Covid-19 is having a very negative impact on our collective mental health; in fact, a tidal wave of mental health issues in the wake of multiple and extended lockdowns has been predicted.
At the clinic, we are now treating more patients with pain conditions related to stress, anxiety and depression.
Amongst these conditions is what is often referred to as temporomandibular joint dysfunction (TMD). TMD is characterised by very unpleasant pain and sensitivity about the jaw, either on one or both sides. TMD is also commonly associated with difficulty fully opening the mouth due to stiffness, deviation of the jaw to one side or sometimes clicking. A stiff and sore upper neck, resulting in referred pain to the back or sides of the head may also accompany TMD.
The cause of TMD may relate to a dental issue involving the bite or alignment of the teeth and the temporomandibular joint and related structures. More commonly, TMD is a consequence of grinding the teeth at night (bruxism) or persistent clenching of the masticatory muscles due to stress. The masticatory muscles are used to open and close the mouth, move the jaw from side to side, and chew food. If the masticatory muscles become tense and sensitive due to persistent overactivity, they are liable to develop trigger points. Trigger points within the masticatory muscles are common and can be the source of TMD related myofascial pain and dysfunction.1
A study conducted in 2010 examining patients with myofascial TMD pain found trigger points in the masticatory muscles as follows:2
- The superficial masseter (78%)
- Temporalis (73%)
- Deep masseter (72%)
Another study showed that in a sample of 190 patients with TMD related pain, 50% had trigger points within the lateral pterygoid muscle.3
Given the relatively high prevalence of trigger points found in those suffering from TMD pain, and given the dry needling technique's effectiveness in treating trigger points,4,5,6 it makes sense that needling techniques have a significant role in treating this condition.
In recent months I have treated many, predominately students and healthcare workers, with severe TMD pain and dysfunction. Needling techniques have been the main focus of the treatment approach, combined with specific gentle manual therapy, therapeutic exercises, breathing and stress management techniques. The results have been excellent, and I am so pleased to help those who are really struggling during these difficult times.
1. Svensson P, Bak J, Troest T. Spread and referral of experimental pain in different jaw muscles. Journal of orofacial pain. 2003 Jul 1;17(3).
2.Fernández-de-Las-Peñas C, Galán-del-Río F, Alonso-Blanco C, Jiménez-García R, Arendt-Nielsen L, Svensson P. Referred pain from muscle trigger points in the masticatory and neck-shoulder musculature in women with temporomandibular disoders. The Journal of Pain. 2010 Dec 1;11(12):1295-304.
3. Wright EF. Referred craniofacial pain patterns in patients with temporomandibular disorder. The Journal of the American Dental Association. 2000 Sep 1;131(9):1307-15.
4. Machado E, Machado P, Wandscher VF, Marchionatti AM, Zanatta FB, Kaizer OB. A systematic review of different substance injection and dry needling for treatment of temporomandibular myofascial pain. International journal of oral and maxillofacial surgery. 2018 Nov 1;47(11):1420-32.
5. Gonzalez-Perez LM, Infante-Cossio P, Granados-Nuñez M, Urresti-Lopez FJ. Treatment of temporomandibular myofascial pain with deep dry needling. Medicina oral, patologia oral y cirugia bucal. 2012 Sep;17(5):e781.
6. Fernández-Carnero J, La Touche R, Ortega-Santiago R, Galan-del-Rio F, Pesquera J, Ge HY, Fernández-de-Las-Peñas C. Short-term effects of dry needling of active myofascial trigger points in the masseter muscle in patients with temporomandibular disorders. Journal of orofacial pain. 2010 Jan 1;24(1):106.