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 […]
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A Watershed is an imaginary line that divides the body and the Lymphatic System into quadrants. Each quadrant has its lymphatic liquid collection canal, and the lower quadrants, as per the two legs, sends the liquid to the cisterna kili, a gland that sits deep behind the belly button that is connected to the upper left duct within the upper left quadrant. Some genetic variation, seeing the thoracic duct connecting to the right lymphatic duct. What does the watershed division look like? The main watersheds are four. A vertical one divides the body into two equal vertical halves. A horizontal one divides the body into the upper and lower body at the inguinal level. Other horizontal watersheds are parallel to each other and are located at: The clavicle line runs through the belly button on top of the iliac crest. In doing so, we have six quadrants: upper, medial, and lower. Other watersheds run vertically within the body. Those are located on the arms and on the upper leg. The importance of watersheds. As we dig more and more within the functionality of the Lymphatic System and MLD as a Lymphatic Drainage technique, we can see that in these specific quadrants, there are bundles of Lymph nodes that get loaded from the lymph vessels connected to them. The watershed division allows the liquid to be directed to a specific body area where lymph nodes are found. Indeed, the lymph nodes are the ones that clean up the lymph fluid, also called obligatory lymph load. When we treat a patient, we have to make sure where we direct the liquid because we want to ensure that the lymph fluid gets sent to the lymph nodes, where it will be processed and then transferred to the lymph/vein duct at the base of the cervical area. This is extremely important when we treat Lymphoedema, where we may bypass the watersheds, where the lymphatic system has been damaged or is missing, to transport the lymphatic fluid from a stagnant area to an active one. How to bypass a watershed To bypass a watershed and transfer the lymphatic fluid from one side of the body to the other side, we have to stimulate the anastomoses, which are the alternative pathways of the lymphatic system. Unless those pathways are stimulated, we can not transfer the fluid side to side along the horizontal or vertical lines. An example would be a person who went through a mastectomy and has a unilateral Lymphoedema. In that case, we need to stimulate the upper anastomosis to transfer the fluid side to side. In the drawing beside, you can notice the upper anterior and posterior anatomoses drawn in thick green lines. The upper watershed and the duct. After the obligatory lymph load reaches the upper watershed (the one running along the clavicle), it gets passed to the venous system. This happens after the obligatory lymph load travels with the trunk collector and passes through the duct. The duct is the last portion of the lymph trunk that connects to the venous system. In conclusion, we want to specify that the lower quadrants (R leg and L leg) and the upper L quadrant drain in the L thoracic duct within the L subclavian vein. Where the R upper quadrant drains into the R duct connected to the R subclavian vein. Below here, is a list of blog posts that talk about conditions where MLD can be beneficial: Bone fracture Sunburn Preeclampsia TMJ Chronic Pain Fibromyalgia Melbourne Massage and Treatment and Lymphatic Drainage Massage At Melbourne Massage and Treatment, Lymphoedema Clinic, I am specialised in Applied MLD and Lymphoedema management. I did train with the Vodder academy for my Lymphatic Drainage practice, and I have a clinical approach to this type of work. If you are in need of manual lymphatic drainage treatment, do not hesitate to book your next appointment now. A 15-minute Online free consultation is also available for those who suffer from Lymphoedema or Lipedema.
Nov
MLD stands for Manual Lymphatic Drainage. As per a deep tissue massage, MLD treatment works on the lymphatic system and not the musculoskeletal system. This technique aims to boost the capacity and ability of the lymphatic system. Manual Lymphatic Drainage history. MLD is a technique implemented by Dr Vodder and his wife, Estrid Vodder, with the help of many other scientists and researchers. Dr Vodder can be described as a visionary of the lymphatic system role. He dedicates his life to the realisation of this technique. Dr Vodder and his wife formulated a series of hypotheses on how the lymphatic system works, and how it is essential to speed up recovery from diverse conditions. All their hypothesis, along the 20th century, were then confirmed and transformed in theory thanks to the works of many other scientists. As per result, after their first few years of hypothesis formulation, in the early 20th century, they could start promoting their work and run seminars and classes about MLD all around Europe. Nowadays, is in Austria in the village of Walchsee -Tyrol -Austria resides the Dr Vodder Academy –Lymphedema Clinic Wittlinger. The Austrian clinic was founded in 1971, and since that, the MLD spread all around the world, with courses that are taught in any continent. The Lymphatic System. To understand the importance of this technique, let’s analyse the body’s anatomy and the lymphatic system’s role. Indeed, for doing so, let’s compare the lymphatic system with the blood circulatory system. Firstly, the lymphatic system is an open system of “capillaries” (lymph vessels) and “veins” (pre-collector and collectors). Secondly, It differs from the blood circulatory system as it transports lymph, not blood, and is open and not closed. Thirdly, the lymphatic system doesn’t have a pump, as is the heart for the circulatory system. In fact, the lymphatic system, pushes the lymph around through a mechanism of osmosis pressure (at the lymph vessels system) and throughout an inner system of inner valves. Furthermore, the lymphatic system has filtering stations: lymph nodes. It is here where specific white cells live. Indeed, the role of the white cells is to help fight back infections carried by viruses and bacteria. Said so, the lymphatic system’s primary role is to collect waste. This happens at two different levels. At the superficial level (80%), where the lymph vessels are (lower dermis and the superficial zone of the subcutaneous tissue) and deep level of the body (20% below the deep fascia) return this waste to the blood system will then direct all the waste to the organs that clean the body, such as liver, kidney etc. How the lymphatic system works. So, our body is covered in skin, right? Below the skin, before the fascia and muscle layers, we got lymph vessels (the equivalent of capillary for the blood system). The lymph vessel spread on a vertical level all along the body in different concentrations. As per role, the lymph vessel collects the Lymph-obligatory load, the waste and excess material the body doesn’t need. Lymph-obligatory load is made from water, protein, lipids, exogenous substances, cells etc… The collection of the lymph-obligatory load comes through a suction and osmosis approach. The lymph obligatory load travels down to the pre-collectors from the lymph vessel. Indeed, pre-collectors are slightly more significant than the lymph vessel Furthermore, rather than spread along the undersurface of the skin, they travel deep down and pass the lymph fluid to the collectors. As per result, the collectors that interconnect the lymph nodes transport the lymph-obligatory load to the blood circulatory system. Another specification to look for is that the lymphatic system is divided into superficial and deep. But we will look at this specification in the next blog post, where we will also talk about the watershed and body quadrant. Manual Lymphatic Drainage compared to the massage technique. So, now that we have a better idea of what the lymphatic system is and how it works, we can say that massage techniques such as Myotherapy, Thai Massage, Remedial Massage, or even Relaxation Massage are not the most indicated for helping the lymphatic system. They still would improve its work, but as the lymphatic system sits right below the skin and works by light stimulation, the friction and pressure applied with these techniques would be too strong. Even though no damage occurs to the lymphatic system when significant pressure is applied to it.