TMJ is a cause of cervical neck instability and poor posture

Ross Hauser, MD

In many patients, we see primary problems related to neck pain and cervical instability see problems of TMJ. In many patients that we see with problems of TMJ, we see cervical neck pain. Surprisingly, despite the research suggesting the connection, many patients were not made aware that their jaw pain could be a problem originating in the neck.

In our article on Cervicogenic dysphagia, swallowing difficulties as being caused by problems in the neck and brain, we explored research that noted that TMJ patients and cervical neck instability patients have difficulties in swallowing.

TMJ and neck problems have long been linked together, however, it is not often that a patient will report to us that their previous health care providers made this link and offered treatments addressing both concerns. In the following research the links and the treatments for both TMJ and cervical neck instability point to a problem in the neck.

In the medical journal Clinical Oral Investigations, (1) oral surgeons in Belgium made a connection between TMJ and cervical instability.

They conducted a study looking for possible correlations between clinical signs of temporomandibular disorders (TMD) and cervical spine disorders.

In the European Journal of Orthodontics, (2) doctors in Japan made a connection:

What? The TMJ altered your posture by stressing your cervical spine? Isn’t posture a problem of swallowing difficulties? Isn’t posture a problem of everything?

Craniocervical physical therapy in patients with myofascial temporomandibular pain disorders. Focus on muscle spasms

In a 2017 study (3) from researchers at the University of Comenius’ Faculty of Medicine in Slovakia, doctors suggested that physical therapy could improve craniocervical dysfunction and myofascial pain symptoms in the head and neck. Here are the highlights of this study:

According to the study’s results, all three groups of patients saw an improvement in pain perception, but the overall subjective remission of painful sensations in the third group took place in as many as 88 % of patients. In this group, there was a significant decrease in the tenderness of trigger points in the trapezius and sternocleidomastoid muscles. This was achieved by a combination of simply relaxing and stretching exercises of cervical muscles with a standard method used in the therapy of masticatory muscles that are significantly more efficient.

In this study, the focus was on muscle spasms and the pain they cause. If you can relax the muscles of the TMJ and cervical neck region, you would have less pain. For some people, this will be very effective. For others, it will not. Typically, the people who will not find success will be people who have ligament damage or weakness and tendon attachment weakness or damage. For muscle techniques to work, there needs to be a resistance that allows the muscles to strengthen. If ligaments and tendons are damaged, there is lesser resistance and the treatment will not succeed as wished. We address this problem below.

What are we seeing in this image? The close anatomical association between temporomandibular joint TMJ in the upper cervical vertebrae

It is easy to visualize how injury to the ligaments that support the atlas and axis could cause pain to travel to the head face and TMJ area through the nervous system likewise TMJ instability can affect the same areas including the neck and upper cervical region

Craniocervical muscle problems in older patients with myofascial temporomandibular pain disorders

A 2019 study from Orthopedic and Oral and Maxillofacial Surgeons in South Korea published in the journal Archives of Gerontology and Geriatrics (4) demonstrated the associations among degenerative changes in the cervical spine, head and neck postures, and myofascial pain in the craniocervical musculature in elderly with myofascial temporomandibular disorders (TMDs).

In this research:

RESULTS:

Cervical Muscle Tenderness in Temporomandibular Disorders

A 2020 study appearing in the Journal of Oral & Facial Pain and Headache (5) examined 192 patients with TMD and cervical muscle tenderness. What they found was cervical muscle tenderness was notable only in those with a myogenous (muscle problems) TMD diagnosis, but not in arthrogenous (degenerative TMJ disc disease). (Our note: the problem was not in the TMJ joint but likely a problem of cervical spine instability). This is something the researchers concluded as well:

“cervical muscle tenderness differentiated between TMD patients and controls and between TMD diagnoses. Specific patient and pain characteristics associated with poor outcomes in terms of cervical muscle tenderness included effects of interactions between myogenous TMD, female sex, whiplash history, comorbid body pain and headaches, and pain on opening. It can, therefore, be concluded that routine clinical examination of TMD patients should include assessment of the cervical region.”

Understanding the TMJ temporomandibular joint itself. What are we seeing in this image?

In this simplified view of the TMJ, we can get an understanding of the mechanisms behind TMJ disc displacement. When this person would close their mouth, they would get the characteristic clicking sound and accompanying “pop” or feeling of displacement. See that the disc in this image has ligaments behind it. The ligaments are there to provide structural stability between the jaw bone at the skull. The ligaments are holding the jaw to the skull. In front of the disc towards the face are the powerful jaw muscles. Attaching these power muscles to the jaw are the muscle tendons. Notice how the muscle turns white as they approach the bone. The tendons are the muscles attached to the bones and they are white in color. They hold the muscles to the jaw. If the ligaments or tendons are weak, damaged, stretched out, or lax, the jaw is floating, the disc can be displaced.

In this simplified view of the TMJ, we can get an understanding of the mechanisms behind TMJ disc displacement. When this person would close their mouth, they would get the characteristic clicking sound and accompanying "pop" or feeling of displacement. See that the disc in this image has ligaments behind it. The ligaments are there to provide the structural stability between the jaw bone at the skull. The ligaments are holding the jaw to the skull. In front of the disc towards the face are the powerful jaw muscles. Attaching these power muscles to the jaw are the muscle tendons. Notice how the muscle turns white as they approach the bone. The tendons are the muscles attachments to the bones and they are white in color. They hold the muscles to the jaw. If the ligaments or tendons are weak, damaged, stretched out, or lax, the jaw is floating, the disc can be displaced.

The temporomandibular joint connects the mandible (lower jaw) to the part of the skull known as the temporal bone. The joint allows the lower jaw to move in all directions so that the teeth can bite off and chew food efficiently. Temporomandibular joint ( TMJ ) syndrome occurs when the joints, muscles, and ligaments involved do not work together properly, resulting in pain.

Temporomandibular joint syndrome and TMD or TemporoMandibular Disorders have been demonstrated to be caused by ligament weakness in many patients, often as a result of clenching the jaw or grinding the teeth, sleeping position, or a forward-positioned mandible (lower jaw).

Malocclusion, or a poor bite, places stress on the muscles and may also lead to the temporomandibular joint syndrome, as may an injury to the head, jaw, or neck that causes displacement of the joint. If left untreated, jaw osteoarthritis can result.

Further reading

Summary and contact us. Can we help you?

We hope you found this article informative and it helped answer many of the questions you may have surrounding your TMJ issues.  If you would like to get more information specific to your challenges please email us: Get help and information from our Caring Medical staff

This is a picture of Ross Hauser, MD, Danielle Steilen-Matias, PA-C, Brian Hutcheson, DC. They treat people with non-surgical regenerative medicine injections.

Brian Hutcheson, DC | Ross Hauser, MD | Danielle Steilen-Matias, PA-C

Subscribe to our newsletter

References for this article:

1 De Laat A, Meuleman H, Stevens A, Verbeke G. Correlation between cervical spine and temporomandibular disorders. Clinical oral investigations. 1998 Aug 1;2(2):54-7. [Google Scholar]
2 Shimazaki T, Motoyoshi M, Hosoi K, Namura S. The effect of occlusal alteration and masticatory imbalance on the cervical spine. The European Journal of Orthodontics. 2003 Oct 1;25(5):457-63. [Google Scholar]
3 Halmova K, Holly D, Stanko P. The influence of cranio-cervical rehabilitation in patients with myofascial temporomandibular pain disorders. CLINICAL STUDY. 2017 Jan 1;710:713.  [Google Scholar]
4 Hong SW, Lee JK, Kang JH. Relationship among Cervical Spine Degeneration, Head and Neck postures, and Myofascial Pain in Masticatory and Cervical Muscles in Elderly with Temporomandibular Disorder. Archives of gerontology and geriatrics. 2019 Mar 1;81:119-28. [Google Scholar]
5 Almoznino G, Zini A, Zakuto A, Zlutzky H, Bekker S, Shay B, Haviv Y, Sharav Y, Benoliel R. Cervical Muscle Tenderness in Temporomandibular Disorders and Its Associations with Diagnosis, Disease-Related Outcomes, and Comorbid Pain Conditions. Journal of oral & facial pain and headache. 2019 Aug. [Google Scholar]

Make an Appointment |

Subscribe to E-Newsletter |

Print Friendly, PDF & Email
SEARCH
for your symptoms
Prolotherapy, an alternative to surgery
Were you recommended SURGERY?
Get a 2nd opinion now!
WHY TO AVOID:
★ ★ ★ ★ ★We pride ourselves on 5-Star Patient Service!See why patients travel from all
over the world to visit our center.
Current Patients
Become a New Patient

Caring Medical Florida
9738 Commerce Center Ct.
Fort Myers, FL 33908
(239) 308-4701 Phone
(855) 779-1950 Fax Fort Myers, FL Office
We are an out-of-network provider. Treatments discussed on this site may or may not work for your specific condition.
© 2021 | All Rights Reserved | Disclaimer