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Another approach, however, vastly different, is to use medications to calm the pain and at least get some degree of relief almost immediately. In some of these cases, the practitioner would prescribe Cymbalta to alleviate the anxiety often associated with the pain. Cymbalta is a well-known drug used to treat depression and anxiety. Admittedly, many TMD patients are hurting so badly that they become depressed, and anxiety sets in as they worry about how their future is looking. Unfortunately, this drug has a host of side effects that may make it not so worthwhile, but as a temporary measure, it might help for now. Some practitioners use Xanax along with the Cymbalta since it takes time for the Cymbalta to activate the desired response.

In other cases, something like Cymbalta is used in conjunction with injections into the muscles of the head and neck region to calm those muscles that have been irritated from the slipped discs. Injectables like Botox®, cortisone, prolotherapy and stem cell therapy have been documented to reduce muscular tension. This also provides some degree of temporary relief and may even help to ‘reset’ the muscles into a better pattern.

Of course, there are the surgical approach options. The least desired surgical treatment entails breaking the jaws and resetting them into a more ideal position, however, this approach may not work very well. Cutting apart the bones of the skull may be more risky than other modalities. A more conservative approach to dealing with the displaced discs in the jaw sockets entails simply putting the discs back on top of the condyles. A 20-minute surgery called plication. By far, this is more conservative and simpler than the other surgeries.

So as a patient, you have a choice: try to figure out the underlying issues and deal with them accordingly, or mask over the symptoms and hope things settle down. As I tell our people, it is up to you and I am simply here to guide you on the journey.

Read more about TMD.

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In most cases, when the MRI is ordered of the TM joints, it is patently clear when there is cortical erosion of either the condyle or the fossa (socket for the condyle). The radiologist will most likely indicate that the articular disc (that protects the condyle) is displaced and thus the condyle is now exposed and is bone on bone in the fossa. This is not a good situation and can lead to all sorts of pain, asymmetry, and other problems in the head/neck region. Think of it like this: If the disc is slipped off the top of the condyle, it can no longer protect your condyle from banging into the socket bone-on-bone. Diagnosis: OUCH!

The cortical erosion of the condyles and fossas can also be diagnosed with the X-ray called CBCT (Cone-Beam Computed Tomography). The CBCT allows the dentist or the radiologist to look very precisely at the condyle and fossa and if erosion has begun it can be clearly seen in the images. Even though some people do not like taking the CBCT due to the radiation, it is really important to do these images every few years to follow up on the cortical erosions.

So, what does one do when cortical erosions are present? Well, in most cases it’s called ‘watchful waiting’ where the doctor checks the range of motion on a regular basis to make sure the erosions are not doing more obvious damage. You should wear your mouth appliance(s) accordingly to protect the joints. And every few years, just re-take the images and compare them to the previous images.

Unfortunately, if things worsen, surgery is sometimes all that is left to offer to a person with severely damaged joints. There are several types of surgery. The simplest surgery is called plication of the articular discs. This means just moving the slipped discs back into the proper position to reduce the risk of bone-on-bone damage to the condyle and fossa. The next level of surgery entails what is called menisectomy – removal of the damaged discs. If the discs are fully removed, this enhances the risk of bone-on-bone, condyle to fossa, banging or pounding. As long as the appliance (splint) is worn, this is not a problem. Unfortunately, if things get worse, then TJR (Total Joint Replacement) is indicated. This is a big surgery but very rarely indicated.

As with most health issues: Treat early and keep a careful watch on your health!

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Now, let’s explore the implications of exercise and its impact on the effectiveness of TMD treatment. Engaging in activities such as running can subject the neck to significant impact, leading to compression of the spinous processes. Consequently, this compression can adversely affect the temporomandibular (TM) joints. Therefore, it is generally not advisable to engage in running while undergoing TMD treatment. An alternative to running is the use of an elliptical machine. This low-impact device provides an excellent cardiovascular workout without putting strain on the neck. It is crucial to prioritize the well-being of the TM joints and cervical spine during the exercise routine.

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TMJ Disorder and Exercise

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So now let’s discuss the ramifications of exercise and how it can and will affect the outcome of TMD treatment. When a person runs, as you can well imagine, the neck takes a pounding which compresses the spinous processes. This can, and will, in turn affect the TM joints. This is why running during TMD treatment is really not recommended. An alternative to running is the elliptical machine. This is a no impact device that allows for a great cardiovascular workout with no compaction to the neck. You have to keep your mind on improving the health of those joints and cervical spine.

Another aspect of exercise is weightlifting of course. Most people really do not want to hear that they should not be lifting weights during their course of TMD treatment. The reason for this is that when you lift something fairly heavy, this pulls on the neck muscles- the sternocleidomastoids. These muscles connect directly into the jaw joint and will pull on a displaced disc. You can well imagine that is not a good thing. Another factor is that lifting above shoulder level causes the body to pull more on the neck than it should. This can hurt the joints as well. Once again, this type of exercise will compromise your ability to heal.

Now let’s bring up a four-letter word that comes up quite often: GOLF. So here you are newly retired, living in a house at the country club, new to the game, or just looking to a retirement in place where you can play golf every day of the week. Along comes the TMJ specialist who tells you not to play until you are better. You have a choice: Get better or not. One path means that you must take a hiatus from using those amazing Ping custom made clubs and telling your friends about the hole in one you got. The best choice is to sit at home and use the elliptical machine and get better. This problem occurs whether it’s golf, tennis, or pickleball. You must make a choice and live with it for some time.  This is not permanent but when you get back into it, you may find your stroke and strength improved. As you can see, dealing with TMD takes some effort. For some folks it means sacrificing their normal activities so it’s good to understand all this before treatment begins.

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But now let’s be realistic.  If a potential patient reports that they have ‘TMJ,’ they really are just trying to say that their jaw is a problem, and it might need some help. The way to help such a person is to measure how big they can open their mouth, and then palpate the various muscles that attach to the TM joint. This goes a long way in diagnosing the problem. In many cases, it is necessary to further that diagnosis by ordering an MRI to determine what the articular discs are doing in the jaw joints. The articular discs are the cartilage that covers the top of the jaw bones and protects the joints from going bone on bone, which really can hurt badly.

In addition, a specialty X-ray called a CBCT must be done to further determine if the bones of the skull are out of alignment. So first, the MRI, then the CBCT to figure out what is really going on in the joints. At this point, a discussion must be done about how best to treat the problem(s). Each person has unique symptoms and determining the best appliance is critical. Often, wearing an appliance or an appliance for each arch in the mouth works to ‘decompress’ the joints. This is very effective. The appliance(s) must be worn for a year or more in order to be effective. Then a new MRI and X-ray must be done to see if the discs have moved or are moving back where they should be.

Sometimes,  unfortunately, the disc is either damaged or is not moving back. At this point, it may be necessary to do surgery to help move the discs back into place or remove the damaged disc. Other therapy options to help with the symptom management are prolotherapy, BOTOX®, or even stem cell therapy to help. Surgery is always the last-ditch option because it is more invasive than any other choice. It is, however, very effective and can provide much needed relief to that person who has suffered for many years. The other options, often called the ‘injectables’, help to lubricate the joints so the displaced discs have a chance to move back where they need to be. Sometimes this works quite well, other times not so much because they are not actually fixing the underlying problem.

So, if you do indeed have ‘TMJ’ problems then you most likely have other body pain or symptoms as well. The TM joint can be a problem and you will want to fix it. If so, see the right doctor, analyze the problem, and treat this before it becomes more difficult.

The post “I Have TMJ” What Does That Really Mean? first appeared on Sleep & TMJ Therapy.

Many people will find that the turbos do not really slow them down too much when eating, but they do need to eat softer foods than they normally might. In general, if your food is fork tender, then it should be easy enough to eat and swallow. Mastication (chewing) is good for your digestive system and muscles, yet when you have a TMJ problem, it is better to go softer for a while so the joints can heal.

Another frequent topic that arises is what exercise can be done when a person has a TMJ problem. The issue when a person has a slipped articular disc is the disc needs time to heal and try to recapture its proper position in the socket. If you work out too hard at the gym, this oftentimes causes a pull on the neck muscles (sternocleidomastoids). These muscles will pull on the slipped discs and make them worse. This is why a more carefully crafted exercise program for TMD cases has been developed.

One of the most important aspects of exercise for the TMJ patient is to make sure you do not lift above the height of the shoulder. A guide would be to not lift above the arm when it is stretched out horizontally. The reason for this is that the body will tend to ‘detach’ from this motion, and you will lose strength. Example: If you swam the ‘crawl’ as it is called, your arms would go above the shoulders, and you would pull the water toward you. In this action, you will stress the muscles in the neck and inadvertently pull on and potentially damage the discs in the joints. This is why over-the-shoulder lifting must be avoided.

There is a nicely modified program for TMD patients that involves being careful to protect the joints while still getting in a good workout. Some of these exercises involve using the elliptical machine. As an example, the Peloton is a quality elliptical type of workout. It is not recommended to use the treadmill because it is so much like running that the neck gets pounded. This can hurt the discs as well. There are several other modifications of exercise programs, but they need individual attention and modification per patient.

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