In the post we will cover some basic anatomy of the jaw and look at research comparing dry needling against manual therapy for treatment of jaw pain.
The temporomandibular joint (TMJ) is the joint of the jaw. When opening the mouth, the jaw bone which called the mandible slides forwards. There is a disc made of cartilage located inside the joint that helps with the sliding motion.
The main muscles of mastication (chewing) are likewise arguably the most important muscles of the jaw. They are:
temporalis
massater
pterygoids
Pain in the jaw is called TMJ disorder or TMJ dysfunction. It's caused by a range of problems and must be considered case by case.
Causes include:
physical predisposition, such as an over or underbite
psycho-emotional factors
clenching the jaw (bruxism)
chewing gum
neck problems
trauma
age
systemic illness
hormonal factors
The condition is characterised by a range of symptoms including:
pain or tenderness in the jaw
pain around the ear
difficulty or pain when chewing
locking, grinding or clicking of the TMJ
difficulty opening or closing the mouth
In November 2023 a study was published by Menéndez-Torre, et al. that aimed to compare the effectiveness of dry needling against manual therapy for TMJ disorder. They reviewed 8 previous studies and focused on which one provided the most reduction in pain.
They found no significant difference in the amount of pain reduction between manual therapy and dry needling.
From the treatment options assessed they found that manual therapy is the most likely option to produce a reduction in pain & the second most likely is dry needling.
They also found evidence that manual therapy has a greater effect on pain reduction than placebo, botulinium toxin (Botox), and cognitive therapy.
Lastly, they found that dry needling has a greater effect on pain reduction than Botox.
This study compared one treatment option against another. However, for TMJ problems we will commonly do both manual therapy on the neck, shoulders and TMJ as well as dry needling of the TMJ.
There is evidence to support that a combined approach is more effective than just doing one in isolation.
Dunning et al. (2002) examined people with TMJ disorder and found that dry needling and upper neck manipulation was more effective than:
interocclusal splint therapy
diclofenac (anti-inflammatory drugs)
TMJ mobilisation (a type of manual therapy)
The study examined two factors: pain reduction and ability to open mouth pain-free.
An interesting part of this study was that the focus was on manual therapy to the upper neck rather than manual therapy directly to the TMJ. The neck plays a significant role in the function of the jaw and as such, at Prom Health and generally as osteopaths when faced with a jaw problem we tend to treat both the neck and the jaw.
As is standard with most areas of research, more research needed to solidify results.
Nevertheless, manual therapy and dry needling alone or combined appear to be very promising options for TMJ disorders and we can attest to this from our own experience over the last 8+ years working as osteopaths and helping people with TMJ disorders.
So, if you have a jaw problem, whether that be for days, months or years, give us a call and see if we can help you too.
References:
Dunning, J., Butts, R., Bliton, P., Vathrakokoilis, K., Smith, G., Lineberger, C., Eshleman, N., Fernández-de-Las-Peñas, C., & Young, I. A. (2022). Dry needling and upper cervical spinal manipulation in patients with temporomandibular disorder: A multi-center randomized clinical trial. Cranio : the journal of craniomandibular practice, 1–14. Advance online publication. https://doi.org/10.1080/08869634.2022.2062137
Menéndez-Torre, Á., Pintado-Zugasti, A. M., Zaldivar, J. N. C., García-Bermejo, P., Gómez-Costa, D., Molina-Álvarez, M., Arribas-Romano, A., & Fernández-Carnero, J. (2023). Effectiveness of deep dry needling versus manual therapy in the treatment of myofascial temporomandibular disorders: a systematic review and network meta-analysis. Chiropractic & manual therapies, 31(1), 46. https://doi.org/10.1186/s12998-023-00489-x