Smiling on the Surface, Clenching on the Inside
Chiropractic is traditionally a field that specializes in spinal care with limited training in dental related pain relief such as the Tempomandibular Joint (TMJ) yet as we check off the lists of regions during a new patient assessment, the jaw cannot be ignored. One of the staple questions we ask each new patient is about their TMJs. “Do you have a history of grinding your teeth?” This simple question invokes an array of not-so-simple answers from patients who truly do not know if they have an issue with their jaw. Most people view discomfort in this region of the body as a normal part of the aging process. Lockjaw and nightguards become common words in our vocabulary that few people have success treating without invasive interventions. With an open mind (and an open mouth), let’s dive deep into the physical and emotional body to discuss the major contributors of jaw pain and I promise, the most common causes will not be what you were expecting.
Do you have a jaw problem?
Excluding traumatic disturbances to the jaw such as hits to the head or dental work, most athletes suffer from slowly progressing jaw pain with no known cause. How can you tell if your jaw is functioning incorrectly? The most common symptoms include tender teeth and limited ranges of jaw motion, often asymmetrical from side to side. Some people notice jaw tenderness in the morning with sensitive teeth as if they clamped down all night. Facial pain that is reported directly over the TMJ is often paired with pain in the back of the neck, ear aches, and tense upper shoulders. Obvious signs include clicking, popping, zig-zagging motions during opening/closing, or the worst symptom, lock jaw. More subtle signs include a thin line of translucency along the tips of your teeth which display decreased density in the enamel due to chronic pressure (Image 3). The fancy diagnoses for grinding is called bruxism; an abnormal repetitive movement disorder of the jaw that is classified into awake or sleeping types (1). These abnormal movements are completely different than the motions of chewing. Chewing is voluntary while clenching or grinding are subconscious, involuntary activity that if not altered will lead to trauma of the teeth and bite. So why does our subconscious make the jaw do something harmful.
Why We Clench
One reason for clenching your teeth is that the body has adapted this movement as a protective mechanism in attempt to find stability. Something is missing in your body’s stabilizing system if the extremities need to clench the teeth, curl the toes, or collapse the knees inward towards the midline (2). These coping mechanisms and signs of instability work to stabilize the deep core which is our internal foundation of support. Many patients are confused when we spend half the visit working on their hips or pelvis to fix a jaw issue, that’s when I show them this picture! This diagram displays the functional connection between many layers of muscles throughout the body. These layers are known as fascial lines which are groups of muscles interconnected by fascia, the collagenous web that surrounds and connects muscles (3). There are many of these lines but the applicable line for jaw pain is the Deep Front Line which is what I consider “your core.” If you look at the picture in side view, you can see how the chewing muscles of the Temporalis, breathing muscles of the midsection, and gripping flexors of the toes, are all connected in stabilizing human movement (Image 4). A weakness somewhere along the chain will alter tensile compression of the entire portion and can cause distant muscles to work overtime to compensate. Weakness, meaning hypermobile joints or muscles that your brain cannot find to properly fire.
“When we knot our muscles, clench our teeth, or tie our guts in knots, it does little for us but cause pain, raise blood pressure, and create more noise in the nervous system.”
-Michelle Levy, author of Mindfulness, Meditation and Mind Fitness.
It is widely recognized that things besides an uneven bite line contributes to TMJ issues which is why so many researchers have explored the connection between stress and jaw pain. As I explained above, clenching is a subconscious way for the body to gain stability and the same rule holds true for the non-physical body. Your mind is searching for stability in life just as much as the physical structure of our frame. So, while you lay there at night sleeping, your stressed and anxious subconscious mind is reeling through busy dreams and stressful memories producing a physical response on the surface. The energy we use to suppress our emotions re-surfaces through the autonomic nervous system leading to pathological changes in muscle tone and joint function (4). A majority of our patients with jaw pain were given a night guard by their dentist or oral surgeon to prevent the damaging effects of sleep bruxism but many of those people will admit to grinding right through the material. The retainer cannot resolve the underlying emotions that cause people to bite down in the first place. Many patients do not realize that they grind their teeth while they sleep but as Dr. Chris Barnes says, “If you catch yourself clenching consciously throughout the day, I guarantee your body is doing it SUB-consciously at night.”
Why Athletes Clench
Every athlete has tricks that help them succeed in their activity, many of which are subconscious. One very common “hack” to activate stabilizing muscle chains is to clench your jaw. Heavy lifters are a great example of dynamic, and quick power accelerators that use clenching as a way to prepare the internal pressure system before a burst of high energy. A group of athletes that should not utilize clenching during their sport are the endurance runners. Running is an efficiency sport that depends on the success of breathing patterns and limiting energy leaks. During gait and movement patterns, clenching the teeth in an effort to stabilize your body during each strike is a waste of energy. The best mechanical sprinters have a relaxed jaw and cheeks that you can visually see jiggle with each step even though their legs and arms are pumping at a high velocity. A relaxed and properly functioning jaw will set the theme for the tissue of your neck and shoulders, which allows the torso to properly refuel with air without taking away from your speed or stamina.
Stabilize, Adjust, Stretch
To restore the underlying weaknesses explained above, your doctor may utilize muscle testing techniques, manipulation, or rehabilitation exercises. Certain screening techniques like SFMA and FMS are wonderful baseline tests to display dysfunctional patterns which will create a direction for your treatment plan (5).
An activator is just one of the manual interventions that can be used to adjust the jaw. It is a noninvasive hand-held device that delivers a spring-loaded impulse on the jaw to correct bony restriction, allowing the mandible to withstand and safely distribute the stress created by athletic participation. Spinal and extremity misalignments create unbalanced forces pulling on the soft-tissue attached to the jaw. Muscular imbalances between your left and right chewing muscles can lead to deviations in the jaw. If the left side is too tight, it will pull the jaw to the left during opening and closing motions. Or if the right sided muscles are too weak they cannot counteract the powerful left sided facial muscles. This uneven push and pull of jaw muscles will eventually lead to pain, uneven teeth wear, and asymmetric use of neck/shoulder muscles. If this is the true cause of jaw pain, releasing the tight tissue with stretching techniques or dry needling should fix the problem quickly. Discovering why the muscles are overactive on one side yet non-responsive on the other is a harder puzzle to understand. That is when muscle testing techniques and neurological scans are necessary to diagnose the mechanism of dysfunction.
Breathing Approach
Another way to decrease the workload placed on this tender area is to alter our daily breathing habits. While sitting there and reading this article, take a big breath in….. What lifted up from the increased expansion of air, your shoulders or your belly? For most of us, the upper ribs and shoulder region is altered during each breath. Multiply that muscle contraction by the on average 23,000 breaths a human takes in a day and imagine the strain placed on this region. Even more so during increased respiratory rates of exercise! By retraining the body to use diaphragmatic breathing, the diaphragm can become the primary respiratory and stabilizing muscle, decreasing the need to clench. This will then restore tone of the small and accessory respiration muscles, reducing pain around the jaw. (Img. 6)
Heal at Home
There are many manual therapists capable of relieving this type of movement disorder but many people like to do some “homework” in addition to professional care. Some yoga poses that I like to recommend for the jaw include lion pose, upward facing dog and camel pose to open the front line of muscles that attach to the jaw. Then using forward fold and downward facing dog poses along with “yes” and “no” head motions will loosen the tight muscles of the neck and shoulders (Shown in photo).
Unfortunately, what exercises work for one person may not work for another so a foolproof way to decrease pain of the jaw while your healthcare provider is working towards improving jaw function is to learn the resting position. With three cues, I can guarantee that you will not possibly be able to clench your teeth. Ready?
Step 1: Slightly open your jaw so the teeth separate and are not touching.
Step 2: Touch the tip of your tongue to the front root of your palate.
Step 3: Close the lips together and seal the deal.
In this position you can relax the tight muscles of your cheeks and mouth, take the pressure off the teeth, and allow the tone of neck muscles to restore.
Reminders During The Day
As you’ve read, there are both physical and emotional causes to jaw dysfunction and both must be addressed to prevent permanent damage. Learning what triggers or postural positions throughout the day are causing you to clench will help you to avoid future stressors and identify the areas of life that provoke anxiety. I have my patients use sticky notes in an obvious area or set a reminder on their phone to display a message every 30 minutes that says, “clenching?” This is one of many tricks to helping you become consciously aware of a clenching problem. This daily awareness will give you the ability to prevent future episodes of pain. Only when you can alter the behavior consciously, can the subconscious clenching be restored. By relieving the emotional triggers that lead to neck and jaw tension, your doctor has a fighting chance to make permanent adjustments to the body’s functional balance to restore daily movements and athletic performance.
Resources:
Ella, Bruno & Ghorayeb, Imad & Burbaud, Pierre & Guehl, Dominique. Bruxism in Movement Disorders: A Comprehensive Review. Journal of Prosthodontics. April 2016. 10.1111/jopr.12479. Web accessed January 2018.
Schamberger, Wolf. The Malalignment Syndrome, diagnosis and treating a common cause of acute and chronic pelvic, leg and back pain. Churchill Livingstone Ltd. 2013. Pgs 315-326. Web accessed January 2018.
Myers, Thomas. Anatomy Trains. Churchill Livingstone. New York, NY. 2014. Pgs 184-190. Print.
Hawkins, David. Letting Go: The Pathway of Surrender. Hay House, Inc. Carlsbad, CA. 2012. Pgs 15-35. Print.
Cook, Gray. Movement: Functional Movement System. On Target Publications. Aptos, CA. 2010. Print
Images:
Main Photo. Purchased via getty images. January 2018.