TMJ Trigger Points

There’s a strong relationship between jaw pain and TMJ trigger points, and it’s well worth investigating this before you move on to other, more invasive forms of treatment. TMJ stands for temporomandibular joint, and it’s the medical name for your jaw joint.

Here’s what’s covered in this article:

Before we look at jaw pain trigger points, we need to examine how complicated and remarkable the jaw joint is.

Jaw Joint Structure

The jaw joint is unique in a number of ways. The first is that you have two joints which are joined together by a large bone.

The jaw joint never works on its own. When one jaw joint opens up, the other joint has to dance with it. The joints themselves are capable of movements in all three planes.

You can open and close your mouth, this is where your jaw joints act like a hinge. You can protrude and retrude your jaw – this is when the joint moves forward and backward. You can move your jaw from side to side and you can do any combination of these movements all together.

The reason for this is that our teeth are not only biting ripping teeth, which are the incisors in the front, but they’re also grinding teeth at the back.┬áTo grind, you have to have a mirror every movement of one tooth on the other to circle around and grind.

As the one, as the jaw gets pulled over to move the one jaw joint, the other one has to move as well and dance with it.

So the name of the jaw joint is descriptive. It’s the temporomandibular joint. This describes how the joint involves the temporal bone, which is on the face and the mandible, which is the jaw bone that moves when you open your mouth

In the joint itself, there’s a big cup in the temporal bone and there’s a relatively small condyle, which is a somewhat spherical structure arising from the mandible. There is space for the condyle to move around in the temporal bone. That’s where all the movement comes from. 

There is a piece of cartilage that flips backward and forward, taking up the excess space in the temporal acetabulum (the cup of the joint.) As the head of the mandible sits back in the cup, the cartilage will be flipped to the front.

The jaw joint, where TMJ trigger points can be found
Jaw Joint Movements

As you push your jaw joint forward, the cartilage will slip up above and then behind the head of the mandible. The cartilage is constantly moving around.

The muscles of the jaw joint are of two kinds, which is similar to a degree to the shoulder joint. The first kind are small muscles that pull the head backward, forward and round. The second are big power muscles that you use for the grinding, ripping and tearing that your teeth do. 

Jaw Joint Injuries

There are several different structures that can become injured in the jaw joint. It’s fairly commonplace to have chronic pain. The reason why is because it’s so complicated and one joint has to move in concert with the other.

The third reason is that it gets a lot of use while talking and chewing. In addition, a lot of people increase tension in their jaw when they are stressed. It’s an unconscious place where they may clench their teeth when they feel stressed anxious or frustrated.

Lastly, some people have the habit of grinding their teeth when they’re asleep. If this is the case, and you don’t protect your teeth with a mouth guard, you may grind your teeth until you literally wear them away.

These are potential causes of pain and problems in the jaw joint.

TMJ Trigger Points which Cause Jaw Pain

TMJ stands for temporomandibular joint. This is your jaw joint, a highly mobile and hardworking joint controlled by several muscles. If these muscles get trigger points, it can make using your jaw very painful.

The single most important muscle in the jaw joint is the lateral pterygoid. There are two pterygoid muscles: the medial and lateral. They attach to the pterygoid bone, which comes down from the temporal bone like a wing. 

TMJ Trigger Points - Lateral Pterygoid
Lateral Pterygoid

The lateral pterygoid muscle wraps around the head of the mandibular bone. It also goes on to attach to the cartilage in the joint.

It is the primary muscle that pulls the cartilage backward and forwards as your jaw moves. One of the most common injuries to the jaw joint is that the cartilage becomes damaged because it has this highly unusual job to do.

The lateral pterygoid is to a degree that grant balancer, where it is balancing the head or condyle of the mandible, and flipping the cartilage over so that it can take up the space so that the head can work. 

If there is damage in the jaw joint, the lateral pterygoid muscle will often get trigger points in it. If the lateral pterygoid gets triggers, it stops functioning properly, and this means the jaw joint doesn’t move smoothly.

What tends to happen is the jaw joint remains as a hinge so you can open and close the joint, but a lot of the complex movements, to the side, and the forward and backward and rotatory movements of the joint become very painful. Trigger points in the lateral pterygoid are felt deep in the ear and around the joint itself.

Treating the Pterygoid Muscle Trigger Points

The lateral pterygoid trigger points are difficult to get to. The only way that you can get to it is actually by opening the jaw. The problem is that the muscle is set inside the joint. So you can open your mouth, put your finger way up inside and push out towards your ear.

It can be an intensely sensitive part, and if you get it slightly wrong, it can trigger a gag reflex. The other way to access these trigger points is if you open your jaw wide, a little triangle appears, in between the condyle and the head of the mandible.

There’s an extra part on the mandible where one of the power muscles, the temporalis comes down from the temporal bone, through a little gap in and joins into a condyle. Where this little triangle appears, the only way you can access lateral pterygoid trigger points is with a needle.

So the lateral pterygoid is a very difficult muscle to get to and treat. It’s also an incredibly important muscle that gets trigger points in it.

To turn TMJ trigger points off, you can use a small purpose-built trigger point tool, which is like a little curved rubber plastic tool, or you can use your finger inside your mouth.

The lateral pterygoid is a vital muscle of the jaw, and trigger points in this muscle are a very common cause of persistent jaw pain and jaw dysfunction.

medial pterygoid trigger points
Medial Pterygoid

The medial pterygoid attaches to the medial, or the inner side of the pterygoid plate. It’s a simpler muscle and you can access the triggers by going underneath your jaw joint and pushing in there. If you have trigger points in this muscle, they will likely be very tender. However, it’s an easier muscle to get to than the lateral pterygoid. 

Those are the two balances of the jaw joint.

Treating the Power Muscles of the Jaw Joint

The big power muscles are the temporalis which arises over your temporal bone, and the masseter.

temporalis trigger points
Temporalis Trigger Points

The temporalis is a fascinating muscle. It is a fan-shaped muscle that arises in a broad fan over the temporal bone. It then narrows down and tucks underneath the arch on your face, which is called the zygomatic arch. It joins into a very strong insertion on the jaw joint itself. It’s a big power muscle, which when it contracts, will pull one side of the jaw up to close your mouth. It’s easy to get this muscle it sits right over your temple.

masseter trigger points
Masseter Trigger Points

What’s fascinating about trigger points in the Temporalis muscle is their pain referral pattern.

If that you turn on a trigger point, you don’t feel it where the trigger is, but each trigger refers down to a particular tooth in the top jaw (depending on which trigger point is active.)

It is one of the false causes of toothache. The trigger point pain can be so specific that you feel it in one tooth.

The Mystery Tooth Pain Trigger Points

Years ago when I was doing general practice, I had just started learning about trigger points.

I had a patient come to me with a bad, persistent toothache. This lady had spent thousands of dollars going to different dentists. She’d seen both dentists, orthodontists, and endodontists. But she still had terrible pain in one of her teeth.

They’d started off with injections, then a root canal, then a complicated operation on her jaw joint – and her toothache still remained.

At this stage, I had just started learning about trigger points.

I said, “Okay, hang on a minute,” and I pulled open my trigger point textbook, and found the Temporalis, and pressed on the spot on her head. And she said: “That’s my sore tooth!”

We both looked at each other and I showed her the book, and said, “Here it is, see, right there in the picture.” We both looked up the triggers together in the book. (This was very early days for me treating trigger points

I stuck some local anesthetic into the trigger points and this lady’s pain went away. This made her both very happy, because the pain was gone, and also rather mad at all the thousands of dollars and the unnecessary, root canal and other operations she’d had.

Therefore temporalis are absolutely worth looking for. The power muscle in the jaw is the masseter, which is the biggest, most powerful muscle. This attaches to the zygomatic arch and runs down to join in a broad attachment to the mandible. When you clench your teeth, you’ll feel a muscle bunch up underneath your fingers.

The masseter very commonly gets trigger points when there’s something wrong with the jaw joint. Those trigger points refer pain around the joint itself up the front of the cheek and also back into the ear.

Most of the trigger points arising from the jaw joint are located around the joint itself and may refer pain into the ear and into the back of the throat. Those are the primary places, the deeper muscles, the medial and lateral pterygoid, tend to refer pain deeper. The more superficial power muscles tend to refer pain more superficially.

A lot of the trigger areas overlap, except for the temporalis, which has the strange referral pattern to one tooth.

Causes of a Clicking or Popping Jaw Joint

If using your jaw causes a popping or clicking noise, this means the cartilage in the joint is not moving smoothly. As you open the jaw joint, the cartilage is being caught.

It should be a smooth thing – as you open up the lateral pterygoid should contract and the cartilage, while there’s space, will just slip forward or backward.

But if the lateral pterygoid isn’t working as it should, or there’s damage to the cartilage such that it gets caught up, then as you open your jaw, there’ll be a ‘clunk’ because the cartilage will come forward and the head of the condyle will clunk backward.

If it’s not painful, that’s good. What you can do to stop this, is treat trigger points in the jaw muscles, and then look at retraining the movement of the jaw joint.

Practice opening your jaw and avoiding this clunking motion. Imagine your jaw muscles relaxing and creating space for the cartilage to slide smoothly and comfortably. To do this successfully, there will be no pressure in the jaw joint itself.

Other Jaw Joint Treatments

There are many treatments for jaw joint or TMJ (temporomandibular joint) pain. There is a whole group of specialists who look at this incredibly esoteric and mysterious thing called your bite. As you bite down the joint comes to rest. Because one joint is joined to the other, the theory is that your bite needs to be symmetrical to allow the joints to come into a “good” position.

The people who are the bite experts do things like they’re put in special splints to change your bots, which are very uncomfortable. They may also grind down or build up your teeth to change your bite.

The problem with this theory is that firstly, there are many other causes of problems in the jaw joint itself.

The second problem is that there are millions of people with the most terrible bites who have no pain. And there are a lot of people who have a very good looking bite but who have pain.

Before going to specialists and looking at complicated operations, it’s a good idea to first see if there are trigger points in the jaw joint muscle. Jaw joint trigger points can cause pain, and also cause your joint to move in a suboptimal way.

Treating the triggers can be a simple, non-invasive way of resolving jaw pain and getting good movement back in your mouth. Here’s where to find out more.