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TMJ – A Case Study

How Physiotherapy Can Help Relieve Jaw Pain (TMJ Dysfunction)

Are you struggling with jaw pain or TMJ dysfunction? You’re not alone! Many people experience discomfort in their temporomandibular joint (TMJ), which can make everyday tasks like eating or talking painful. Depending on the cause of your TMJ pain, physiotherapy can often help alleviate your symptoms and improve your quality of life.

What Can You Expect From Physiotherapy for Jaw Pain?

Let’s look at a typical case of a client visiting our clinic for jaw pain treatment:

 

Client Case Study:

TK, a 30-year-old woman, was referred to physiotherapy by her dentist for TMJ dysfunction. She had been experiencing pain on the right side of her jaw, occasionally affecting the left side as well. The pain began 6 months ago without any clear cause, and there was no history of clicking, locking, or injury to the jaw. TK also had recurring neck stiffness and occasional headaches.

Despite expecting the pain to resolve on its own, it became more persistent over time. Recently, she switched to a desk job that involves less physical movement, which she feels may have contributed to her symptoms. Additionally, TK grinds her teeth at night (bruxism), and her dentist fitted her with a night guard to help manage this.

 

 

Physiotherapy Assessment for Jaw Pain

When TK visited the clinic, the physiotherapist conducted a thorough assessment, focusing on her jaw and neck. This included:

  • Checking the range of motion and muscle strength in her neck and jaw
  • Assessing the ligaments and joints of the cervical spine and TMJ
  • Examining the muscles inside the mouth to assess jaw movement

The physiotherapist diagnosed TK with myofascial pain syndrome affecting her TMJ, particularly on the right side. She also had articular dysfunction in her upper cervical spine. In simple terms, this means her muscles were tight and the joint movement in her jaw and neck was not optimal.

Treatment Plan for TMJ Dysfunction

TK was advised to attend 6 physiotherapy sessions, scheduled once a week, which is typical for managing TMJ issues. Each session focused on relieving jaw pain and improving her overall function.

What Does Treatment Involve?

A physiotherapy approach usually involves manual therapy on the outside and inside of the mouth and jaw

  • Manual therapy on the muscles and joints in the jaw and neck
  • A customized home exercise program that includes:
    • Jaw and neck range of motion exercises
    • Strengthening exercises for the cervical spine and jaw
    • Relaxation techniques and diaphragmatic breathing to reduce muscle tension
    • Ergonomics tips for better posture at work and while sleeping

The Results

After several treatment sessions, TK reported significant improvement in her jaw pain, with only minor tightness remaining, which she managed through her home exercises. A follow-up appointment was scheduled 6 weeks later to ensure her progress was maintained. TK later contacted the clinic to share that her symptoms continued to improve, and she was discharged from physiotherapy care.

Why Physiotherapy for Jaw Pain?

If you’re suffering from jaw pain or TMJ dysfunction, physiotherapy may be the solution you need. Our team of experts can assess your symptoms and create a personalized treatment plan to help you get back to living pain-free. Contact us today to learn more or schedule your appointment in Warman or Saskatoon!

*Pro Tip: both Shannon Domres (Warman, Saskatoon) and Kendra Usunier have keen interest in TMJ assessment and treatment!

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Physio for your… Behind?! Anorectal Disorders Explained!

Pelvic floor physiotherapists are physios who have had additional training to perform external and internal pelvic exams in order to treat a variety of pelvic floor disorders. Among those disorders include some that pertain to the dysfunction of the bowel – your behind. These anorectal disorders may include

  • Leaking of stool from the rectum (fecal incontinence)
  • Inability to control flatulence (being unable to hold back a fart)
  • Chronic constipation
  • OASIS (obstetric anal sphincter injuries) which include 3rd or 4th degree perineal tears sustained during labour and delivery, rectocele, rectal prolapse, and pain disorders of the anus
There is something we can do to help!

Fecal incontinence refers to the uncontrolled passage of fecal material (aka poop) in individuals who are 4 years old or older. There can be various reasons why fecal incontinence may be present. There may be damage to the internal or external anal sphincters during OASIS. Radiation therapy for certain pelvic cancers may have reduced the ability of the rectum to stretch contributing to incontinence, stool consistency may be too liquid making it difficult for the sphincters to stop the feces from exiting the anus (possibly due to partial bowel resection surgery due to various medical conditions. Food intolerances/poor diet may also cause stool consistency to be too loose. There may be some weakness in the external anal sphincter muscle or the puborectalis portion of the levator ani muscle (the main pelvic floor muscle group) contributing to leakage of stool.

Some leakage can be due to nerve disorders (example multiple sclerosis). Sometimes even chronic constipation can be a source of loose stools leading to fecal incontinence!

 

What does it mean to have a 3rd or 4th degree tear during labour and delivery?

A 3rd degree tear is a tear into the external anal sphincter and a 4th degree tear includes tearing into the internal anal sphincter. These two sphincters are what control the exit of the stool and gas out at the anus from the rectum. When there is a tear in the sphincters, the scar tissue that forms from the injury may cause problems. Common issues to these injuries include having pain during bowel movements and it can contribute to constipation. There can also be low tone of the IAS or EAS (internal or external sphincters) or weakness of the external anal sphincter that may cause fecal incontinence or difficulty with controlling an unwanted fart. Fecal urgency can also be a symptom following 3rd or 4th degree vaginal tears.

Even if there is no bowel dysfunction in the post partum period following labour and delivery with a 3rd or 4th degree tear, having a pelvic floor physiotherapist examine the pelvic floor and provide an individualized home exercise program to optimize the scar tissue mobility, pelvic floor mobility and strength, and provide education on optimization of defecation strategies. This can be very helpful as sometimes occult injuries (meaning those without obvious injury to the anal sphincters) are present. They could result in symptoms like fecal urgency and loss of control of farting or fecal incontinence later in life (post menopausal).

Proactive treatment can be beneficial in these cases!

Chronic constipation is often characterized by:

  • having a bowel movement less than 3 days/week
  • and/or a stool consistency on the Bristol Stool Chart of Type 1 or Type 2
  • history of very large bowel movements (plugging the toilet for instance)

A pelvic floor physiotherapist can be helpful in providing various strategies to assist with the evacuation of the bowels. Some basic recommendations may include:

  • general advice on fibre and fluid intake recommendations for optimal stool consistency
  • activity recommendations
  • manual therapy techniques to assist with motility of the stool through the rectum
  • education on various physical evacuation strategies
  • breathing techniques to assist with optimal bowel evacuation
  • minimization/elimination of straining

 

 

 

For those suffering from prolapse, a physiotherapist can help by teaching optimal defecation techniques to reduce strain to the area, thereby reducing strain to the tissues. There may also be too much tension in the pelvic floor muscles or there may be scar tissue present from obstetrical or other surgical injuries which can lead to pain in the pelvic floor or anus with or without having a poop.

Struggling? Book online with a physiotherapist today in Warman at Warman Physiotherapy & Wellness or Saskatoon, at Warman Physio Saskatoon. Don’t see a spot that works? Add yourself to the waitlist! You can even select if you have a therapist, location, and day/time preferences!

 

 

This post was created by Maja Stroh MPT and pelvic health physiotherapist at Warman Physiotherapy & Wellness

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