Marc Darrow, MD,JD.

Over the years we have received our fair share of emails from patients seeking help for their TMJ. In many of these emails, the sender will describe to us osteoarthritis of the jaw that came as a result of a traumatic injury such as a jaw dislocation during a hockey game or a dislocation or a fractured jaw from an accident. Some will write that their TMJ problems developed when they had some wisdom teeth removed. Others will suggest that TMJ came upon them slowly as a degenerative joint disease. This article will focus on the later, the connection of degenerative TMJ and degenerative cervical disc disease.

When TMJ has its root in cervical spine disorders

TMJ can develop from a combination of slow moving inter-related factors, sometimes starting with poor head posture that contributes to the stretching and weakening of the cervical spine ligaments and lateral TMJ ligaments. As a result of these degenerative changes, the lower jaw slips forward and creates a worsening of the patient’s problems. Like the people I described above, who had an acute event that began their TMJ problems, people who develop TMJ over time can also experience loud popping or the clicking of bones rubbing together in the loosened joint, accompanied by pain and stiffness as the muscles tighten, trying to compensate for the instigating laxity.

Many people with TMJ have a neck problem.

In our more than 25 years experience in helping patients with TMJ, we have seen many patients that needed a better assessment of their TMJ pain.

 

When TMJ makes neck pain worse, when neck pain makes TMJ worse

We see a lot of patients where traditional TMJ treatments such as night appliances, bite guards, pain medications, et al, did not provide relief. The question is why? Sometimes, after an examination of the patient’s head, jaw and neck, we find that many of these patients have a cause and effect relationship where their neck pain and neck instability is causing and affecting a worsening of their TMJ problems. Their neck is hurting their jaw.

In these patients we find that pain can be traced to soft tissue damage and weakness in the back of the skull, the cervical vertebrae facet joints, the cervical neck ligaments, and the cervical neck muscles. The idea of cervical neck problems causing TMJ problems are not a new idea. In a 1998 study published in the journal Clinical Oral Investigations (1) researchers found that 31 consecutive patients with symptoms of TMJ indicated stability problems at the C0-C3 vertebral levels and tender points in the muscles of the cervical spine. In 2003 study found that instability in the cervical spine impacted TMJ problems.(2) The researchers of this study found that in many TMJ patients the right and left masticatory muscles were so badly imbalanced that they were causing the cervical spine to become displaced and distorted the patient’s posture.

In 2016, researchers added (3) to this line of study by studying whether neck strengthen exercises would relive jaw pain in patients with temporomandibular disorder. The findings were positive that the exercise treatment of the cervical spine based on joint mobilizations, segmental stabilization, and muscle stretching produced statistically significant changes in TMJ patients. The exercise protocol decreased self-reported pain, increased pain-free maximum mouth opening, and improved mandibular function. There was also a significant improvement in masticatory muscle sensitivity on the left side. Some patients reported an improvement to 0 on the pain scale.

A 2023 paper (4) examined the effect of manual therapy applied to the cervical joint for reducing pain and improving mouth opening and jaw function in people with TMDs. In reviewing patient data of 213 participants, of which 90% were women, the researchers found manual therapy applied to the cervical joint decreased orofacial pain and improved PPT (pressure pain threshold) and jaw function.

The above 1998 study was cited most recently in March 2024 paper (5) where researchers connected the occurrence of cervical spine pain as a more common problem in younger people (ages 18 – 30) with temporomandibular disorders (TMDs). The researchers noted: “In young people, this problem is rarely recognized and properly treated.”

Why are the cervical neck muscles not more full explored when treating patients with TMJ?

In a November 2018 study in the Canadian journal of physiology and pharmacology (6) doctors questioned why the cervical neck muscles are not more full explored when treating patients with TMJ. The researchers note that disorders or impairments of the masticatory muscles have an obvious effect on how the patient opens and closes their mouth and would therefore account for pain. These researchers point out that the neck muscles may impact negatively on the TMJ muscles and cause further pain and a worsening degenerative condition.
A March 2023 paper (7) suggests that patients with myofascial TMD accompanied by headaches who received manual therapy and stretching exercise therapy for the cervical spine experienced significant treatment duration-related reductions in headache severity and TMJ pain after the intervention.
An April 2024 study (8) evaluated the effect of different kinds of treatment modalities for temporomandibular joint pain and its relevance to chronic cervical pain after 12 months treatment. Forty-eight participants with chronic cervical and TMJ pain were selected using research diagnostic criteria and randomized into four equal groups of 12, which included control, soft splints, transcutaneous electrical nerve stimulation (TENS), and low-level laser (LLL). The cervical and TMJ pain was recorded using visual analog scale (VAS 0 – 10 patient reported pain) scores at baseline, 3 months, 6 months, and 12 months. TENS and LLL were found to be equally effective in reducing pain in the jaw joint region, followed by soft splints. The treatments to the TMJ had no impact or cervical neck pain.

Research on different TMJ injections

References:

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.
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
3. Calixtre LB, Grüninger BL, Haik MN, Alburquerque-Sendín F, Oliveira AB. Effects of cervical mobilization and exercise on pain, movement and function in subjects with temporomandibular disorders: a single group pre-post test. J Appl Oral Sci. 2016;24(3):188-97.
4 Liberato FM, da Silva TV, Santuzzi CH, Ferreira Fachini de Oliveira N, Nascimento LR. Manual Therapy Applied to the Cervical Joint Reduces Pain and Improves Jaw Function in Individuals with Temporomandibular Disorders: A Systematic Review on Manual Therapy for Orofacial Disorders. Journal of Oral & Facial Pain & Headache. 2023 Apr 1;37(2).
5 Odzimek M, Brola W. Occurrence of Cervical Spine Pain and Its Intensity in Young People with Temporomandibular Disorders. Journal of Clinical Medicine. 2024 Mar 27;13(7):1941.
6 Fougeront N, Fleiter B. Temporomandibular disorder and comorbid neck pain: facts and hypotheses regarding pain-induced and rehabilitation-induced motor activity changes. Canadian journal of physiology and pharmacology. 2018 Aug 1;96(11):1051-9.
7 Lee IS, Kim SY. Effectiveness of manual therapy and cervical spine stretching exercises on pain and disability in myofascial temporomandibular disorders accompanied by headaches: a single-center cohort study. BMC Sports Science, Medicine and Rehabilitation. 2023 Dec;15(1):1-1.
8 Nemani SM, Chidambaranathan AS, Muthukumar B, Srinivasan S. Evaluation of the effect of different kinds of treatment modalities for temporomandibular joint pain and its relevance to chronic cervical pain: A randomized controlled trial. The Journal of Indian Prosthodontic Society. 2024 Apr 1;24(2):128-35.