TMJ Clicking: Why can be painful?

Temporomandibular Joint (TMJ) disorders are a common source of jaw pain, clicking, and discomfort that can impact anyone at any age. At Melbourne Massage and Treatment in Fitzroy North, I see many clients presenting with TMJ clicking and associated symptoms. One of the key factors behind the painful symptoms is retrodiscal tissue compression, a condition that not only causes joint noises but may also lead to chronic jaw pain.

What Causes TMJ Clicking?

Let’s start understanding why TMJ clicks.
When looking at the TMJ, we can see that between the two bones that make up the joint, there is a disk, called the articular disc, which is made of cartilage and is meant to keep the bones apart (the temporal bone and the mandibular condyle). In a healthy joint, the disc moves smoothly with the jaw during opening and closing. But when the disc is out of alignment, the condyle may snap over it, creating that characteristic “click.” For reference, a condyle is a rounded protuberance at the end of a bone, which in this case, fits into a cavity.

The Role of Retrodiscal Tissue Compression in TMJ Clicking and Pain

Right behind the disc lies a tissue known as the retrodiscal tissue, which contains blood vessels, nerves, and connective tissue. When the disc is displaced anteriorly, the condyle may compress this sensitive area during jaw movements. This compression can lead to:

• Inflammation

• Persistent pain

• Increased joint stiffness

• Neurovascular irritation

This is possible because the tissue, as mentioned earlier, is innervated, where the disk, is not. Therefor, the disk compression on its own, is not going to replicate any pain, as there is no nerve to pick up any stimulus in there.

Forward Head Posture Would Not Help.

Forward head posture is a common presentation linked to TMJ clicking. Forward head posture is characterised by the head sitting forwards compared to the midline of the body, and is often due to a lack of strength in deeper neck flexor muscles. This presentation can make the TMJ presentation worse because of the excessive load placed on the muscle that surround the TMJ (masseter and temporalis muscles).
Other reasons include the misalignment of the teeth, which can make the chewing action more difficult and over time, create strain along the TMJ tissues (muscles, ligaments and tendons), but also referral pain from the cervical joint tension can lead to manifest stress in the jaw and face muscle due to constant pain and disconfort.

How Myotherapy Can Help

At Melbourne Massage and Treatment, I offer a combination of evidence-based manual techniques and exercise therapy to address the root causes of TMJ dysfunction, aiming not just to manage symptoms but to promote long-term recovery.

1. Joint Mobilisation

Gentle mobilisation techniques to the jaw, cervical spine, and upper neck can reduce joint restriction, improve mobility, and relieve the pressure on retrodiscal tissue. Mobilisation helps restore normal disc-condyle mechanics, reducing clicking and improving range of motion.

2. Dry Needling

Dry needling of trigger points in the masseter, temporalis, and lateral pterygoid muscles can reduce hypertonicity and relieve pain referred to the jaw and head. Targeting myofascial restrictions can also indirectly reduce stress on the TMJ itself.

3. Targeted Exercise Therapy

Specific exercises for jaw control and cervical strength are crucial for maintaining results between sessions.

• Jaw isometric exercises are ideal for pain management and quick relief.

• Resistance bend exercises for jaw opening.

• Relaxation techniques for parafunctional habits like clenching

Over time, these exercises can enhance joint stability, reduce overloading, and in some cases improve mild degenerative changes by promoting better joint mechanics and tissue resilience.

4. Deep Tissue Massage

Massaging the muscles surrounding TMJ and the cervical muscles can help reduce tension, stimulate the nervous system to relax and give a break from pain and discomfort, while improving mobility.

As always, there is not one solution for the common presentation of many. Each individual is different, and the treatment results can be different. But what we can expect is that, if we balance the usage of hands-on treatment and exercises, we can create some real change with some great benefits.

TMJ Clicking and Menopause

Menopause is a topic I have already spoken about in my blogs. Briefly, we can refer to menopause as the day past 12 months of missing menstrual periods in a woman’s life cycle. Before that is called perimenopause, after that day, we talk about post-menopause.

This step is achieved when a woman has no more eggs to release, and her menstruation has stopped.
While it is not the same journey for each woman and there are many changes that women can go through, a common one is stiffness of ligaments. Again, this is not happening in one day, but is a change that comes with time and is different person to person.

This is possible because of the lack of estrogen. Indeed, estrogen, along with controlling many other aspects of the biological life of a woman, is also responsible for the elasticity of the ligament. Put: less estrogen, less elasticity. This can explain why, during this phase, women start experiencing more TMJ pain and potentially TMJ clicking. On the other hand, we have no yet enough evidence to say that Hormonal Replacement Therapy is effective for establishing this presentation (Robinson et al., 2019).

FAQ – TMJ Clicking

1. What causes the clicking sound in the TMJ?
The clicking occurs when the articular disc in the jaw joint becomes displaced, and the mandibular condyle snaps over it during jaw movement. This is often due to disc misalignment.

2. Why does retrodiscal tissue compression cause TMJ pain?
The retrodiscal tissue contains nerves and blood vessels. When compressed due to disc displacement, it can lead to inflammation, pain, and stiffness in the TMJ area.

3. Can TMJ clicking happen without pain?
Yes. If the articular disc is displaced but the retrodiscal tissue isn’t compressed or irritated, the joint may click without producing pain.

4. How does forward head posture affect TMJ?
Forward head posture strains neck muscles and can overload TMJ-related muscles like the masseter and temporalis, potentially worsening clicking and discomfort.

5. How can myotherapy help with TMJ clicking?
Myotherapy uses joint mobilisation, dry needling, deep tissue massage, and targeted exercises to improve disc-condyle mechanics, reduce soft tissue tension, and restore proper function.

6. Are exercises helpful for TMJ dysfunction?
Yes. Jaw isometric exercises, resistance band movements, and postural training can support joint stability and reduce the recurrence of symptoms.

7. Is there a link between TMJ issues and menopause?
Yes. Reduced estrogen during menopause can lead to decreased ligament elasticity, which may contribute to TMJ stiffness and increased pain.

8. Is Hormone Replacement Therapy (HRT) effective for TMJ pain?
Current evidence does not clearly support the use of HRT for TMJ pain relief (Robinson et al., 2019), though more research is needed in this area.