TMJ Tensegrity : James Earls for TMJ Therapy® at BFS 2018

TMJ Tensegrity : James Earls for TMJ Therapy® at BFS 2018

The source and the end-point of many issues, the temporomandibular joint, is a rewarding area

for therapists to explore. It takes a mindful handvand a sensitive mind to work carefully as it is an

area rich in meaning, mechanoreceptors andvmastication.

There are many obvious indicators to work in the area, the obvious being the

common TMJ disorders but the jaw’s links to other areas may give it an extra

importance for those with neck, shoulder, pelvic and lower limb issues.

Tensions can be carried up and down the body – jaw issuesvcan reflect down to the foot and vice versa. Without anvobvious indicator as to the origin of an issue, it can be difficult to be conclusive onvwho instigated the problem.

Exploration

To get a sense of some the relations between the jaw and the rest of the body work through the following exercises:

1.Let your jaw relax, let it be as slack as ego and tight muscles will allow, and then shift your head forward.

What happens to your mandible? What happens in the TMJ? How does the front of your neck feel? There are no absolute answers to any of these questions, only the answers that you feel for yourself. We are all a little different with different histories of usage and injuries that will affect our reactions to movement.

Most people will feel the cranium move further forward than the mandible, or, the mandible is a little further back relative to the cranium. Either way, the result is the same and the mandibular condyles will be interacting with the back of the TMJ and your bite will change. Now try correcting your bite to open and close the jaw while keeping your teeth aligned. How much work is that? But yet, that is where many people put their heads.

Try the exercise again – do it sitting and standing.

Do you feel a change in your spinal curves? Did your pelvis change position?

Taking your head forward creates extra cervical lordosis and this is often (not

always – there are no absolutes!) mirrored with an increase in the lumbar lordosis.

Now try to feel the relationship in the opposite direction. Relax your jaw again and then anteriorly and posteriorly tilt your pelvis.

Can you feel a relationship between pelvic tilt and mandibular retraction/ protraction?

What would happen to the pelvis if you correct jaw tracking? What would happen to jaw tracking if you correct the pelvis?

Why do you think your mother nagged you to sit up straight at the dinner table?

2.Now try the same thing with a lateral tilt.

Relax your jaw again and then tilt your head to the left.

How does that feel in the joints? How would you describe it?

Do you feel the lengthening of the tissues on the right? Where do you feel it?

(Remember there are no correct answers!)

Once again, try opening and closing your jaw, explore the tracking issues and the changes in tension between the left and right.

Explore the differences if you tilt your head to the right.

3.Now we can explore the changes in the jaw coming up from the rib cage.

Can you tilt your rib cage to the left? Did your head follow it? If so, straighten it up again so your eyes are level.

If you can coordinate this slight contortion, can you sense that your head is now titled to the right relative to the rib cage? This means that the cranium and mandible should be neutral relative to each other and, therefore, the joints should be able to track properly. But, can you feel the stretch/tightening/tensioning of the tissues on the left side of the neck area?

You can add your own descriptor of the sensation, but the tissues on the left side have to be relatively longer than the right to let your head tilt back to the centre.

If you are not used to considering relative positions like this it is worth taking a few moments to experiment and get the concept in your head before moving on.

Try the same exercise tilting to the other side. Is there one side that gives you a clearer sense of the tissue lengthening on one side of the neck? Now explore the sensations in your jaw as you tilt your rib cage side to side and then your pelvis side to side. Maybe try shifting your rib cage side to side (not easy but give it a try) and then the same with your pelvis (a little easier).

When you shifted your rib cage, did you feel a change in the jaw?

When you shifted your pelvis, did you feel the rib cage and the jaw adapt?

Did you notice anything change in your feet as your bodyweight shifted?

It is important to view the body as a pattern, it is more than the accumulation of the parts - i.e. it is a tensegrity system. Changing the position of one area reflects

through to all of the others but not always in an unpredictable way. There are

certain relationships that change together because of the anatomy.

Gravity, Skeleton & Soft Tissue

Some of those changes are driven through the skeletal system by joint coupling,

some are created to minimise the tilt of the head relative to the horizon and some

are created through soft tissue continuities.

Changing soft tissue dynamics is, perhaps, the most individually determined of

the three – gravity is a constant, our skeletal systems are quite (not totally!)

homogenous but it is the soft tissues that accumulate the many insults, tensions

and weaknesses over the years.

Each of the three dynamics – correction to gravity, skeletal coupling and tissue

communications are all happening simultaneously in the client’s system. The soft

tissue is effected by the client’s emotional, psychological and physiological states

and we must remain cognisant of each but they remain beyond the scope of this

short exercise.

The TMJ is a delicate joint suspended between the cranium and rib cage with a

range of tissues. We sacrifice many things in our system to keep our eyes and

ears level, making the neck the area of last compensation for patterns coming up

from the rest of the body.

The supra- and infrahyoids form a continuity of tissue attaching the mandible, via

the hyoid, to the scapula (omohyoid) and the manubrium (sternohyoid and

sternothyroid).

Images © Blend 2015 Text © James Earls 2018 More superficially, the platysma forms a continuity from the front of the chest to

the galea capitis which includes the occipitalis, frontalis, the auricular muscles

(deep to the temporalis), the mimetic and orbicularis oculi and oris muscles.

This important layer joins the ligamentum nuchae at the back of the neck and is

therefore tensioned by all of the muscles blending into it – the trapezius, and the

splenii. The ligamentum nuchae is an extension of the interspinous and

supraspinous ligaments, bringing us back to the relationship between spinal

curves (these ligaments will be stretched in cervical flexion) and jaw tracking.

The fascial connections from the jaw to the rest of the body are almost endless.

The superficial layer drapes over the front of the chest with the platysma, a

middle layer brings us to the front of the sternum with the hyoids and a deeper

layer will bring us into the thoracic cavity with the oesophagus and trachea.

Altering the length/tension relationships through any of these continuities can

affect the jaws need to adjust the sling between the masseters and medial

pterygoids and require balancing tensions and timing of the lateral pterygoids.

Imbalance in the lateral pterygoids can lead us to the mistimed tracking of the

interarticular disc and all the complications that follow.

Balance & Coordination

The semicircular canals, which play a huge role in balance and coordination,

reside on the cranial side of the TMJ. What influence might spread across from

taut, overworking jaw muscles to our vestibulo-ocular reflexes? Could they be

dampened and altered in some way? Clinical experience would seem to suggest

so as jaw tension, the lateral pterygoids and the sub-occipitals all interrelate.

Returning to our first exploration of sagittal plane changes with the relationships

between pelvic tilt, rib cage tilt, head position and spinal curves – what effect do

those changes have on the relationships between the diaphragms of the body?

Our pelvic floor, the respiratory diaphragm and the floor of the mouth should all

be relatively parallel to one another but changing the angle of one, alters the rest

and thereby, effects their reciprocity.

Another domed diaphragm, that of the feet, also relates to pelvic position. What

happens to your arches as you explore between anterior and posterior tilt of your

pelvis? Most commonly, the feet pronate as you anteriorly tilt – another coupling

of skeletal patterning.

Making Sense of it all – Tensegrity

Putting everything into context for our clients is not easy. We must assess skeletal relationships, interpret soft tissue patterns and be mindful of emotional contexts. We should not be surprised when we work on the low back and the jaw eases, or vice versa– they are linked!

When a client is complaining of foot issues and their pronation or supination is affected, why not check the jaw for a holding pattern. If we cannot balance the quadratus lumborum to ease tilted rib cage, can we start to relax the area by first exploring the jaw?

Blend would like to thank James Earls for his generous support and for

writing this article for Blend and TMJ Therapy®.

If you would like to learn more about this fascinating subject, sign up to our

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Images © Blend 2015 Text © James Earls 2018