If your jaw clicks when you chew, aches by mid-afternoon, or leaves you with tension headaches, you’re not alone. Temporomandibular disorders (TMD, often just called “TMJ”) affect an estimated 10 to 15 percent of Americans. The good news is that most people improve with conservative, hands-on care, and that’s where physiotherapy can help.

Meet your jaw: the anatomy

The temporomandibular joint (TMJ) sits just in front of your ear, where the rounded end of your lower jaw (the condyle) meets your skull. A small cartilage disc sits between the two surfaces and keeps the movement smooth. Four pairs of muscles run the show:

• Masseter: the strong cheek muscle you use to bite and chew.

• Temporalis: the fan-shaped muscle across your temple.

• Medial pterygoid: a deep muscle that helps close the jaw.

• Lateral pterygoid: a deep muscle that helps open the jaw and guides the disc.

Your neck muscles are part of the picture too. Figure 1 shows where each of these sits and where we focus treatment.

Figure 1. Side view of the skull and jaw showing the chewing muscles, the TMJ and the main treatment locations (simplified, not to scale).

TMD falls into a few broad groups: joint problems, jaw muscle problems, headache-related conditions, and issues in surrounding structures. The most common are muscle pain, joint pain and disc displacement (the “click”).

Why does it happen?

There’s rarely one cause. Common contributors include:

• Clenching or grinding, especially under stress

• Past injury, such as a blow to the jaw or whiplash

• Arthritis

• Habits like gum chewing or nail biting

• Poor sleep

• A nervous system that’s more sensitive to pain

Because the causes overlap, the best results usually come from addressing several of them together.

When tight muscles irritate nerves: tingling in the face, neck and hands

Jaw problems rarely stay in the jaw. Tight, overworked chewing muscles can irritate or compress the nerves and soft tissues running through and around them. Some people notice:

• Tingling, burning or a “crawling” feeling in the face, temple or around the ear

• Aching that spreads into the neck and shoulders

• Pins and needles in the arm or hand

The hand symptoms often come from the neck. A jaw that is clenched or held forward tends to go with a stiff neck, rounded shoulders and a forward head position. That posture can tighten the muscles at the base of the neck and the chest, where the nerves to the arm pass through. In many people, jaw tension and neck-and-arm symptoms are part of the same postural pattern, which is why we assess the whole chain from jaw to shoulder rather than the jaw alone.

Tingling and numbness have many possible causes, so we always check them properly. We look at the neck, shoulders and nerves to confirm what’s driving your symptoms before choosing treatment.

Posture and desk set-up

Many patients ask whether their posture is to blame. Honestly, the research is mixed. One review found that the link between posture and TMD is widely discussed but has little evidence behind it. At the same time, a review of studies on correcting forward head posture found favourable results when it was added to TMD rehabilitation, though only six studies qualified.

Since good ergonomics are low-risk and often help your neck and shoulders anyway, we recommend:

• Raising your screen to eye level

• Supporting your forearms on the desk

• Avoiding cradling your phone against your shoulder

• Resting your jaw with lips together, teeth apart and your tongue lightly on the roof of your mouth

• Taking a movement break every 30 to 45 minutes

Exercises you can start at home

Gentle, pain-free movement is a cornerstone of care. Your physiotherapist will tailor a programme, but typical exercises include:

• Slow, controlled mouth opening in front of a mirror, keeping the jaw straight

• Light resisted opening and closing

• Chin tucks to realign the neck

• Deliberate jaw relaxation between repetitions

A few minutes, several times a day, is usually enough. Stop if symptoms flare and let us know. Research supports this approach: a physiotherapy review found that active exercises and manual mobilisation may be effective, and that combining exercise, manual therapy, posture correction and relaxation may work well.

Once pain and tension have calmed, we progress to strengthening and motor-control work for the deep neck flexors, the shoulder blade muscles and the jaw muscles. Strong, well-coordinated muscles hold your head, neck and jaw in a better working position, so the benefits of treatment last longer. This is gradual work that builds over weeks and months.

Hands-on treatment and myofascial release

In the clinic, we use massage, trigger-point pressure and stretching on the masseter and temporalis, and joint mobilisation for the TMJ itself. Some therapists, with specialist training, also release the deep lateral pterygoid from inside the mouth. We often treat the neck as well, because that can help the jaw. A meta-analysis found cervical manual therapy reduced pain and raised the pressure-pain threshold of the masseter.

By easing tension in the jaw, neck and shoulder muscles and the fascia around them, myofascial release can reduce the pressure on nearby nerves and soft tissues, which often settles tingling and referred aching. It also helps the jaw and neck move more freely and comfortably, so joint mechanics improve.

We believe in being straight with you about the evidence. Manual therapy seems effective in the medium term, but its effect appears to fade without ongoing self-care, which is why we pair it with exercises. And large reviews rate the overall evidence as low quality, so we monitor your progress closely and adjust as we go.

What your dentist can offer

Dentists are important partners in TMD care. The most common treatment is a stabilisation splint, or night guard, which can protect your teeth from grinding. The research on splints is less convincing than many people expect. A large health technology assessment of 52 trials found very low-quality evidence and could not show that splints reduce TMD pain as a group. For sleep bruxism, Cochrane found insufficient evidence either way.

That doesn’t mean splints are useless. They’re low-risk and may help some people, and your dentist can advise whether one suits you. We’d simply suggest treating a splint as one tool alongside exercise and manual therapy, not a stand-alone cure. We’d also be cautious about irreversible treatments such as bite adjustments or orthodontics aimed at fixing jaw pain.

How the options compare

Approach	Evidence quality	Risk	Our take
Education, self-care, ergonomics	Low to moderate	Very low	Start here
Jaw and neck exercises	Low	Very low	Start here
Manual therapy and myofascial release	Low; medium-term benefit	Low	Strong partner to exercise
Stabilisation splint	Very low	Low	Optional, reversible add-on
Medication or injections	Variable	Moderate	Selected or short-term cases
Surgery or irreversible bite changes	Weak	High	Last resort

Our evidence-based recommendations

1. Get a proper assessment. The DC/TMD protocol reliably identifies common pain-related TMD, though most joint-disorder criteria are suitable for screening only.

2. Begin with the basics: education, relaxation, heat, a softer diet, ergonomic tweaks and graded jaw exercises.

3. Add physiotherapy if symptoms persist, combining manual therapy, exercise and neck care.

4. Discuss a splint with your dentist as an optional extra, not a first-choice cure.

5. Be wary of irreversible procedures unless conservative care has failed and a specialist recommends them.

When to seek help

See us at Freedom In Movement Physiotherapy and Wellness in Oakville, or your doctor promptly if your jaw locks, you’ve had a recent injury, you have swelling with fever, or your pain keeps getting worse. New or worsening numbness, tingling or weakness in your arm or hand, especially with neck pain, deserves a proper assessment. Seek urgent care if it comes on suddenly, affects your face or speech, or comes with severe headache, chest pain or loss of coordination.

Ready to get your jaw moving comfortably? Book an assessment at Freedom In Movement Physiotherapy and Wellness and we’ll build a plan around you.

This article is for general education and isn’t a substitute for personal medical advice.

References

1. Schiffman E, Ohrbach R, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications. J Orofac Pain. 2014. https://doi.org/10.11607/jop.1151

2. Schiffman E, Ohrbach R. Executive Summary of the DC/TMD. https://pmc.ncbi.nlm.nih.gov/articles/PMC4884471

3. Expanding the Taxonomy of the DC/TMD. 2014. https://pmc.ncbi.nlm.nih.gov/articles/PMC4520529

4. NIH news release on the first evidence-based TMD criteria (2014). https://www.nih.gov/node/10626

5. Armijo-Olivo S, et al. Effectiveness of Manual Therapy and Therapeutic Exercise for TMD: Systematic Review and Meta-Analysis. Phys Ther. 2016;96(1):9–25. https://pmc.ncbi.nlm.nih.gov/articles/PMC4706597

6. Medlicott MS, Harris SR. Systematic review of exercise, manual therapy, electrotherapy, relaxation training and biofeedback in TMD. Phys Ther. 2006;86(7):955–973. https://search.pedro.org.au/search-results/record-detail/15694

7. Efficacy of Manual Therapy in TMJ Disorders: Medium- and Long-Term Effects. Systematic review and meta-analysis. https://pmc.ncbi.nlm.nih.gov/articles/PMC7690916/

8. Cervical manual therapy and exercise in TMD: systematic review and meta-analysis. Pain Med. 2020;21(10):2373–2384. https://pubmed.ncbi.nlm.nih.gov/32181811/

9. Manual Therapy in the Treatment of Myofascial Pain Related to TMD: A Systematic Review. J Oral Facial Pain Headache. 2020. https://www.epistemonikos.org/en/documents/5fce69edc358531e825486c1e30412cd4597917d

10. Oral splints for patients with TMD or bruxism: a systematic review and economic evaluation. Health Technol Assess. https://database.inahta.org/article/18716

11. Occlusal splints for treating sleep bruxism. Cochrane Database Syst Rev. https://www.cochrane.org/CD005514/ORAL_occlusal-splints-for-temporomandibular-disorders

12. Effects of stabilization splints on TMD of muscular origin: systematic review. 2022. https://redi.cedia.edu.ec/document/170870

13. Batista JFOL, et al. Exercises with or without occlusal splints for myogenic TMD: systematic review. J Appl Oral Sci. 2023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9882960/

14. Static body postural misalignment in individuals with TMD: a systematic review. Braz J Phys Ther. https://scielo.br/j/rbfis/a/rqQHwQ7gCQTgpSPb4KTrL9R/?lang=en

15. The impact of forward head correction on temporomandibular dysfunction: a narrative review. https://nchr.elsevierpure.com/en/publications/the-impact-of-forward-head-correction-on-temporomandibular-dysfun/

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Jaw Pain, Clicking or Locking? A Physiotherapist’s Guide to TMJ Disorders - Anatomy, causes, posture, exercises and what the evidence says about treatment