Jaw Pain – Temporomandibular Joint (TMJ)

Jaw pain is often caused by abnormal temporomandibular joint (TMJ) alignment. The TMJ can be located by placing your second and third fingertips just in front of the lower end of your earlobes, then opening and closing your mouth. Signs of TMJ dysfunction include locking, grating, clicking, or pain and stiffness with opening and closing the mouth.

The TMJ can often develop faulty movement patterns, particularly after events such as prolonged dental appointments, sitting or standing with poor head posture or eating a large, hard apple. Dysfunction of the TMJ can also be a source of headaches.

Some physiotherapists are trained to assess and treat TMJ function. This generally involves internal mouth mobilisation (a gloved hand technique) to reduce stiffness, massage and exercises to address the specific direction of tightness or weakness. Treatment can also involve advice regarding posture to improve the position and function of the TMJ.

At Hawker Place Physiotherapy and Pilates, we offer a range of treatment techniques, including specialised exercise programs, massage and manual therapy, dry needling and mechanical traction, as well as clinical pilates. We also believe in the importance of educating patients about their condition, our treatments, self-management strategies and the management of more complex conditions, such as chronic pain.

Exercise Programs

Exercise forms an integral part of most rehabilitation programs. Exercise helps to increase energy and range of motion, build muscular strength, increase flexibility and improve cardiovascular health. Strengthening and stretching are often core components of exercise programs designed to reduce pain and rehabilitate injuries.

Strengthening

Muscle strengthening is essential for decreasing pain, improving function, increasing stabilisation around joints and preventing injury. For many conditions a structured program of progressive strengthening exercises has been found to be more beneficial than medication or surgical intervention. For example, the 2018 guidelines published by the Royal Australian College of General Practitioners recommends land-based strengthening exercises as the best form of treatment for hip and knee osteoarthritis.

Strengthening exercises should be undertaken following a thorough physiotherapy assessment and should be continuously monitored and progressed throughout the rehabilitation of injuries.

Stretching

Stretching aims to increase the flexibility of muscles and improve joint range of motion (ROM) by elongating muscles and associated soft tissues, such as connective tissue and scar tissue. Stretching is often indicated following periods of inactivity or rest, or in the presence of excessive muscular tightness. Rehabilitation programs for many injuries often include stretching as it can also promote healing and prevent future injury.

Massage & Manual Therapy

Soft tissue massage and manual therapy aim to improve circulation, decrease tension, increase joint range of motion, decrease stiffness and relieve pain.

Massage

Massage therapy can be an important adjunct to exercise-based physiotherapy treatments. Conditions that may benefit from massage therapy include postural tension and headaches, neck and back pain and general muscle tension following sporting injuries. Massage therapy includes several different techniques, which are applied based on individual patient needs. Some of these techniques include:

• Trigger point massage: Also known as ischaemic pressure, involves sustained holds over trigger points, which often present as tight, painful knots in muscles
• Myofascial release: A form of soft tissue manipulative therapy that stretches the thick fibrous bands of tissue beneath the skin to remove tightness and reduce tension
• Effleurage: Long, gliding strokes in the direction of the lymph nodes, which can improve circulation and promote relaxation

Manual Therapy

Manual therapy includes techniques such as mobilisation and manipulation, designed to improve joint range of motion and decrease stiffness. Manual therapy can be particularly useful following periods of immobilisation, such as prolonged use of a sling following shoulder surgery, or immobilisation in a cast following a fracture.

Although soft tissue massage and manual therapy can provide short-term relief, they are most effective when combined with an individualised and structured exercise program. In many cases, massage and manual therapy should not be used as stand-alone treatments if long-term improvements are desired.

Dry Needling

Dry needling is a physical modality that aims to relieve trigger points in tight muscle tissue. Not be confused with the Eastern practice of acupuncture, dry needling is a technique that can be implemented by physiotherapists with specific training.

Dry needling can be categorised into superficial and deep dry needling. As the name implies, superficial dry needling does not reach the myofascial trigger points and is painless. Deep dry needling however, elicits a twitch response by releasing myofascial trigger points. In some cases, this can provide immediate pain relief. However it is also possible for deep dry needling to elicit the full pattern of referred pain, before providing relief.

While dry needling can provide temporary relief of pain and muscle tension, it is important to still determine the source of pain with a thorough physiotherapy assessment.

Mechanical Traction

Traction is a treatment technique most often used in the presence of low back or neck pain. It involves drawing adjacent vertebrae apart to increase intervertebral space and relieve pain and associated symptoms. Traction can be applied manually with a therapist’s hands, or mechanically via a machine.

Research shows there is limited evidence that mechanical traction is an effective treatment for low back or neck pain. However, some patients find it provides significant relief and enhances their other physiotherapy treatments.

At Hawker Place Physiotherapy and Pilates, we take the time to complete a comprehensive assessment and work with patients to develop realistic and relevant treatment goals. Based on these assessments, we provide treatments individualised to each patient and their injury or condition.

Musculoskeletal Screening

Musculoskeletal screening involves an in-depth analysis of movement patterns, strengths and weaknesses, flexibility and other biomechanical factors. The assessment is specific to individual needs, sports or hobbies.

A comprehensive musculoskeletal assessment can significantly reduce the likelihood of injury, particularly when combined with an individualised exercise program based on identified imbalances.

This assessment is useful for people who are:

• Commencing a new exercise regime or sport and may be concerned about their risk of injury
• Entering pre-season for their sport, especially if they have not been as active during the off-season
• Wanting to identify any remaining deficits following an injury

Ultrasound

The function of ultrasound varies according to the frequency of the sound waves. At Hawker Place Physiotherapy and Pilates we use diagnostic ultrasound (also known as real-time ultrasound) to observe, assess function, and rehabilitate certain muscle groups.

The use of real-time ultrasound can assist:

• Retraining the deep core stability muscles such as the transverse abdominis and pelvic floor muscles
• Assessment of bladder function in men and women with various bladder conditions
• Rehabilitation of pelvic floor muscles in males pre- or post-prostatectomy surgery
• Retraining the abdominal muscles and pelvic floor muscles in women with pelvic floor issues or during the postnatal period
• Assessment of the correct activation of particular muscle groups, such as gluteal muscles

At a higher frequency, ultrasound can also be used to stimulate cellular activity and promote healing, as well as relax very tight and tender muscles.