Treating TMJ & Headache Pain

by Erik Dalton PhD.


Innovative Manual Therapy

A positive test for a head-forward posture requires that the zygomatic arch (under the eye) be more than 3 centimeters forward of the sternoclavicular joint. Clients presenting with head-forward postures are vulnerable to increased stress not only in the neck but the jaw as well. When treating TMJ and head pain, therapists should be reminded that the jaw functions separately from the cranium. Embryologically, the jaw develops from visceral myotomes…not cranial. In those with forward head postures, the head and neck move forward in the sagittal plane causing the occiput to backward-bend on atlas to level the eyes (See Class II in Box A below).


side knee1		 This proprioceptive reflex (Law of Righting) will always cock the head back to level the eyes against the horizon even if it means ravaging the neck.

As the head moves forward, the capital extensors (suboccipitals, semispinalis, splenius, longissimus and trapezius) must fight gravity to keep the head from dropping. Soon, the entire nervous system goes into a heightened state of alert. In a forward head posture, passive tensile forces begin to shorten and tighten the hyoid and digastric muscles creating a strong tug on the mandible which
translates the jaw posteriorly and inferiorly (Fig 1).

Jaw retrusion develops as these shortened muscles fight to hold the jaw back as the head translates forward. To make matters worse, the temporalis and masseter muscles are forced to co-contract against the hyoids so the mouth can be kept closed. Prolonged temporalis and masseter contraction promotes abnormal mandibular positioning and disc compression at the temporomandibular joint (TMJ).


Common symptoms accompanying
this strain pattern include:
  • Suboccipital pain syndromes
  • Mouth breathing
  • Difficulty swallowing
  • Teeth clenching
  • Face and neck pain
  • Migraines
Box A:

When comparing Class II and Class III structures to the Class I, Normal, the line of weight bearing (LWB) falls more posterior to the plumb line in the Class II, Retrusive jaw (extensor-dominant neck) and anterior in the Class III, protrusive jaw (flexor-dominant neck).

The Class II subject is likely to experience TMJ dysfunction as the mandible is crammed into the condyles.


Box A


alignment technique

O-A and A-A alignment technique

Note: TMJ disruption is notorious for its negative impact on the 11th cranial accessory nerve. Since the upper trapezius and sternomastoids are directly innervated by the 11th cranial, jaw pain neurologically shortens these muscles initiating a “Catch 22” pain cycle. As the upper traps cock the head back and the SCMs pull it forward, excessive tension mounts in the hyoids, digastrics, masseters, and temporalis which, in turn, cause even greater TMJ compression and pain.

Optimal head and neck functioning requires that TMJ surfaces retain their ability to glide freely on one another. Since the main innervation to the dural membrane is the vagus and trigeminal nerves, faulty neck and jaw alignment can pinch and twist this sensitive membrane affecting myoskeletal as well as visceral structures. Trigeminal nerve treatment should always be complemented with masseter and temporalis work for they are also “up-regulated” in most TMJ and forward head cases.

Occipitoatlantal work demonstrated in the Advanced Myoskeletal Techniques home-study course helps therapists relieve 11th accessory and 9th trigeminal pain conditions. Meantime, continue using all techniques that have proven successful in reversing forward head postures and accompanying TMJ pain.