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TriggerPointTherapy

RoutineforTMJ

MassageTechniquestoUnlockYourTMJ

AnnieCoomesLMT,CST

IllustratedbyChristineKenneyMScBMC

Copyright©2017AnnieCoomesLMT,CST.

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Preface

Introduction

CONTENTS

TemporomandibularJoint(TMJ)Anatomy

EducateYourself

UnderstandingPain

Mind-BodyConnection

MassageTechniques

MassageTechniquesforMasseter

MassageTechniquesforTemporalisMuscle

MassageTechniquesforMedialPterygoid

MassageTechniquesforLateralPterygoid

MassageTechniquesforDigastricMuscles

Glossary

Resources

AbouttheAuthor

Formyclientsthroughtheyearswhohavetrustedtheinherentwisdom

inthebody,yourtrusthasdeeplytouchedmysoulandreinforcedmy

passionforthiswork,andyouhavebeenmygreatestteachers.

PREFACE

Thisbookhascomeintobeingthroughtherequestsofmyclientsthroughthe

years.Theyhaveseenthebenefitsofthisroutine.Theyhavebroughtintheir

childrenwhenthedentistwastalkingaboutbracesorremovingteethtomake

room.Thisroutine,alongwithcraniosacraltherapy,openedupandrealignedthe

musclesandbonessosomechildrendidnothavetogothroughtheeventof

wearingbraces.

Thisroutinehasmanyapplications.Whobenefits?

• Thoseseekingreliefafterdentalandorthodonticvisits

• Childrenandadultsthatgrindorclenchtheirteeth

• Childrenandteenswearingbraces,theroutinecanhelpbetweendental

visitstorelievetension

• Thosewhohaveringingintheearsandsinusproblems

• Sleepapneapatientsanddenturewearers

• Headachesandmigraines

• Facialnervepainandticks

Atonetimeoranother,allmyclientshaveexperiencedthisroutine.

There will always be a need for temporomandibular joint (TMJ) work. The constantuseofthejawwhentalkingandchewingalonewillreinforcetheneed forthisroutine.Ithinkthemostimportantopportunityistoworkwithour childrenandteachthemthisroutineisoftheutmostimportance.Wecanstartto educatethemontakingcareoftheirbodiesandseehowmuchbettertheycan feelwithpreventativetherapy.

Wecanstartbymassagingourbabiesandhelpingtoreducethetensionand stress from birth. Massage strengthens bonding, sensory development in the nervoussystemandcommunicationwithbaby.Howwonderfultohavemassage fromsuchanearlyage.Asourchildrengrow,theywilllearnthepoweroftouch

andthehealingcapabilitiesithasforourmentalemotionalandphysicalwell-

being.Andhopefullytheywillpassonthishealingtouchtotheirchildren.

INTRODUCTION

Welcome to the world of massage therapy and bodywork, an alternative treatmentthatbringssupportandchangetoyourphysical,mental,andemotional well-being.Massagehasbecomeanalternativetounexplainedpain,discomfort, and tension deep in the body. The bodywork community and other healing disciplinesrecognizethebody’sinherenthealingpotential.

Ourhealingwisdomcomesfromdeepwithinand,giventheopportunity,has

proventimeandtimeagaintheinformationthatthelayersofanatomyhold.This

isanexcellenttimetohealthebody,unresolvedtraumas,andpsychologicaland

spiritualblocksthathaveoccurredinourlives.

Thebodyandmindaredeeplyintertwined.Mygoalinthisbookistodeepen yourunderstandingofthemind-bodyconnectioninregardstoTMJ.Thereare noknowncausesforthisdisorder.Openingyourawarenessandlookingatallthe knowledge that is available with this disorder will help you manage your symptoms.

Weallhavethesameanatomybutareuniqueinhowweexpressourstress,

emotions,andpsyche.Soourleveloftensionandpainmayvaryfrompersonto

person.

Massageisatechniquewhoseeffectsaremeasurable.Ifallowed,resultscan enhanceyourentirebeing.Paintellsastory,andwewilldiscussdifferenttypes ofpainandmodalitiesinmassagetherapythatcanworkforyouathome.My goalwiththisbookistogiveyousomemeasurablemassagetechniques,tohelp you shift your awareness, and to teach you how to manage your symptoms associatedwithTMJ.

Myclientshaveaskedmeovertheyearstoputthisroutineinanunderstandable form so they can prevent further symptoms from recurring, work with their children,relievethetensionandpainassociatedwithwearingbraces,lessenthe tensioninthejaw,drainanesthesiaafterdentalvisits,andreduceheadaches associatedwithTMJ.Mymissionstatementishelpingotherstohelpthemselves!

Sohereitis!Wemadeithappen!Enjoy!

Sohereitis!Wemadeithappen!Enjoy! Articulardisc

Articulardisc

TEMPOROMANDIBULARJOINT

(TMJ)ANATOMY

The temporomandibular joint (TMJ) is made up of the temporal bone, the mandible/jawbone,andthearticulardiscthatisattachedtotheretrodiscaltissue andsandwichedbetweentwosynovialmembranes.Synovialmembranesarelike waterbeds.Theylinejointsandtendonsheaths.Movementoccursinasmooth fluidmotionwhenthemembraneisintact.

Thetemporalboneiswhereyourinnerearislocated.Justforwardoftheearis themandibularfossa/indentationthatholdsthecondyles,theroundedendsofthe mandible. 1 Ligamentsholdthebonestogether.Theyaretensilestrongandnot elastic, 2 sothesefibersdonotgeneratepain.Thearticulardiscisattachedtothe posteriorcondyle,whichcarriesthediscwithitwhenopeningandclosingthe mouth. 3

Discdisplacementoccurswhenthediscbecomeslodgedforwardofthecondyle andcannotreestablishtheconnectionwiththedisc.Poppingandclickingsounds areassociatedwithdiscdisplacement.Dentalsplintsareusuallyfittedforthis condition.However,musclesplayahugeroleinmisalignmentduetotension andtriggerpointsinthemuscles. 4

Thearticulardiscismadeupofcollagenfibersbutisnotsuppliedwithblood vesselsoranervesupply.Sopainisnotgeneratedfromthedisc.However,the retrodiscaltissuethatthediscisattachedtobecomescompressedbetweenthe bones after disc displacement, and inflammation can occur. This tissue is supplied with blood vessels and nerve endings and fed by the synovial membranes.Whenitbecomesdamaged,itbecomesamajorcontributorofTMJ pain. 5

Keeping it simple, let’s put it together. When the mouth fully opens, the retrodiscaltissuefullylengthens,andthediscandcondylemoveforwardonthe retrodiscaltissue.Inaperfectworld,theyshouldslidebackagainandsitinthe mandibularfossa.Butifthediscbecomesdisplacedintheforwardposition,the

condylewillreturntothejointwithoutthediscandcompresstheretrodiscal

tissuebetweenthetwobones.Overtime,thisirritationtothetissuecancreatea

lotofinflammationandpain.

The next time the mouth opens, the condyle will move forward and try to reconnecttothedisc.Ifthisattemptfails,youwillhearthepoppingandclicking whenthecondyletriestorepositionwiththedisc.Thisrepetitivestrivingto reconnectcreatestriggerpointsinthemuscles,misalignmentofthejaw,disc displacementbyreducingmovementofthecondyle,misalignmentoftheteeth, restrictedmouthopeningandclosing,andgrinding,clenching,andlockjaw. 6

Reliefisontheway.Areyoureadytochangeyoursituation?

EDUCATEYOURSELF

Knowledgeispower.Themoreyouknow,theeasieritistogettotherootofthe

problem.IhavebeengratefultimeandtimeagainfortheknowledgeIhave

gainedbybecomingamassagetherapist.Anatomyisconcrete.Youcanfeelit,

touchit,andmanipulateit.

Thisquickreferenceguidewillhelpyoutoevaluateyourpain.Youwilllearn

• thebasicanatomyoftheTMJ;

• thefivemusclesofmastication/chewing;

• thetriggerpointsandtheirreferralpainpatternsspecifictoeachmuscle;

• massagetechniquestoreleasetensioninthemuscles;

• whichmusclescontributetoclenching,grinding,lockjaw,popping,and

clicking;and

• whichmusclescontributetodiscdisplacementandmisalignment.

Yourworkingknowledgeofthisroutineincreasesyourconversationalskillswith

otherpractitionersandempowersyouinyourquestforpainrelief.Usingthis

routinebetweenvisitswithotherpractitionersenhancesthehealingprocess.Let

yourdentist,orthodontist,massagetherapist,cranialsacraltherapist,andother

health-careprovidersknowyouareworkingwiththisroutine.

Learninghowtoapplymassagetechniquescorrectlywilleffectivelyreduceyour painandsymptomsassociatedwithTMJ.Withrepetition,youwilldevelopa sensitivitytoyourtouch.Youwilllearntoadjustyourpressurewhencontacting tissues.Workgentlyandslowlyinsteadofforcingyourwaythroughthetissues togetresults.Thiswillhelptoeliminatepainandalignmentissues.Working slowly allows you to evaluate tissues for knots, taut bands, and inflammation/fullnessinthearea.Ifyoupushtoohard,youwillelicitaguarding responseinthetissues.Musclesbecometighter,bloodflowdecreases,andyour painlevelwillgoup.Sobackout.Waitforthetissuestosoftenandrelax.Weall havethesameanatomy,buthowoursymptomsarisedependsonourpastand

presentphysical,emotional,andmentalexperiences.Weareuniqueinourown

way!

UNDERSTANDINGPAIN

Paintellsastory.Muscleachesandpainaretwoofthetopcomplaintsofpeople seekinghelpfrommassagetherapy.Let’slookatthisabitfurther.Didthepain comeonsuddenlyorgraduallyovertime,reducingyouractivitylevelandrange of motion? Did a certain event or lifestyle change upset your mental or emotionalstate,anddidyouhavetroublebouncingback?Howdoyouhandle stress?

Painisdescribedasacuteorchronicinmassagetherapy.Acutepainissharpand severeandcomesonsuddenly.Symptomsincludeheat,redness,swelling,and inflammation.Consultyourhealthcareprovider,anddonotworkintheseareas ifyouareexperiencinganyofthesesymptoms.Themodalitycommonlyused foracutepaininmassagetherapyisice.Icannotsayenoughabouticeinthe first twenty-four to forty-eight hours after an injury. It helps to reduce inflammationdramatically.Afteraninjury,useiceeveryhouronthehourforthe firsteighttotwelvehours.Thedecreaseinpaincanbedramatic.Theacronym RICE(rest,ice,compress,andelevatetheinjuredarea)isbasicinjuryfirstaid.

Chronic pain is pain and inflammation in the soft tissues of the body. This includes muscles, ligaments, tendons, and fascia. Fascia covers every organ, muscle,bloodvessel,nerve,andboneinthebody.Itisavascular,meaningithas lowbloodsupplybutishighlynerveinnervated.Myofascialpainisoneofthe majorcausesofunexplainedpaininthebody.Ifaninjuryisnotthecauseof pain,theunderlyingchronicissuesthathavebeenweakeninganareaovertime rise to the occasion, eliciting an acute pain response. The body asks for immediate attention. Ice an area if it is sore. If you experience stiffness, alternatingiceandheatwillreduceanyinflammationandincreasetheblood flow.Alternatingthiscombinationcanhelptoincreasethehealingprocessinthe tissues.Consultyourdoctorbeforeapplication.

Educate yourself about fascia. The medical community is starting to acknowledge this amazing tissue and how it affects chronic pain. Some practitionersarespecificallytrainedinmyofascialreleasetechniquesandwould

appreciatesomeonedoingthistriggerpointtherapyself-careroutinebetween

visits.

Nutrition,hydration,andhealthoftheguthavebeenhelpfulinreducingchronic pain symptoms, decreasing stress levels, and improving the health of the immunesysteminmyclients. 7 Ihavewitnessedanimprovementaftertheyhave incorporatedthesechanges.

Anexcellentwaytolowerstresslevelsandrelaxthebodyisthroughbreathing techniques.Theyaresimple,inexpensive,andeffectiveandcanbedonearound any person, place, or thing that upsets you. Breathing techniques help the nervoussystemtolowerthecomplexstress(inflammation)responseinthebody. Asyoupractice,thebodywillbegintoentraintotheeffectsandstartbreathing foryouwhenyoucomeunderstress.Itisamazingtoexperienceyourbody talkingtoyou.

Giveitatry!Startinhalingandexhalingthroughyournose.Focusinward,and

followyourbreathforafewminutes.Ifyourmindwandersoff,bringitbackto

yourbreathingandcontinue.Themindwillreallytrytosabotageyou,sokeep

workingwiththecycle.Breathe,refocus,andbreathe.Builduptofiveminutes.

Afterfiveminutes,youshouldfeelmoreopenandrelaxed.Keepthebreathing

going,andseeifyoucandeepenthecyclesintotheabdomen.Repeatforanother

fiveminutes,breathingslowlyandevenly.

Myclientshavedoneverywellwithusingbreathingtechniquestomanagepain

levels.Ifyouexperiencealotofnegativethoughts,thiswillhelprewireyour

brain.

Witheachnegativethought,startthebreathing,refocusing,andbreathingcycle.

Deepenthebreathingintotheabdomen,andaffirmthatyouwanttoreleasethe

patterninyouthatcausesthisnegativethoughtprocess.

Thebodyknowshowtohealitself.Sowithafewsimpletechniques,youcan start to have a conversation with your body and shift your awareness. The physiologicalbenefitsareprettyamazing.Provetoyourselfthatyoucancontrol yourstressandreduceyourpain.

Youcandealwithphysicaltraumainthesameway.Usebasicfirstaidfor

injuries,andincludethebreathingtechniquestointegratethephysicalforces

trappedinthetissuesbyatrauma.Youcandealwithemotionalandmental

traumasthesameway.Breathingtechniquescanhelpthenervoussystemto

relaxandintegratethepsychologicalissuessotheydonotstaytrappedinthe

tissues.

Inotherwords,youwillreducethefight-or-flightresponseandfreezeresponse

inthetissues.Don’tbeafraidtofindahealth-careprofessionaltohelpyouwith

theseissues.Overwhelmingsituationsneedsupportfromsomeonewhocanhold

thespaceforyoutoheal.Claritywillcomewithsupport.

Thereliefyoucanfeelwhenyoustopcarryingaroundemotionalandmental

issuescanbelife-changing.Inmycraniosacraltraining,unresolvedtraumasare

majorcontributorstochronicpain.

MIND-BODYCONNECTION

Massagetherapyrecognizesthedirectmind-bodyconnection.Inworkingwith people who have chronic pain over the years, I’ve found clients show improvementwhentheyareabletoconnecttounresolvedtraumastrappedinthe tissues.Inmassagetherapy,wecallthisemotionalmapping.Frombirth,we storeourexperiencesinthetissuesofthebody.Thecompressionsfrombirth,if not resolved, organize around this chaos and shape our physical, emotional, psychological, and social states structurally in the tissues of the body. The relationshipswithourparentsandcaretakers,alongwithourreactionstoour environments,becomewiredinournervoussystemsandcanstaywithusinto adulthood.Itsoundsgrim,butonceyouthinkaboutwhyyoureacttocertain peopleorsituationsandwonderwhyyoujustdidorsaidsomethingsooff-kilter, youcantakeastepbackandworkwiththisfreshparadigm.Tissuememorycan bereleased.Body-centeredtherapiesareexcellentformakingthisconnection. 8

Asbabies,weareworkingfromthereptilianbrain,whichreactstoourworld.

Weneedthesafetyandencouragementofourfamiliestobuildastrongsenseof

selfandtofeelsafeinourenvironment.Welookintotheeyesofourparentsfor

reassuranceandtheirresponsestoourneeds.Iftheyareangryand/ordepressed

anddon’tfeedorchangeuswhenweneedsomething,ournervoussystems

respondwithfight-or-flight/freezeresponse.Thosearetheonlyresourceswe

haveasinfants.Sinceouranalyticalbrainisn’tdeveloped,wemustprocess

everythingfromthereptilianbrain.

Stop and think about that. How would your life present itself if you were constantlyreactingtoyourenvironment?Haveyoueveraskedyourself,What wasIthinking?afteraconfrontationorconversation?Aswegetolder,ourstress levelsmimicthoseearlytimes.Sobeingawareofyourreactiontodifferent situationsandpeoplecanhelpyoutointegratethoseoldstimuli.

Thebirthingprocessphysicallytrapsalotofcompressedenergyandfreezesitin

layersoftissue.Themandible,forinstance,takesonalotofdraggingforces

duringthebirthprocess.Wecarrythatphysicalstressfortherestofourlives.As

wegrowolder,westarttodevelopourspeechandbegintocommunicate.What happenswhenourcaregiversandparentstellusthatwearetobeseenandnot heard? 9 Well,thoselooks,statements,andjudgmentsarestoreddeeplyinthe nervoussystemontheirwayintothesubconsciousmind.

Sohowdowerecognizethoseunresolvedtraumas?Thislistcomesfrommy yearsofexperienceworkingwithbirthtraumaandTMJ.Emotionsdrivepain levels. 10 Soasyouareworkingwiththisroutine,allowyourselftoletgo!Quiet yourmind,andallowthetissuestotalktoyou.Youmightbesurprisedwith whatyoufind.

Howdowerecognizethiscomplexity?

Guardingourselvesshowsafight-or-flightresponseinthenervoussystem,so we grind, clench, overreact with anger and frustration, tense up, or become anxious.Oriftherewereabuse,weshutdownandslitheraway,frozeninthe hopelessnessoftheexperience.Hereareafewguidelinestohelpyourecognize unresolvedissuestrappedinthenervoussystem. 11

Sympatheticagitationfeelslikethis:

• Youhavetroublesleepingorgrindyourteethwhileyouareasleep.

• Youhaverestlessness.

• Youhavemuscletension.

• Yougrindorclenchyourteeth.

• Youhavearapidheartbeat.

• Youhaveanattractiontodangeroussituations.

• Youhaveangerorfrustration.

• Youarequicktoreact(short-tempered).

• Youhavefeelingsoffearfulnessorparanoia.

Parasympatheticshutdownfeelslikethis:

• Youarespacey,unfocused,orforgetful.

• Youfeelhelplessnessorhopelessness.

• Yourdigestionisslow.

• Youaredepressed.

• Youarelistless.

• Youhavechronicfatigue.

Takeyourtimetofocusinward.Stopwhatyouaredoingandrefocus.Give yourself five minutes with breathing to shift the physiological reaction happeninginthebody.Letitgo!Getbusydoingsomethingelse.Thiswillallow the brain to let go of the old pattern and rewire a new one. Body-centered meditation,yoga,andbreathingexercisesareafewsuggestionstohelpintegrate andmanagestress.

Youmightneedthehelpofaprofessionaltoholdspaceforyou.Onceyou understand and can relax into the process, it’s easier to do on your own. I encourage you to seek a safe, supportive health care professional who understandstraumaandcanhelpyouallowthesefeelingstoemerge,integrate, andheal.

Empoweryourself.Livethelifeyoudesire.

MASSAGETECHNIQUES

Triggerpointtherapyisamassagetechniquethatinvolvestheapplicationof ischemicpressuretotendermuscletissueinordertorelievepaininotherpartsof the body. It may also be called myofascial (myo, meaning muscle, fascial meaningconnectivetissue).Bothmusclesandfasciacanhavetriggerpoints. Thetriggerpointtechniquecanreleasebothtissues.

Myofascialreleaseisatechniquethatreleasesfasciaandyouwilllearnsimple

techniquesinthisroutine.

Fasciahasthreelayers.

Superficiallayerisassociatedwiththeskin.

Deeplayersareassociatedwithmuscles,bones,nervesandbloodvessels.

Viscerallayerwhichcoverstheorgansandholdstheminplace.

You will be working with the superficial layers to start. As you repeat the routine,thebodywillletyouintothedeeperlayers.

This is a non-force technique. Feel for a tight area in the muscle you are working,stretchtheskinslightly,andwaitpatientlyforsignsofrelease.(The tissueundertheskinwillmoveunderyourstretch.)Followthemovementofthe releaseinwhateverdirectionittakesyou,untilthemovementstops.Repeatif youfeeltension.Triggerpointanyknots,tenderspots,and/ortautbands.Usethe triggerpointillustrationsasyourguide.

Onceyougetafeelforthistechnique,youcanuseitalloverthebody.

Skinrollingisliftingtheskinandrollingitbetweentwofingers.

Strippingisslidingfingersinthedirectionofthemusclefiberstoincreasefresh

circulationtoanarea.Thiswillgiveyouachancetolocatetriggerpoints,knots,

andtautbands.

Signsofreleasearewhenthetriggerpointsstarttoreleaseandthemusclesrelax.

Youwillfeeldifferentsensationsthatincludewarming,softening,lengthening, widening, tingling, and feeling of spaciousness. Signs of release for fascia include a softening, gliding movement under your fingers, warming, and tingling.Releasescanbefeltalloverthebody,regardlessofwhereyouare working.

Ischemiccompressionisthetermusedtodescribetheapplicationofpressureto

atriggerpoint.Useyourfingertiporacottonswabtolocateandapplypressure

toahypersensitiveareainthemuscle.Theillustrationsshowspecificlocations

inthemuscles.

Muscle

Function

CauseandEffectof

ActiveTriggerPoints

Masseter

Closingthejaw

Grinding

Biting

Clenching

Chewing

Restrictingopening

Sinusitis

Toothhypersensitivity(too

hotorcold)

Stuffinessinear

Itchingintheear

Head-forwardposture

Whiplash

Dentalwork

Tinnitus 12

Temporalis

ClosingthejawRetrusionof

Restrictingtheopeningof

mandible

themouth

Chewing

Toothsensitivity

Malocclusion

Clenching

Grinding

Gumchewing

Thumbsuckingafter

   

infancy

Dentalwork 13

Digastric

Openingjaw

Mouthbreathing Grinding Clenching Difficultyswallowing Tendernessinthroat, tongue,andpalate 14

Retrusionofmandible

Medial

Closingthejaw

Restrictingtheopeningof themouth PreventingtheEustachian tubefromopening Grinding Clenching Suckingthumbafter infancy Chewinggum Emotionalstress Prolongedopeningofthe mouthduringdentalwork Painbitingdown Paininthroat Swallowing 15

Pterygoid

Assistinginchewing

Lateral

Openingthejaw

Number-onesourceofpain

Pterygoid

Pullingmandibleoutofthejoint,

inTMJ

movingthejawfromsidetoside

Lockingofthejaw

Discdisplacement

Malocclusion

Popping

Clicking

Mouthbreathing

Sinusitis

Prolongeddentalwork Painbitingdown 1 6
Prolongeddentalwork Painbitingdown 1 6

Prolongeddentalwork Painbitingdown 16

Prolongeddentalwork Painbitingdown 1 6 MasseterMuscle Action:closesthejaw,assistsinchewingandbitingdown.

MasseterMuscle

Action:closesthejaw,assistsinchewingandbitingdown.

Dysfunction:grinding,clenching,sinusitis,toothsensitivity,itching,stuffiness,

tinnitusintheear.

tinnitusintheear. MasseterTriggerPoints • Stripmuscle • Triggerpoint

MasseterTriggerPoints

• Stripmuscle

• Triggerpoint

NOTES

MASSAGETECHNIQUESFOR

MASSETER

Warmupmusclesusingskinrollingandstrippingbeforedoingtriggerpoints.

Masseter—Large

• Skinrolling:Useonefingerontheinsideofthecheekandtheotheronthe

outside.Pinchandrollbetweenfingers.Workfromtoptobottomandside

toside.

• Stripping.Thistechniqueisaglidingmotionusingyourthumb,knuckle, or fingertips. Follow the direction of the muscle fibers. Start at the mandible, and work toward the cheekbone. The illustrations show the fibersofthemusclesnicely.

• Findthetriggerpointsintheillustration,andthemosttenderspotiswhere

youwillstart.

• Holdtriggerpointsforonetofiveminutes.WhenIworkatriggerpoint,I

waitforthepulsingtostartandstop.Thisresetsthemusclelength,andthe

resultsaremorecomplete.Signsofreleasewillfeelspacious,likethereis

moreroominyourmouth,warmth,tingling.

• Workonthenexttriggerpoint.Repeatuntilalltriggerpointsarereleased.

Iftender,onlyworkasmanytriggerpointsascomfortable.Resultswill

comeintime.

• Strippingaftertriggerpointswillhelpremovetoxins.Relax!

Masseter—Small

Thesmallmasseterisdirectlyinfrontoftheear.

• Skinrolling:Thesmallmassetercanfeelashardasaboneandbevery tender.Soyoumightwanttofindthetriggerpointfirstandthendothe massage techniques. Use your common sense here! Try both ways of releasingthemuscle,andseewhatyourbodylikesbest.

• Stripping: at an angle. Illustration shows fiber direction. Cross fiber friction.Workagainstthegrainovertheropeyedgeofthemuscle.

• Triggerpoint:foronetofiveminutesoruntilpulsingstartsandstops.Wait

forsignsofrelease.

forsignsofrelease. TemporalisMuscle

TemporalisMuscle

Action:closesthejaw,assistsinchewingandinbiting,andretrusion(backward)

movementofmandible.

Dysfunction:toothsensitivity,clenching,grinding,malocclusion,andrestricting

ofthemouthopening.

ofthemouthopening. TemporalisTriggerPoints • Myofascialrelease •

TemporalisTriggerPoints

• Myofascialrelease

• Stripmuscle

• Triggerpoint

NOTES

MASSAGETECHNIQUESFOR

TEMPORALISMUSCLE

Locatethetemporalistendon.Slowlystartopeningandclosingthejawwith

smallmovements,fingersaboveyourcheekbone,justoverthetmj.Youwillfeel

itmovingunderyourfingerswhenyouopenandclosethejaw.Onceyouhave

foundthetendon,useyourfingertipstotractiontheskinandtendonupwardand

hold.Waitforsignsofrelease.

Option:Thismoveisgreatifyouplaceyourelbowsonthetableandletthe

weightofyourheadhangfromyourfingertipswhileholdingtheupwardtraction

onthetendon.Repeatforthemuscle(nexttechnique).

Tractionthemuscle:spreadingallyourfingerswideacrosstheentiremuscle,

abovetheear.Tractionthemuscleupwards,andholdforsignsofrelease.

Tractionthescalp:placefingersasclosetoyourscalpandgentlytractionthe roots of your hair outwards. Loosens fascia on the cranium (myofascial technique).Waitforsignsofrelease.

Stripping:temporalishasthreedifferentfiberdirections.(Seeillustration.)Strip

inthefiberdirection.Feelfortautband,knots,ortenderspots.

TriggerPoint

Triggerpointmuscle.Holdforonetofiveminutesoruntilpulsingstartsand

stops.Waitforsignsofrelease.

MedialPterygoidMuscle Action:aidsinchewingandhelpstoclosethejaw

MedialPterygoidMuscle

Action:aidsinchewingandhelpstoclosethejaw

Dysfunction:grinding,clenching,restrictingoftheopeningofthemouthafter

dentalvisits,andpaininthroat

MedialPterygoidTriggerPoints • Triggerpoint • Stripmusclebehindmolarstocornerofjaw.

MedialPterygoidTriggerPoints

• Triggerpoint

• Stripmusclebehindmolarstocornerofjaw.

NOTES

MASSAGETECHNIQUESFOR

MEDIALPTERYGOID

Guideyourfingeralongthebottomofyourupperteeth,pastyourlastmolar,

untilyoufeelaverticalband.Themusclerunsbehindtheupperteethtothe

insidecornerofthemandible.

Withjawandtonguerelaxed,striptheverticalbandfromtheupperteethdown

tothebottomteethwitha“C”motion.Thismusclefeelshardlikeaboneiftight.

Triggerpoint.Repeatthreetimesifnottootender.

Lyingdowncanhelpwiththegagreflexanddrooling.

Externalattachmentisunderthecornerofjaw.Musclewillfeellikeaknot.

Caution!Thecarotidarteryisbehindthecornerofthemandible.Youwillfeela

pulseinthisarea.Donotpressonthepulse.Workaroundit,notonit.

Skinrolling:gentlyworkthesideofyourfingerunderthemandible.Startatthe

chin,andworkbacktothecornerofthemandibleandaroundcornerofthejaw

uptotheear.Gentlyrollyourfingerintoandawayfromthejawbone.Thisisa

smallmove.Workaroundthecornerandupthebackofthemandiblegently.

Alwayscheckforthepulseofthecarotidartery.

Triggerpoint:Hookyourthumborfingerupunderthecornerofthemandible

andgentlyworkthemusclenexttotheboneuntilyoufindthetriggerpoint.

Holdthepoint,waitforsignsofrelease,andrelax!

LateralPterygoid Action:openingthemouth,movingthemandibleforwardandoutofthejoint, andmovingthejawfromsidetoside.

LateralPterygoid

Action:openingthemouth,movingthemandibleforwardandoutofthejoint,

andmovingthejawfromsidetoside.

Dysfunction:number-onesourceofpaininTMJ,lockjaw,poppingandclicking sounds, sinusitis, tension after dental visits, malocclusion, trouble breathing throughthenose/mouthbreathing.

LateralPterygoidTriggerPoints • Triggerpoint • Strippingmuscle

LateralPterygoidTriggerPoints

• Triggerpoint

• Strippingmuscle

MASSAGETECHNIQUESFOR

LATERALPTERYGOID

Iencourageyoutofindpatiencewiththesenexttwomuscles.Theycanbe

extremelypainfulwhenyoufirststartthisroutine.

Whenyoufirststarttryingtolocatelateralpterygoid,youwillwonderifyouare

intherightplace,thatis,ifwhatyoupalpateisactuallythemuscleorabone.

Remember,youarenotusedtovisuallyseeingthismuscle,likeyoucaninyour

armorleg.Thereisnoproprioceptionofthismuscletoyourknowledge.By

now,youhavelearnedsomeanatomyandworkedwithothermusclessoyouare

onestepclosertofindingit.

Triggerpointthemusclebeforethestrippingtechnique.

InferiorHead

Guideyourfingerorpinkyfingeralongthegumlineofyourupperteethuntil

youreachthelasttooth/molar.Keepgoinguntilyousinkintoasoftfleshy

hollow.Directyourfingerupwards,andslowlyopenandcloseyourjaw.You

willfeeltheinferiorheadofthelateralpterygoidmovingonthecondyleofthe

mandible.Thismuscleisshortandstrong.Relaxyourtongueandjaw!Thisis

veryimportanttohelpreducepainandrelaxthemuscle.Findtriggerpoint.

Repeat.Waitforpulsingtostartandstopandyoufeelsignsofrelease.

Lyingdowncanhelpwiththegagreflexanddrooling.

Bitedownonyourfingertofeelthetriggerpoint.Useacottonswabifthe

mouthopeningissmall.Locatethetriggerpoint,holduntilpulsingstartsand

stops,andrepeatifyoucantolerate.Waitforsignsofreleaseandrelax!

Strip:themuscleaftertriggerpointtechnique(optional).Thismuscleisvery sore on most people, so very light pressure is all you need. Icing can help afterward.Restandiceforafewdaysifreallysore,beforeandafter.Anice cube in a sandwich baggy works well. As you release the trigger points

completely,painwillsubside,andmovementinthejawwillincrease.

SuperiorHead

Locatinglateralpterygoid:ontheoutsideofyourmouth,placeyourfingersover

theTMJ.Openandclosethemouthtolocatethejoint.(Seetheillustration).

Nowfindthehollowbetweenthecondylesofthemandible(openjaw).Youwill

beabletofeelthemusclemoving.Useafingertipinthishollowwillstripand

triggerpointthelateralsuperiorhead.Triggerpointbothsidesofthemouthto

keepyourbiteeven.

Triggerpoint:Insidethemouth(betweenteethandjaw).Openandclosetofind

thesuperiorhead,justabovewhereyouwereworkingwiththemedialpterygoid.

Rollyourfingertipleftandrighttostrip.

Optional:Useacottonswab,ifnecessary.Ifsore,lightenpressurebutdon’t

moveoffthepoint.Holdthetriggerpointuntilpulsingstartsandstops.Waitfor

signsofrelease.Iceandrestadayortwobetweenroutines.

DigastricMuscle Action: aids in swallowing, opening the jaw, and retrusion of the jaw (backward).

DigastricMuscle

Action: aids in swallowing, opening the jaw, and retrusion of the jaw (backward).

Dysfunction:grinding,clenching,mouthbreathing,andtendernessinthethroat.

DigastricTriggerPoints • Triggerpoint • Stripmusclefromchintoangleofjaw.

DigastricTriggerPoints

• Triggerpoint

• Stripmusclefromchintoangleofjaw.

NOTES

MASSAGETECHNIQUESFOR

DIGASTRICMUSCLES

Theactionofthemuscleissecondarytoothermuscles,butit’sworthaddingto

theroutine.Digastricandstylohyoidhelptostabilizeandlineupthehyoidbone.

Theposteriorbellyattachestothebump(mastoidprocess)behindyourear.The

anteriorattachmentisontheinsideofthechin.Intheillustration,thedigastricis

thewidermuscle.Thethinnermuscleisthestylohyoidmuscle.Thesemuscles

helpmakeupthefloorofthemouth.

CAUTION!Gentlypressinthishollow.Aslightwideningisallyouaretryingto

accomplish.Deeppressurecanirritateanerve.

Massageunderthechinandtriggerpoint,theanteriorbellies.

Usingstripping,feelforthegroovebetweenthemastoidprocessandtheear.Itis

averysmallspace,justperfectforyourfingertip.Gentlymoveyourjawforward

andbackwardwithsmallmovementstofindthemuscle.Onceyouhavefoundit,

startslowlyandlightlytorotateyourfingertipinthatgroove.Ifitistender,

lightenyourpressure.Waitforsignsofrelease.

Caution! There is a boney attachment(point) that the stylohyoid attaches to. Lightpressureisallthatisneededhere.Iftender,uselightpressure,alittlework willgoalongway.Youwon’ttriggerpointtheposteriorbelly.

Usestrippingunderthechin.Theanteriorbellieshaveatriggerpoint.Startby

strokingyourfingersfromthechintotheAdam’sapple.Seeifyoucanfeelthe

hyoidbonebetweenthesetwopoints.Ifnot,thatisokay.Thetwomusclebellies

willfeelropey.

Triggerpointtheanteriormusclebelliesunderthechin.Waitforsignsofrelease.

Relax!

GLOSSARY

Anterior:Thisislocatedtowardthefrontofthebody.

Articulardisc:Thisconnectivetissuediscactsasacushionbetweenthetwo

bones.It’scollagentissuewithnobloodornervesupply.Itdoesnotproduce

pain.

Attachment:thepointwheremusclesortendonsattachtoabone.

Bilateral:Thismeanstwomuscles,oneoneachsideofthebody.

Digastric:Thisisasuprahyoidmusclethatmakesupthefloorofthemouthand

assistsinopeningthejawandswallowing.

Discdisplacement:Thisisforwarddislocationofthearticulardisc.Thedisc

locksforwardontheretrodiscaltissueanddoesn’treturntoitsoriginalposition

betweenthetwobones.Thejawlocksandclickswhenopening.

External:Thesearemusclesontheoutsideofthehead.

Fascia:Thesebandsoftissueundertheskininterconnectalltissues,muscles,

bones,organs,andnerves.

Internal:Thesemusclesareontheinsideofthemouth.

Ischemiccompression:pressureappliedtoatenderspotinamuscle,forcingthe

bloodoutofthearea.Whenreleasedanewsurgeoffreshoxygenatedblood

floodsintoanarea.Relievesreferralpainandlocalpaininmusclesandfascia.

Lateral pterygoid: This muscle assists in closing the jaw, pulling the disc forward,andfacilitatingtherotarymotionofchewing.

Malocclusion:Thisismisalignmentoftheteeth,thatis,teethnotfittingtogether

correctly.

Mandible:Thisisthejawbone.

Masseter:Thismuscleclosesthemouthandassistsinbitingandclampingdown

withtheteeth.

Mastication:Thismeanschewing.

Maxilla: These two bones in the mouth hold the upper teeth and maxillary sinuses.Theymeetwiththepalateandsphenoidboneandareusedasaguidefor theinternalmuscles.

Massagetechniques:Thesearetechniquesappliedwithyourhandsorfingersto

releasemusclesandfasciainthebody.Includedinthisbookwillbeskinrolling,

stripping,andtriggerpoints.

Medialpterygoid:Thisinternalmuscleassistsinchewingmotionandclosing

andprotrudingofthejaw(e.g.,anunderbite).

Myofascial release: myo(meaning muscle) and fascial meaning connective tissue.Techniquereleasesfasciaandtriggerpoints.

Posterior:Thismeanstowardthebackofthebody.

Protrusion:Thisisforwardmovementofthemandible(e.g.,underbite).

Referralpain:painthatisfeltinanotherareaofthebodyawayfromthetrigger

point(cause).

Retrodiscaltissue:Thisconnectivetissueattachesthedisctothetemporalfossa,

allowingthedisctostretchforwardwhenthemouthopens.Itholdsthediscin

placeasitmovesoverthecondyle.Thistissueissuppliedbybloodandnerves;

therefore,itisamajorsourceofpaininthejoint.

Retrusion:Thisisbackwardmovementofthemandible.

Skin rolling: This myofascial release technique involves lifting the skin and rollingitbetweentwofingers.

Stripping:Thisisamassagetechniquewhereyoustartslidingyourfingersfrom

oneendofthemuscletotheotherinthedirectionofthemusclefibers.(See

illustrationsforfiberdirection.)

Temporalis:Thisisamuscleonthesideoftheheadwheretheactionistoclose

thejaw.

Temporomandibularjoint(TMJ):Thisjointismadeupoftwobonesandadisc

(temporalbone,articulardisc,andcondyleofthemandible).Itisresponsiblefor

movementofthejoint.

Trauma:Thisisaphysicalinjuryoremotional,psychologicaleventthatelicits

anoverwhelmingresponseofshockthatcannotbedischargedfromthenervous

system.Theunresolvedissuesbecometrappedinthetissues,bone,andpsyche.

Triggerpoint:Thisishypersensitivityinthemuscleorfascialtissue.Trigger

pointscanincludeknots,tautbands,andtenderspotsthatreferpaintoother

areasofthebody.

RESOURCES

ChiNeiTsangInstitute.VisceralManipulation.Berkeley,Calif.

Coomes,Annie,LMT.“OhMyAchingBack.”www.cranialsacral.blogspot.com.

Daniluk,Julie,RHN.MealsThatHealInflammation:EmbraceHealthyLiving

andEliminatePain,OneMealataTime.Carlsbad,Calif.:HayHouse,2011.

ClairDaviesandAmberDavies,TheTriggerPointTherapyWorkbook,3 rd ed.

Durana-Scurlock, Suzanne. Full Body Presence: Learning to Listen to Your

Body’sWisdom.Novato,Calif.:NewWorldLibrary,2011.

Gach,ReedMichael. Acupressure’s Potent Points: AGuide to Self-Care for

CommonAilments.NewYork:BantamBooks,1990.

Hay,LouiseL.HealYourBody.Carlsbad,Calif.:HayHouse1982,1984.

Herman,Judith,MD.TraumaandRecovery.NewYork:BasicBooks,1992,

1997.

Kaplan,GaryDr.,DO.TotalRecovery:BreakingtheCycleofChronicPainand

Depression.NewYork:RodaleBooks,2014.

Levine, Peter. Waking the Tiger: Healing Trauma. Berkeley, Calif.: North

AtlanticBooks,1997.

Chia, Mantak, and Juan Li. The Inner Structure of Tai Chi: Mastering the

ClassicFormsofTaiChiChiKung.Rochester,Vt.:DestinyBooks,2005.

Pert,CandaceB.MoleculesofEmotion:WhyYouFeelTheWayYouFeel.New

York:Scribner,1997.

MichaelKern,WisdomintheBody:TheCraniosacralApproachtoEssential

Health(Berkeley,Calif.:NorthAtlanticBooks,2001),237.

LouiseL.Hay,YouCanHealYourLife(Carlsbad,Calif.:HayHouse,1999),

201.

BesselvanderKolk,MD,TheBodyKeepstheScore:Brain,Mind,andBodyin

theHealingofTrauma(NewYork:PenguinGroup,2014),75.

OlmosStevenDDS,FunctionalAnatomyandTMJPathology4

ABOUTTHEAUTHOR

AnnieCoomesisa1992graduateofBallStateUniversitywithabachelor’s

degreeinexercisescience.ShegraduatedfromColoradoInstituteofMassage Therapy(CIMT)inColoradoSpringsandwascertifiedincraniosacraltherapy

inBoulderin2000.

ShelivesandpracticescraniosacraltherapyinColorado.

ENDNOTES

1DavidG.Simons,JanetG.Travell,andLoisS.Simons,MyofascialandDysfunctionUpperExtremities,

vol.1(Philadelphia:WilliamsandWilkins,1982),173.

2StevenR.Olmos,DDS,FunctionalAnatomyandTMPathology,6.

3 David G. Simons, Janet G. Travell, and Lois S. Simons, Myofascial Pain and Dysfunction Upper

Extremities,173.

4 Clair Davies and Amber Davies, The Trigger Point Therapy Workbook, 3 rd ed. (New Harbinger

Publications,2013),81.

5StevenR.Olmos,DDS,FunctionalAnatomyandTMPathology,4.

6ClairDaviesandAmberDavies,TheTriggerPointTherapyWorkbook,3 rd ed.,6.

7Dr.GaryKaplan,DO,TotalRecovery:BreakingtheCycleofChronicPainandDepression(NewYork:

RodaleBooks,2014).

8MichaelKern,WisdomintheBody:TheCraniosacralApproachtoEssentialHealth(Berkeley,Calif.:

NorthAtlanticBooks,2001),237.

9LouiseL.Hay,YouCanHealYourLife(Carlsbad,Calif.:HayHouse,1999),201.

10BesselvanderKolk,MD,TheBodyKeepstheScore:Brain,Mind,andBodyintheHealingofTrauma

(NewYork:PenguinGroup,2014),75.

11PeterLevine,WakingtheTiger:HealingTrauma(Berkeley,Calif.:NorthAtlanticBooks,1997),147–

149.

12ClairDaviesandAmberDavies,TheTriggerPointTherapyWorkbook,3 rd ed.,82–86. 13DavidG.Simons,JanetG.Travell,andLoisS.Simons,MyofascialPainandDysfunction, vol. 1

(Philadelphia:WilliamsandWilkins,1982),223,231,236,252,260,264.

14DavidG.Simons,JanetG.Travell,andLoisS.Simons,MyofascialPainandDysfunction, vol. 1

(Philadelphia:WilliamsandWilkins,1982),223,231,236,252,260,264.

15Ibid.

16ClairDaviesandAmberDavies,TheTriggerPointTherapyWorkbook,3 rd ed.