Pain in the temporomandibular joint (TMJ) is one of the most common causes of orofacial pain and can manifest itself in various ways: jaw pain, clicking when opening or closing the mouth, difficulty chewing, headaches, neck tension or a feeling of facial fatigue. Although common, it remains a condition that is poorly understood by those who experience it.
It is now known that TMJ problems - often grouped under the term Temporomandibular Disorders (TMD) - are not only the result of local structural changes, but of a complex interaction between muscular, joint, neurological and psychosocial factors. This view is in line with the biopsychosocial model of pain, widely accepted by leading international pain organisations.
What is the TMJ and why does it hurt?
The temporomandibular joint connects the lower jaw (mandible) to the temporal bone of the skull and is involved in essential functions such as speaking, chewing, yawning and swallowing. It is a highly specialised joint that combines rotational and translational movements.
Pain associated with TMJ can have different causes, including:
- chewing muscle overload
- changes in the articular disc
- limitation or alteration of mandibular movement
- sensitisation of the nervous system
- stress factors, sleep and parafunctional habits (such as grinding or clenching the teeth)
There is not always a direct relationship between visible changes in imaging tests and the intensity of pain felt, which reinforces the need for careful and individualised clinical assessment, consistent with current knowledge about musculoskeletal and temporomandibular pain.
TMD: a multifactorial condition
Current scientific evidence describes TMD as a multifactorial condition, where biological, psychological, and social factors are intertwined. This framework is aligned with the biopsychosocial model of pain.
People with TMD often have an association with:
- headaches, including migraine
- neck pain and shoulder tension
- sleep disturbances
- high levels of stress
- other conditions of persistent pain
This pattern suggests that the TMJ should not be assessed in isolation, but integrated into the overall functioning of the person.
Assessment and approach in physiotherapy
Physiotherapy plays an important role in the assessment and monitoring of temporomandibular disorders, through a person-centred approach based on scientific evidence.
The assessment includes, among other aspects:
- analysis of jaw movement
- muscle and joint assessment
- relationship with the cervical spine
- pain and functionality patterns
- relevant lifestyle factors
Intervention may involve pain education, self-regulation strategies, therapeutic exercise, manual techniques and integration with other health professionals, whenever necessary, according to the best available evidence for TMD.
It is important to emphasise that there is no single solution for all people with TMJ pain. Effective care involves understanding the individual context and adjusting the intervention progressively and safely.
In conclusion
TMJ pain is real, common and can have a significant impact on quality of life. The good news is that, when properly understood and approached scientifically, it can be treated effectively.
At Physioclem, our approach to TMJ integrates clinical knowledge, active listening and respect for each person's pace, always seeking a well-founded, safe and humane response.
Bibliographic references
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Herrera-Valencia, A., Ruiz-Muñoz, M., Martin-Martin, J., Cuesta-Vargas, A., & González-Sánchez, M. (2020). Efficacy of manual therapy in temporomandibular joint disorders: a systematic review and meta-analysis. Journal of Clinical Medicine, 9(11), 3404. https://doi.org/10.3390/jcm9113404
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