Training with knee pain


10% of the adult population experiences complaints of the temporomandibular joint at some point. Temomandibular dysfunction(TMD) is an umbrella term for complaints in the jaw region. TMDs are complaints of the jaw that are manifested by pain, decreased jaw mobility and possibly a cracking sound of the jaw when talking, eating or swallowing. 

Anatomy of the jaw joint

The joint of the jaw lies just in front of the ear, at this point the bone of the lower jaw meets the bone of the skull. Between these two pieces of bone is a small cartilage disk. When the jaw moves, it slides along to make the movement as smooth as possible.

When we look at the muscles, the jaw has 4 major muscles that perform two main movements, opening and closing the jaw. The two largest muscles are the m. Temporalis and the M. Masseter both ensure that the jaw can close in a powerful way. Of the two smaller muscles m. Pterygoideus medialis and lateralis, the pterygoideus medialis is also for closing the jaw. The m. pterygoideus lateralis is responsible for opening the jaw.

Cruciate ligament injury

Complaints of the jaw joint

TMD is characterized by regional acute or persistent pain at the ear or in the lower jaw or by decreased function of the jaw during, for example, eating or yawning. Headaches can also result from these complaints often radiating from the jaw to the side of the face/head. Because it is an umbrella term you can still distinguish different types of TMD.

Muscle-related TMD - here the cause is located in the jaw muscles

  • Localized pain in the jaw on the affected muscle
  • Myofascial Pain on palpation that spreads throughout the muscle
  • Myofascial pain with radiation, this is pain that radiates beyond the muscle

Arthrogenic TMD here the cause is in the joint.

  • Arthrogen: Pain with jaw movements (even unloaded)
  • TMJ disc disorder where the disc does not move properly or when there is disc degeneration where the disc is affected.

All images show complaints in or around the jaw joint, however, in a myogenic image the radiation areas can differ.

Physical testing of the jaw joint

Axis I temporomandibular diagnosis; in the first part of the examination the jaw itself is inspected, the mobility of the jaw is looked at how the function is at that moment. The therapist looks to see if he can possibly provoke the symptoms with further physical examination. Axis 2 we look at the severity of the complaints(psychosocial). This is intended to examine how a client deals with the complaints. Based on this we will draw up a treatment plan together.

Risk factors

  • Age between 35-44 years
  • Occurs more often in women than in men
  • Smokers have increased risk of jaw problems
  • Psychological complaints such as depression
  • Clenching of the jaw or grinding of the teeth
  • Overbite or underbite
  • Past jaw surgery
Knee Osteoarthritis
Kevin van Geel

Orofascial specialist Casper Bolkenbaas

The treatment of TMD

The treatment depends on what kind of jaw complaints the person has. However, there is a basis with which most complaints can be treated. It may be that the therapist puts more focus on a specific part compared to the rest. 

The following techniques are often used to treat:

  • Manual jaw region (mobilizing)
  • Manual Neck Region (mobilizing)
  • Massage therapy
  • Racking 
  • Exercises for the jaw and neck muscles

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