TMJ And Massage Therapy

Dec. 1, 2012
My family and I like to watch “How It’s Made.” If you’re not familiar with this television show, it’s a step-by-step presentation ...

Structural Integration Relieves Muscle Strain And Tension

By Sonya Prater, RDH, BS, FACE

My family and I like to watch “How It’s Made.” If you’re not familiar with this television show, it’s a step-by-step presentation about how things are made. From candy to machinery, it’s quite interesting to see the process in which things are created.

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I am always amazed when I think of the human body. I often wonder how in the world we were put together so intricately, and yet we come into this world with no instructions or blueprint. Over the course of a few thousand years, scientists have put an overwhelming amount of time, energy, and money into figuring out all the intricacies of the human body. Like machines, when one part malfunctions, you can bet another one will, and then another, and so on. It’s funny to me how our bodies can be so complex and our minds so simple, but that’s for another time.

Focusing on one area of the body, since this is a dental related article, the temporomandibular joint (TMJ) is affected by other working parts of the body. Our society is so used to treating symptoms that we seldom think, “Why do I have this headache?” or “Why does my back hurt?” We often chalk it up to stress, which is usually the leading cause of, well, everything! I guess we can attribute some things to stress, but since that particular word can cover a whole gamut of issues, I often consider it to be an excuse. I have a friend who is always “stressed out.” It’s quite humorous to me really. We like to be “stressed” and we like to take our “prescription medications” and we like to tell everyone what ails us.

Not everyone I know falls into that category. But how different would the world be with a more homeopathic approach? I’m not talking about all natural dietary supplements, powders, or potions. Instead, what if there was a way for our bodies to actually have a sense of balance, with all parts working together seamlessly?

Let’s refer back to the machine analogy. When a machine is first built, it functions perfectly, assuming all the parts are clean, well oiled, and in their proper place. When a part wears down, like all parts do eventually, it must be repaired or replaced. Being in touch with how the machine should function is key to problem solving. Simply lubricating a part instead of repairing the real problem will directly affect other parts that used to work properly. Repairs become more complex and more costly. The same is true with our bodies.

Let’s say Mrs. Jones lost a tooth 10 years ago. She didn’t feel the need to replace the missing tooth and, like many people do, she learned to eat without it. The missing tooth, however, created additional pressure on the surrounding teeth. Over time, the surrounding teeth began to drift and the bite continued to adjust to the changing positions. All the while, muscles, joints, and tissues compensated for all the changes. Mrs. Jones favored the opposite side to chew on and began having problems with her joints, experiencing headaches more often and hearing a popping/clicking noise around her ear. Up until now, she hadn’t seen any doctors for her headaches or TMJ, instead using Advil three to four times daily, but after a few years she didn’t feel much relief from the Advil, so she moved on to Aleve, which did the trick at first.

Another year or two down the road, Mrs. Jones realized either the headaches and jaw pain were getting worse, or the medicine was no longer working. As a result, she talked with her family physician during a routine visit. He put her on Flexeril because he thought her problem was probably just muscular, and the Flexeril would help relax the muscles enough to give her some relief. I’m oversimplifying this scenario, but I’ve seen this situation time and time again — treating symptoms with medications. As you can see, there is a domino effect. The bad news for Mrs. Jones is she has had continual damage over the past 10 years. The good news is we know a lot more now about how to actually treat the problem, and there are alternative ways to treat TMJ rather than with medications.

A chiropractor once told me, “Pain is not normal.” After dwelling on that for a while, I realized he was right. Yet how many people live with pain and discomfort on a daily basis? What can be done about it? I recently learned of a new alternative method of treating TMJ, or any other problems in the body — massage therapy. But there’s more to it than that. There are different categories of massage therapy — relaxation, therapeutic, and medical.

The type of massage therapy I’ll discuss here falls under the medical realm. I’m referring to structural integration, or SI. Structural integration is a form of deep tissue massage therapy that balances the body by removing strain and tension (there’s our “stress”) in the musculoskeletal system. It re-forms the neuromuscular patterns in the body through movement education and interactive dialogue. Basically, the therapists teach old dogs new tricks.

It all starts with something called fascia. I believe we all learned about that in biology. Fascia is the fibrous connective tissue that surrounds muscles, organs, and bones. It is like a strong spider web that holds a body together, greatly defines our shape, and is a container of support. (That sounds a lot like a girdle to me.) This “girdle” acts as a shock absorber when the body encounters an accident, illness, or emotional tension. Over time, this stress causes the fascia to lose its elasticity and become hardened, twisted, and short. Chronically, this leads to limited joint mobility and impaired muscle potential, which in turn makes the body less resilient and prone to further injury.

Have you ever sprained your ankle and gotten back into the game too quickly? I did that playing volleyball in college. The results of that decision affected me for years. I overcompensated for the injury, thus putting unnecessary strain on the other ankle to regain strength and support. Initially this is what needs to happen in order for the strained area to heal. However, it compromises the integrity of the body’s natural alignment and further disrupts what should be a smooth running machine.

The regular stress of daily living can create habitual patterns that are not healthy, that can cause physical discomfort as well. I don’t know about you, but 17 years of hovering over patients and looking upside down in their mouths has created undue stress on my body that may take years of therapy to correct. SI aims to restore the body’s structural and functional integrity, which in turn enhances general health. Essentially, the body is viewed as a whole system. A malfunctioning “part” is not the primary focus. The whole body is in a state of reorganization in order to find resolution. Treating each symptom is not the cure. Symptoms may be the problem, but more commonly, they are indicative of another problem. Finding a solution to the underlying problem produces the results we all seek.

TMJ dysfunction involves not just the bones and joint. It involves the muscles, connective tissue surrounding the muscles, and also intraoral factors. It should come as no surprise that although surgery is sometimes necessary, the more we learn about the head and neck, the less often surgery may be needed. Degenerating muscle and connective tissue, as well as missing and malaligned teeth, all play a significant role in TMJ disorders.

Some corrections can be made with better tooth position (orthodontia or porcelain reconstruction), and other corrections can be made to the head and neck. Chiropractic, massage therapy, and dentistry can all go hand in hand. Having relaxed muscles so that the jaw opens and closes properly, a centered axis (neck alignment), and proper position of the teeth are all extremely important in the overall health of the TMJ. Therapists who use the SI method of treatment will also work intraorally to help correct TMJ problems. Many massage therapists are not certified to do this type of treatment, and may look at you a little funny if you ask about it. I’ve had the typical massages. I feel better and a bit more relaxed for a short time afterward, but I can definitely say there has never been any resolution to my problems.

To give you a brief synopsis of how treatment is initiated, the process starts by asking the client these questions:

  1. How long has the problem been going on
  2. How does the pain/discomfort present itself
  3. When does it happen? When you’re eating, sleeping, etc.
  4. Have you ever had an accident or experienced any trauma

The therapist will evaluate the body with a visual lineup. Again, this is a 3-D approach to the body as a system. Although my jaw may be hurting, something might be wrong in my alignment from my foot to my neck. Remember the body charts from biology? Everything is connected, from muscles, to blood vessels, to bones and connective tissue. Let’s all sing together now — “The leg bone’s connected to the knee bone; the knee bone’s connected to the ….” Remember that song? I always thought it was funny, but I never really learned the whole song.

In conclusion, structural integration is one method. This isn’t the only one, and there are many more things to learn about massage therapy. I think it’s awesome that alternative methods have been explored. I encourage you to familiarize yourself with treatment alternatives. Use them as a reference for personal or professional use. RDH

“The doctor of the future will give no medicine, but will interest his patients in the care of the human body, in diet, and in the cause and prevention of disease.”

Thomas Edison

SONYA PRATER, RDH, BS, FACE, graduated from Western Kentucky University and has been in private practice for over 17 years. She has held eight state licenses and remains in active status in South Carolina and Georgia. She is currently practicing in Savannah, Ga., in a very progressive, customer service-driven dental office that specializes in highly complex and reconstructive TMD cases.

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