Physiotherapy for the jaw joint is applied for stress, deformity or after an accident. Painful tension and resulting dysfunction of the jaw are alleviated and natural balance is restored. Reason for this lies often within the jaw joint muscle, which is responsible for stability and mobility of the jaws. Abnormalities such as an unsymmetrical opening or closing of the mouth are only one of the rarely noticed symptoms of a so-called craniomanibular dysfunction (CMD). More noticeable is a jaw clicking. Most common symptom of a jaw dysfunctionality is pain while chewing or yawning, where the most extensive opening of the mouth should occur. Another contributing factor is knightly grinding of the teeth (bruxismus), which went undiscovered for a lengthy time period. Not rarely the change in relation of tension can displace the jaw’s disc and many patients have a strong overbite. In these cases clarification with a dentist should be sought to rule out other sources such as tooth root inflammation. With a fitting diagnosis physiotherapy can prove very beneficial. The issue is analyzed by deviations in the movement, felt by palpation and confirmed with specific tests. Depending on the problem, soft tissue techniques such as massage of the jaw muscle are applied. For this the therapist utilizes his hands on the inside of the mouth, stretches and loosens with special grasps the tense soft tissue gently. In some cases also dry needling is applied at the jaw to relax the often noticeable masseter. An important part of the therapy is to identify unfavorable behaviors such as pressure applied to the palate or biting. Commonly these sort of behaviors are practiced unnoticed under strain and simultaneous concentration. During therapy these physiological patterns are meant to be replaced.

A patient with tense neck muscles came to our practice. The symptoms existed since three months and resulted in heavy single-sided headaches on the left side of her head.

The anamnesis established the hypothesis, that working at a desk in front of a computer where the culprit and could cause such tension. More probable these activities in combination with stress increased the symptoms. After two sessions of physiotherapy with no improvement the hypothesis is reviewed and reveals that an ice skating accident with an impact on the lower jaw five years ago is causing the issues. By palpating the muscles surrounding the jaw it proved that the tension is much too high and the mouth could not be opened to a maximal extent anymore. The opening of the mouth is asymmetrical. Upon questioning the patient she explained that she also suffers from bruxismus, the nightly grinding of teeth. A movement analysis shows that she can only achieve the maximal opening of her moth by protraction, the forward tilting of her head. This tilting also helps her jaw feel looser when on the phone or chewing. This compensation falls to the expense of the big neck muscles, which results in the primary symptom of “a tense neck and headaches”

During following physiotherapy the jaw closing muscles that center the jaw joint are loosened via soft tissue techniques. Additionally a particularly persistent tension point is treated with dry needling. The patient is asked to monitor her behavior during every-day stress. An exercise to coordinate the jaw is supplied. The patient is pain free after six weeks and returns to the practice once a month to loosen the muscles in her jaw.

This example shall demonstrate how closely linked the symptoms of jaw and neck are related and how differential diagnosis may influence the therapy.