Before we dive into anything, I want to be clear in that I have these set up very intentionally: in order that you will likely be adding them into your routine. You’ll notice that with acute flare ups /active jaw pain, I talk about relaxation techniques and self mobilizations. I do not go into what most of us think as exercises (strengthening) for the jaw directly, but rather indirectly by building up strength to support the TMJ structures. And even then it’s at the end. This is because, as a whole, exercises geared towards TMJ specifically don’t work. Research done by Shaffer in 2014 found that “because many, if not most, patients with TMD over recruit their muscles of mastication, it may be more advantageous to focus on relaxation techniques and patient education than therapeutic exercise.” Hence why I talked a lot about things like dry needling last week. And absolutely stress, diet, and sleep should be considered here, too, as those are going to play a role in TMD pain. And diaphragmatic breathing, but that is another post in of itself. For stress, I like the app Insight Timer, though I know plenty of people like Headspace. And you can do little things like drink more water and drop the room temp at night a couple degrees to help you sleep a little better. Okay, now onto the physical stuff…

A quick word on the physical aspects of diet: it may be helpful to temporarily eat only softer foods and allow for more chewing/time in mouth before swallowing so there’s less overuse of the TMJ muscles. And avoid using a straw as that increases intraoral pressures.

One “exercise” that can help some is self mobilizations - the first video below. I’m only showing side to side ones here. You can also do anterior (forward) glides to help with opening, but I have found (both with myself and patients) that the muscles in the area that you press for that are often too sensitive. Place your hands as I do on either side of your jaw, just below that bone in front of your ear. Gently push your jaw directly across on one side or the other, depending on where you are restricted. (Note that I’m alternating left and right in this video, not trying to target a specific side). Try to keep your jaw relaxed while doing this so the muscles don’t guard up against motion.

While I don’t think the Rocabado 6x6 really works for any long term change, I do like using a few of them as relaxation techniques. Speficially contract/relax of protusion (jutting your jaw forward like a bulldog) and of opening. The entire time, you gently press the front your tongue onto the roof of your mouth (Rocabado stated this was to promote relaxation of the jax musculature and diaphragmatic breathing). You only need to use 2 fingers of resistance to “block” the motion, hold for 6 seconds, slowly relax, and repeat 6 times for each motion. Check out the second video below to see me do these 2 (first protrusion and then opening)

(side note: anyone know how to modify the size of videos on squarespace?! I feel like these are unnecessarily huge, but I couldn’t figure out how to change them)

Like I talked about last week, there are often other things at play when you have TMD. Specifically, neck pain and headaches are common. And there are exercises to help with those. (videos below, in order)

• C1/2 SNAGS. These are also great for anyone with cervicogenic headaches, which I’ll be talking about next week. Or really for anyone who has neck pain (hello, people with desk jobs). This is essentially a way for you to mobilize the upper neck, and if you remember from last week, there are shared nerve pathways at play here! Using a belt or dog leash or something similar, find that bump right at the back of your skull - come just down off that to where it feels like it drops off - then immediately below you’ll feel another bone - that’s C2. Place the leash directly over that bone, like I show in the video and hold the ends of the leash in your hands. Keep it pretty locked in on that position by pulling it taught. As you notice, I drop one hand lower - this is the anchor hand and will stay still. The other hits just below the ear and will b the hand that creates rotation (I’m not actively moving my neck. My hand pulls the leash in order to move my head in that direction). I usually do this for a minute every hour whenever I have a flare up.

  Oh, and if you are curious, SNAG stands for Sustained Natural Apophyseal Glide - but that’s not really important.

• Cervical Retraction. This acts to unload the structures at the back of the jaw. You can use a wall or the headest in your car (whenever I have a flare up, you can catch me doing these at every red light). The back of your head should not come off the wall. Think about trying to look at your own chin or sternum without bending your head forward - you end up giving yourself a super lovely double chin! May not be cute, but it is effective here.

• Thoracic twists in child’s pose - Honestly, I’m sure someone has come up with a better name for this, but whatever. Make sure you sit all the way back on your heels, or if you can’t quite do that, place a pillow or something between your rear and feet to bolster support only as much as needed. Bring your elbows together and all the way in to touch your knees. This position locks out different components that may want to compensate otherwise. Place on hand behind your back (or behind your head if that’s more comfortable for you) and try to turn your chest up to the ceiling as much as possible. Repeat 5 or so times each side

• Shrugs - Lift the top of your shoulders towards your ears while bringing your shoulder blades together (feel slight tension in your neck and shoulders). Hold this feeling of tension for 3 to 5 seconds. Relax your shoulders into their normal position. Repeat steps 1 - 3 at least two more time. Can do these holding weights as well, as I’m showing. This is basically a contract/relax exercises to the traps and some to the levator scap and other neck muscles, which helps them relax.

As you are able, overhead pressing will be key in building back some supporting strength. As this is something that was likely very painful and avoided when jaw pain was bad, you may want to start with a landmine press and then progress back to overhead work. And depending on how bad symptoms are initially, landmines may be something you can use as a modification whenever overhead pressing is programming so you can keep up that strength while rehabbing. But once you’re able, things like overhead carries (I especially love bottoms up kettlebell carries) are great for the jaw, neck, and shoulder! Snatching may be another thing you’re avoiding during higher levels of pain - a good sub for that is heavy snatch high pulls or kettlebell swings, depending on the workout’s intended stimulus. (If you want info on other modifications, such as heavy medball squats instead of wall balls, just comment or message me!)

There are several other neck and shoulder accessory drills that are good for building up strength to support the jaw, but these are a solid start! Drop any thoughts/comments below. And as always, this blog is not intended to be medical advice, so if you’re looking for individualized care, text me at 480-751-2137 :)