emporomandibular Joint

Dysfunction
January 21, 2012 neurokinetictherapy

Temporomandibular Joint Dysfunction or TMJD is a

common malady affecting millions throughout the world.
According to statistics most sufferers are women. I believe
the reason for this is, that in many cultures women are
not allowed to express their anger, and as a consequence,
it somatizes in the jaw. We do know that suppressed
anger and stress contribute greatly to TMJD. Most jaw
clenching occurs at night but can also happen on an
unconscious level throughout the day. In my experience,
treatments like EMDR, are very effective for the
psychological aspects of TMJD. The physical causes
include malocclusion, improper orthodontia, cranial
trauma at birth, whiplash, and of course any blows to the
jaw. Standard treatments include night guards, oral
appliances, adjusting tooth height, orthodontia, cranial
osteopathy, physical therapy, and chiropractic. It is my
contention and experience that these treatments would be
more effective if they included a method to make the jaw
muscles less facilitated/reactive to other muscles and
functions throughout the body.
Symptoms of TMJD include jaw pain, headaches
(especially around the eyes), neck pain, and tinnitus
(ringing in the ears). Tinnitus often is caused by a
hyperactive lateral pterygoid muscle which has fibers that
connect to the inner ear. But to treat the jaw as if it
existed without any connection to the rest of the body is
to do it a great injustice. Lets explore some of the basic
and more complex relationships. Mastication is a very
complex movement. It involves movement superiorly,
inferiorly, anteriorly, posteriorly, medially and laterally. All
of these planes of motion affect other muscles throughout
the body creating similar planes of motion. Jaw opening
creates superior, inferior, anterior, and posterior
movement. Chewing adds the medial and lateral
components. I will first address the four major muscles of
mastication: the temporalis, the masseters, the medial

pterygoid, and the lateral pterygoid.

NeuroKinetic Therapy views the jaw muscles as a default
mechanism for overcompensation. In other words, the jaw
muscles can become facilitated for other inhibited muscles
throughout the body. The temporalis muscle can
compensate for muscles along the Front Line, including
the neck flexors, pectorals, abdominals, hip flexors, and
dorsiflexors. Due to its interesting configuration, the
temporalis muscle can also compensate for muscles along
the Back Line. These include the spinal muscles, the
gluteals, the hamstrings, and the plantarflexors. The
masseters, the strongest muscle in the body for its size,
affects the Front Line and Back Line in a similar fashion.
This muscle is capable of medial and lateral translation of
the jaw, creating ipsilateral lateral movement. Thus it can
affect muscles that side bend the neck, side bend the
torso, hip abductors, and the peroneals. Both the medial
and lateral pterygoids create contralateral lateral
movement of the jaw. Therefore they can affect the same
muscles as the masseters, only on the opposite side.
Some good examples of these relationships are as follows.
The temporalis often compensates for inhibited neck
flexors and gluteals. The masseters often inhibit those
same muscles and the hip flexors. The pterygoids often
inhibit the scalenes, the latissimus dorsi, the obliques, the
quadratus lumborum, and the hip abductors. If these
relationships are left unattended the tension in the jaw
muscles increases tremendously resulting in the
aforementioned symptoms. Remember that the tension in
these muscles is a result of a faulty relationship with other
muscles/functions. To simply release these muscles
without first figuring out what they are compensating for,
could result in destabilizing functional integrity. Treat the
cause not the symptoms.
The muscles of the floor of the mouth can also
compensate globally, but I find them most involved in
bracing with the diaphragm and the pelvic floor muscles,
similar to the Valsalva maneuver. This kind of bearing
down is a very common compensation pattern often
involved with emotional issues. When treating the muscles

of the floor of the mouth, it is important to consider the

diaphragm and pelvic floor muscles. Clenching, breath
holding, and anal tightening are common reactions to
stressful situations which can result in developing
dysfunctional movement patterns. These can often be the
missing pieces to solving long-standing puzzles.
Successful treatment of TMJD must include a
consideration of the global relationships between the jaw
muscles and the rest of the body.

The Scalenes, the Dynamic Duo + 1

July 2, 2012 neurokinetictherapy 6 comments

The Scalenes are an important neck muscle comprised of

three parts, the anterior, the middle, and the posterior.
The anterior and the middle will be the subject of this post
because the posterior is mostly involved as a synergist for
the upper trapezius. The brachial plexus passes through
an opening between the anterior and middle scalenes,
making it subject to dysfunction if the scalenes are
hypertonic.

The scalenes are also accessory muscles of respiration and

can cause breathing imbalances if one is a chest breather.
The scalenes are also involved in the kinetic chain of the
arm as well as the front line and lateral line. We will
examine all of these relationships to reveal just how
dynamic these muscles truly are.

In cervical dysfunction the scalenes can be either

facilitated or inhibited. If the sternocleidomastoid muscle
is inhibited, the scalenes may compensate to stabilize
neck flexion. In the case of whiplash, the scalenes may
become inhibited by facilitated neck extensors. I find it
very important to release the scalenes indirectly by
stabilizing the first and second ribs while performing a
myofascial stretch. I have found that working directly on
the scalenes can cause them to rebound and tighten up
even further. To strengthen the scalenes, resist at the
forehead while nodding towards the ipsilateral shoulder.
The scalenes also ipsilaterally flex the neck, and therefore
can become inhibited by either the ipsilateral or
contralateral upper trapezius. The scalenes produce
ipsilateral rotation of the cervical spine, and can become
facilitated by an inhibited contralateral
sternocleidomastoid or an ipsilateral longus colli.

Because the brachial plexus passes through an opening

between the anterior and middle scalenes, hypertonicity,
whether caused by facilitation or inhibition, must be
addressed. The extra pressure on the brachial plexus
caused by hypertonic scalenes can result in Thoracic
Outlet Syndrome. Symptoms include numbness and
tingling in the arms and hands, as well as loss of strength
in both the arms and hands. I have found the scalenes to
be compensating for 13 different functions in the arm line
with someone who had TOS. Reestablishing the proper
relationship between the scalenes and these 13 different
functions was crucial in the resolution of the TOS.

The scalenes are an important part of the front line kinetic

chain. It is not unusual for the scalenes to be facilitated
for an inhibited ipsilateral psoas and adductors. They may
also be facilitated for an inhibited contralateral TFL and
adductors. Even dysfunction of the extensor hallucis
longus can be compensated for by the ipsilateral scalenes.

In the lateral line, the scalenes oftentimes become

facilitated in combination with the peroneals in cases of
over pronation or ankle sprains. The most likely inhibited
muscle in this scenario is the TFL. The scalenes can also
be dynamically involved with the obliques and the
quadratus lumborum.

The scalenes are also accessory muscles of respiration.

They elevate the first and second ribs, and in chest
breathers, they can become,along with the pectoralis
minor, dominant muscles of respiration. In this situation
they can become facilitated for inhibition of the muscles
that depress the rib cage, such as the quadratus
lumborum and the obliques. Resolution of these dynamic
muscular relationships along with restoration of proper
breathing patterns can go a long way to resolving this
issue.
The scalenes are important to consider in cervical
dysfunction, Thoracic Outlet Syndrome, problems with the
arms and hands, dysfunction of the muscles of the front
line, dysfunction of the muscles of the lateral line, and
improper breathing patterns. Remember to treat these
muscles with respect and they will reward you with

outstanding therapeutic outcomes.