in jaw function. A tenderness response becomes more clinically relevant when it resembles the patient’s familiar pain.
The masseter may be important in some presentations and less relevant in others. Treatment should be based on examination findings rather than assuming that one muscle is the primary cause of every TMD.
Additional MSR procedures for the temporalis, pterygoid muscles, TMJ, cervical region, and related structures are available through MSR Pro.
Explore the MSR Pro protocol library:https://www.motionspecificrelease.com/msr-memberships
Looking Beyond the Jaw When Clinically Relevant
The jaw does not function in complete isolation, but this does not mean that every TMD requires treatment of an entire “kinetic chain.” Some patients have a predominantly local jaw disorder. Others also present with neck pain, headache, previous trauma, sleep disturbance, widespread pain, or other factors that may influence recovery.
Depending on the assessment, a broader plan may consider:
Cervical or thoracic symptoms that occur alongside the jaw complaint
Jaw and neck movement capacity
Headaches and other overlapping pain conditions
Clenching, grinding, or repeated jaw behaviours
Sleep quality and recovery
Stress, emotional distress, and pain-related fear
Previous injuries and relevant medical or dental conditions
Signs of increased pain sensitivity or a more widespread pain presentation
These factors should be investigated rather than presumed. Cervical, thoracic, or shoulder treatment is included only when the examination identifies a clinically relevant reason to address those regions.
Manual therapy is best viewed as one possible component of care. Education, self-management, progressive jaw exercise, general physical activity, sleep support, and collaboration with dental or medical professionals may also be important.
Fascial Expansions and Their Role in TMD Treatment
Fascia is a body-wide connective-tissue system that surrounds, separates, supports, and links muscles, bones, nerves, blood vessels, and organs. It contains collagen, elastin, fluid, sensory nerve endings, and other specialized components that allow tissues to transmit force while sliding relative to one another.
In anatomical research, myofascial expansions refer more specifically to fibrous connections through which portions of a muscle or tendon blend with surrounding deep fascia. These expansions provide pathways for distributing muscular tension beyond a single attachment point.
Although fascia is continuous throughout the body, continuity alone does not prove that a restriction in the shoulder, hip, or knee causes TMD. Long-distance mechanical explanations should therefore be treated as clinical hypotheses rather than established causes of jaw pain.
Within Motion Specific Release, fascial expansions provide a framework for considering how the jaw relates to nearby muscles, connective tissues, nerves, and regions such as the cervical spine. Treatment may include local and regional soft-tissue procedures, joint mobilization, acupuncture or acupressure, and functional exercise.
The regions selected for treatment should be based on the patient’s symptoms and examination findings, not simply on the existence of an anatomical connection.
Integrating Fascial Anatomy and Traditional Chinese Medicine
Motion Specific Release also integrates anatomical assessment with selected concepts and treatment points from Traditional Chinese Medicine.
Points commonly considered in TMD and orofacial-pain treatment may include:
ST6: Located over the masseter region
ST7: Located near the TMJ and inferior border of the zygomatic arch
ST8: Located near the temporal region and sometimes considered when headache symptoms coexist
LI4: A distal point located on the hand
GB20: Located in the suboccipital region
Point selection should be individualized and performed within the practitioner’s training and professional scope. Acupuncture may provide short-term pain relief for some people with muscle-related TMD, but the evidence remains limited and study methods vary. Acupressure has been studied less extensively.
Traditional acupuncture channels and anatomical fascial planes are different conceptual systems. Areas of overlap may offer clinically interesting ways to organize assessment and treatment, but they do not establish that meridians and fascial pathways are the same structures.
Fascial Expansion Demonstration
Available with an MSR Pro subscription
In this clinical demonstration, Dr. Abelson explains how fascial anatomy is considered within the Motion Specific Release approach to TMD. The video presents selected soft-tissue, joint, acupuncture or acupressure, and movement-based procedures that may be incorporated into a broader treatment plan.
These procedures represent only a small portion of the available MSR protocols. They are intended for appropriately trained healthcare practitioners and are not self-treatment instructions.
The goal is not to “restore balance” throughout an assumed fascial chain or guarantee tissue healing. It is to apply clinically reasoned interventions that may reduce symptoms, improve comfortable movement, and support active rehabilitation.
MSR Pro members: Sign in to access the complete demonstration.
Explore MSR Pro membership:https://www.motionspecificrelease.com/msr-memberships
Upcoming Course: Move Beyond Isolated Techniques
Interested in learning how these procedures fit into a complete assessment and treatment strategy? The upcoming online MSR TMD course will connect clinical examination, treatment selection, and functional rehabilitation. Course announcements will be shared with MSR members and newsletter subscribers.
Exercise: Restoring Jaw Movement and Function
Exercise and patient education are important components of conservative TMD care. Depending on the diagnosis, exercise may help improve jaw coordination, comfortable range of motion, muscular capacity, and confidence with everyday activities such as speaking, chewing, and yawning.
There is no single exercise program for every TMD. The appropriate starting point depends on whether symptoms involve the chewing muscles, the TMJ, restricted opening, joint hypermobility, locking, or an accompanying cervical problem.
A rehabilitation program may include:
Jaw relaxation and awareness: Learning to recognize unnecessary clenching and allowing the jaw to rest with the teeth slightly apart.
Controlled movement: Practising smooth opening, closing, protrusion, and side-to-side movement within a comfortable range.
Mobility exercises: Gradually restoring movement when opening or other jaw motions are limited.
Coordination exercises: Improving control of the jaw’s movement pathway rather than forcing it to remain perfectly straight.
Gentle resistance exercises: Building muscular capacity when appropriate for the diagnosis and stage of recovery.
Functional progression: Gradually returning to normal chewing and other daily activities as tolerance improves.
Cervical exercise: Addressing neck mobility, strength, or endurance when cervical symptoms and examination findings are clinically relevant.
Breathing and mindfulness: Using slow breathing and present-moment awareness to recognize clenching, reduce unnecessary muscular effort, and develop more adaptive responses to pain and stress.
Exercises should be performed slowly and within a manageable range. Mild muscular effort may be expected, but sharp or increasing pain, worsening locking, new neurological symptoms, or a significant reduction in jaw movement should prompt reassessment.
Breathing, Mindfulness, and Jaw Awareness
Stress does not cause every TMD, and jaw pain should never be dismissed as “just stress.” However, stress and emotional arousal can influence clenching, sleep, muscle activity, pain sensitivity, and the way persistent symptoms affect daily life.
A brief breathing and awareness practice can be incorporated before or during jaw exercises:
Sit in a supported position and allow your shoulders to settle.
Let your lips rest together while keeping your upper and lower teeth slightly apart.
Breathe slowly and comfortably, preferably through your nose if this feels natural.
Allow the exhalation to become slightly longer without straining or holding your breath.
Notice whether you are pressing your teeth together or creating unnecessary tension in your jaw, face, tongue, or neck.
Continue for one or two minutes before beginning the movement exercises.
The objective is not to force the jaw to relax or make the pain disappear. It is to improve awareness, reduce unnecessary effort, and create a calmer starting point for movement.
Mindfulness and breathing practices are best considered supportive components of care. Emerging research suggests that mindfulness may help some people manage the sensory, emotional, and behavioural dimensions of persistent TMD pain. The strongest evidence supports psychological and relaxation strategies when they are integrated into a broader treatment plan rather than used as stand-alone cures.
6 Effective Jaw Release Exercises
This video demonstrates six exercises intended to encourage comfortable jaw movement, muscular awareness, and control. These exercises are examples rather than a universal prescription. Some may be appropriate for one type of TMD and unsuitable for another.
Avoid forcing the jaw through pain or repeatedly trying to produce a click or pop. People with acute trauma, recurrent dislocation, significant locking, or unexplained facial pain should obtain an appropriate assessment before beginning a jaw exercise program.
5 Minute Neck Pain Relief
Neck pain and TMD frequently coexist, but not every person with TMD requires cervical exercise. This routine may be useful when neck stiffness, movement sensitivity, muscular fatigue, or headache accompanies the jaw complaint.
The exercises should be performed at a frequency that matches the person’s comfort and response. More frequent exercise is not automatically better, particularly during a sensitive flare.
These videos provide general education and do not replace an individualized diagnosis or exercise prescription. When symptoms are persistent, worsening, or accompanied by locking, significant swelling, trauma, facial numbness, weakness, or other warning signs, consult an appropriately qualified healthcare professional.
Self-Management Strategies for TMD
Self-management is an important component of conservative TMD care. The most appropriate strategies depend on the diagnosis, symptom severity, and activities that aggravate the problem. These measures are generally intended to settle a flare while supporting a gradual return to normal jaw function.
Medication
Short-term pain medication may help when symptoms interfere with sleep, eating, exercise, or participation in treatment. Options such as non-steroidal anti-inflammatory drugs or acetaminophen are not appropriate for everyone and should be taken only as directed.
A dentist, physician, or pharmacist can advise whether a medication is suitable based on the person’s health, other medications, allergies, pregnancy status, and risk of side effects. Persistent or escalating pain should be reassessed rather than managed indefinitely with over-the-counter medication.
Temporarily Modify Aggravating Activities
During a painful or sensitive period, it may help to reduce activities that place unusually high or prolonged demands on the jaw. Examples include:
Chewing gum
Biting fingernails, pens, or other objects
Clenching the teeth while concentrating
Taking very large bites
Prolonged chewing of tough foods
Shouting or extended singing when these activities reproduce symptoms
Opening the mouth excessively during yawning
When yawning, placing a fist or hand gently beneath the chin may help limit excessive opening. The hand should guide the movement rather than force the jaw closed.
These modifications should usually be temporary. The longer-term objective is to restore tolerance for speaking, chewing, yawning, and other meaningful activities rather than avoiding them indefinitely.
Heat and Cold
Heat or cold may provide short-term symptom relief. Neither is universally superior, so the choice can be guided by comfort, symptom response, and clinical advice.
Heat: A warm pack or damp towel may help reduce muscular discomfort and make gentle movement easier. In my clinical experience, many patients with muscle-dominant TMD prefer heat.
Cold: A wrapped cold pack may be more comfortable during an acute, irritable flare or after an activity that has aggravated symptoms.
Always place a layer of cloth between the skin and the heat or cold source. Avoid excessive temperatures, prolonged application, or falling asleep with a pack in place. Extra caution is required when facial sensation or circulation is impaired.
For a more detailed discussion, see Dr. Abelson’s article: Ice or Heat: Exploring the Logic
Eating During a Flare
When chewing is painful, temporarily choosing foods that require less effort may help symptoms settle. Options might include:
Eggs, yogurt, tofu, or soft fish
Soups, stews, pasta, and cooked grains
Mashed potatoes and well-cooked vegetables
Bananas, applesauce, and smoothies
Hard, chewy, or oversized foods may temporarily increase symptoms. Cutting food into smaller pieces, chewing slowly, and alternating sides can reduce the immediate demand on the jaw.
A softer diet should not automatically become a long-term restriction. As symptoms improve, gradually reintroducing a wider range of food textures can help restore chewing capacity and maintain adequate nutrition. Anyone experiencing unexplained weight loss, difficulty swallowing, or an inability to meet nutritional needs should seek professional assessment.
Jaw Resting Position and Awareness
Outside activities such as eating, swallowing, and speaking, the teeth do not need to remain in contact. A relaxed resting position commonly involves:
Lips resting together or slightly apart
Teeth separated
Jaw muscles relaxed
Tongue resting lightly against the palate, if comfortable
This position can serve as an awareness cue for people who habitually brace or clench their jaw. It should not be forced, and it is not a method of repositioning the TMJ or correcting an airway disorder.
Persistent mouth breathing, nasal obstruction, loud snoring, witnessed pauses in breathing, or excessive daytime sleepiness warrants appropriate medical, dental, or sleep assessment.
Workstation and Daily Positioning
There is no single “perfect” posture, and posture alone should not be presented as the cause of TMD. However, prolonged or uncomfortable positions may aggravate jaw, neck, or shoulder symptoms in some people.
Helpful adjustments may include:
Changing position regularly
Taking brief movement breaks
Positioning the monitor at a comfortable height
Supporting the forearms when working
Using a headset instead of holding a phone between the shoulder and ear
Addressing cervical mobility or endurance when neck findings are clinically relevant
Pillow selection is similarly individual. A particular orthopaedic pillow cannot be recommended for every person with TMD. The best option is generally one that supports restful sleep without aggravating jaw or neck symptoms.
Stress, Sleep, and Relaxation
Stress does not explain every case of TMD, and TMD pain should not be dismissed as psychological. However, stress, poor sleep, pain-related worry, and increased jaw-muscle activity can interact and contribute to a symptom flare.
Slow breathing, mindfulness, relaxation training, and awareness of daytime clenching may complement movement-based rehabilitation. These strategies can help regulate muscular effort and improve pain coping, but they should not replace appropriate assessment or treatment.
When stress, anxiety, trauma, insomnia, or persistent pain is significantly affecting daily life, collaboration with a psychologist, physician, or another qualified professional may be beneficial.
For a guided introduction to breathing and mindfulness, see:
Progress Rather Than Protection
The purpose of self-management is not to protect the jaw from every load. Short-term modification can help settle an irritable episode, but recovery should usually include a gradual return to normal movement, chewing, communication, and other valued activities.
Recommendations should be adjusted when symptoms worsen, locking becomes more frequent, jaw movement decreases substantially, or new swelling, trauma, numbness, weakness, or other warning signs develop.
An Individualized Approach to TMD Care
TMD is not a single condition, and there is no universal treatment protocol. Effective care begins with identifying whether symptoms primarily involve the temporomandibular joint, the muscles of mastication, restricted or uncoordinated movement, persistent pain mechanisms, or a combination of factors.
Depending on the assessment, conservative care may include:
Education and self-management strategies
Temporary modification of aggravating activities
Manual therapy and joint mobilization
Jaw mobility, coordination, and resistance exercises
Cervical treatment when clinically relevant
Breathing, relaxation, or mindfulness strategies
Gradual return to normal chewing and daily activities
Manual therapy may provide short-term improvements in pain and movement for some patients, but it is most appropriately combined with active rehabilitation. Progress should be measured by meaningful changes in comfort, jaw function, eating, speaking, sleep, and participation in daily life.
When findings suggest dental disease, significant locking, recurrent dislocation, inflammatory arthritis, neurological involvement, trauma, sleep-disordered breathing, or another condition outside the treating practitioner’s scope, referral or multidisciplinary collaboration is essential.
The goal is not to apply the same technique to every patient or promise a cure. It is to provide conservative, evidence-informed care tailored to the person’s diagnosis, needs, and goals.
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References
Abelson, B., Abelson, K., & Mylonas, E. (2018). A Practitioner’s Guide to Motion Specific Release: Functional, Successful, Easy-to-Implement Techniques for Musculoskeletal Injuries. Rowan Tree Books.
Alqutaibi, A. Y., Alhammadi, M. S., Hamadallah, H. H., et al. (2025). Global prevalence of temporomandibular disorders: A systematic review and meta-analysis. Journal of Oral & Facial Pain and Headache, 39(2), 48–65.
Armijo-Olivo, S., Pitance, L., Singh, V., Neto, F., Thie, N., & Michelotti, A. (2016). Effectiveness of manual therapy and therapeutic exercise for temporomandibular disorders: Systematic review and meta-analysis. Physical Therapy, 96(1), 9–25.
Busse, J. W., et al. (2023). Management of chronic pain associated with temporomandibular disorders: A clinical practice guideline. BMJ, 383, e076227.
Calixtre, L. B., Oliveira, A. B., de Sena Rosa, L. R., Armijo-Olivo, S., Visscher, C. M., & Alburquerque-Sendín, F. (2019). Effectiveness of mobilisation of the upper cervical region and craniocervical flexor training on orofacial pain, mandibular function, and headache in women with TMD: A randomized controlled trial. Journal of Oral Rehabilitation, 46(2), 109–119.
de Oliveira, L. R. L. B., et al. (2023). Temporomandibular joint: From anatomy to internal derangement. Radiologia Brasileira, 56(2), 102–110.
Di Francesco, F., Minervini, G., Siurkel, Y., Cicciù, M., & Lanza, A. (2024). Efficacy of acupuncture and laser acupuncture in temporomandibular disorders: A systematic review and meta-analysis of randomized controlled trials. BMC Oral Health, 24, 174.
International Network for Orofacial Pain and Related Disorders Methodology. (n.d.). Diagnostic Criteria for Temporomandibular Disorders: Assessment Instruments.
Iturriaga, V., Bornhardt, T., & Velasquez, N. (2023). Temporomandibular joint: Review of anatomy and clinical implications. Dental Clinics of North America, 67(2), 199–209.
La Touche, R., Martínez García, S., Serrano García, B., et al. (2020). Effect of manual therapy and therapeutic exercise applied to the cervical region on pain and pressure-pain sensitivity in patients with temporomandibular disorders: A systematic review and meta-analysis. Pain Medicine, 21(10), 2373–2384.
List, T., & Jensen, R. H. (2017). Temporomandibular disorders: Old ideas and new concepts. Cephalalgia, 37(7), 692–704.
Lobbezoo, F., Ahlberg, J., Raphael, K. G., et al. (2018). International consensus on the assessment of bruxism: Report of a work in progress. Journal of Oral Rehabilitation, 45(11), 837–844.
Melchior, M. O., et al. (2025). Impact of a mindfulness-based intervention on pain and psychological factors in women with chronic painful temporomandibular disorders. Journal of Oral Rehabilitation, 52, 2269–2282.
National Academies of Sciences, Engineering, and Medicine. (2020). Temporomandibular Disorders: Priorities for Research and Care. The National Academies Press.
National Institute of Dental and Craniofacial Research. (2024). TMD: Temporomandibular Disorders. National Institutes of Health.
Omidvar, S., Jafari, Z., Shabani, M., et al. (2019). Association between tinnitus and temporomandibular disorders: A systematic review and meta-analysis. Annals of Otology, Rhinology & Laryngology, 128(7), 662–675.
Park, E. Y., Cho, J. H., Lee, S. H., Kim, K. W., Ha, I. H., & Lee, Y. J. (2023). Is acupuncture an effective treatment for temporomandibular disorder? A systematic review and meta-analysis of randomized controlled trials. Medicine, 102(38), e34950.
Rocha, C. P., Croci, C. S., & Caria, P. H. F. (2013). Is there a relationship between temporomandibular disorders and head and cervical posture? A systematic review. Journal of Oral Rehabilitation, 40(11), 875–881.
Schiffman, E., Ohrbach, R., Truelove, E., et al. (2014). Diagnostic Criteria for Temporomandibular Disorders for clinical and research applications: Recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. Journal of Oral & Facial Pain and Headache, 28(1), 6–27.
Schiffman, E., Ohrbach, R., Truelove, E., et al. (2016). Executive summary of the Diagnostic Criteria for Temporomandibular Disorders for clinical and research applications. Journal of the American Dental Association, 147(6), 438–445.
Shimada, A., Ishigaki, S., Matsuka, Y., et al. (2023). Effectiveness of exercise therapy on pain relief and jaw mobility in patients with pain-related temporomandibular disorders: A systematic review. Frontiers in Oral Health, 4, 1170966.
Slade, G. D., Ohrbach, R., Greenspan, J. D., et al. (2016). Painful temporomandibular disorder: Decade of discovery from OPPERA studies. Journal of Dental Research, 95(10), 1084–1092.
Standring, S. (Ed.). (2020). Gray’s Anatomy: The Anatomical Basis of Clinical Practice (42nd ed.). Elsevier.
Valesan, L. F., Da-Cas, C. D., Réus, J. C., et al. (2021). Prevalence of temporomandibular joint disorders: A systematic review and meta-analysis. Clinical Oral Investigations, 25(2), 441–453.
Vieira, L. S., Pestana, P. R. M., Miranda, J. P., et al. (2023). The efficacy of manual therapy approaches on pain, maximum mouth opening, and disability in temporomandibular disorders: A systematic review of randomized controlled trials. Life, 13(2), 292.
Wilkie, G. (2022). Temporomandibular joint anatomy, function, and clinical relevance. British Dental Journal, 233, 539–546.
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DR. BRIAN ABELSON, DC. - The Author
Dr. Brian Abelson is a chiropractor, author, and educator with more than 30 years of clinical experience in musculoskeletal care, rehabilitation, and sports performance. His educational work focuses on musculoskeletal conditions, human movement, sports biomechanics, and evidence-informed approaches to treatment and rehabilitation.
He is the developer of Motion Specific Release (MSR) and Clinical Director of Kinetic Health in Calgary, Alberta, Canada.
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