myofascial techniques tmj

8/2/2019 Myofascial Techniques TMJ

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!"#$%&'(%)*+,'-.(/0,&!BY TIL LUCHAU & BETHANY WARD

Image 1: The medial pterygoids (purple) along with the masseters (orange) form left and right "slings" thatsupport, close, and help align the mandible. Also shown are the lower head of the lateral pterygoids (green)and the articular surfaces of the TMJ (yellow). Source images courtesy of Primal Pictures, used with permission.


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WORKING WITH THE MEDIAL AND

LATERAL PTERYGOIDS

Where would we be without jaws? In the evolutionary version of our creation story, there was a long period

when no animals had them. Ancient animals such as amphioxus had a mouth, but not a mandiblei. Once

jaws appeared, however, they proved extremely popular, as now all vertebrates (except for lampreys and

hagfish) have mandibles.

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In this article, well discuss myofascial techniques for two of the most valuable players in TMD: the

medial and lateral pterygoids. Although often overlooked, in our clinical experience, direct, sensitive workwith these important structures is often the key to alleviating TMJ symptoms, and a part of shifting the

usage patterns that contribute to continued misalignment and joint irritation.

Since the pterygoids are deep muscles, they will not usually be the first structures you choose to address.

Necessary preparation would include work with larger head/neck/shoulder patterns, and with outer layers

such as the masters, temporalis, and digastrics. In our next article, well describe ways to work with these

supporting players. In the meantime, we will assume that readers are familiar with other methods for

preparing the surrounding structures before working the pterygoids. For inspiration, you may want to check

outAdvanced-Trainings.coms Anterior Neck/Shoulder Differentiation Technique on YouTube, whichaddresses the superficial cervical fascia and its effect on jaw alignment and mobility.

Speaking, swallowing, and mastication all require three-dimensional movement of the mandible. But with

this high degree of mobility comes greater susceptibility to jaw misalignment. Restricted soft tissues,imbalanced movement patterns, and fascial strain from elsewhere in the body can disrupt the delicate

balance of the TMJs. The effects of jaw misalignment are compounded by the powerful forces of bite

compression, which can squeeze or bind the articular disks and surrounding tissues. The result is tissue

irritation, pain, and if uncorrected, possible joint degeneration and damage over time.

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MEDIAL PTERYGOIDS

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LATERAL PTERYGOIDS

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LATERAL PTERYGOID ASSESSMENT

Since the anterior wall of the ear canal is contiguous with the posterior side of the TMJ capsule (Image 7),

we can easily assess the amount of anterior mandibular condyle movement here. Position the tip of your

little finger just inside each ear passage (Images 8 and 9). With your finger pads, feel for the mandibular

condyles, which are palpable on the anterior wall of the canal. Ask your client to slowly begin to open his

or her jaw, and you'll feel the condyles glide anteriorly. As the jaw begins to open, which condyle glidesanteriorly (away from your finger pad) first? The lateral pterygoid on that side is likely tighter, so work that

side as described below and recheck.

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Image 7 (right): The anterior wall of the externalacoustic meatus (purple) is the posterior side ofthe TMJ capsule (yellow). Palpating themovement of the condyle just inside the earcanal is an effective way to assess lateralpterygoid tension and balanced function. Sourceimage courtesy of Primal Pictures, used withpermission.#

Images 8 (left) and 9 (right): To assess left-right balance of the lateral pterygoids, use your finger pads topalpate the anterior wall of the external acoustic meatus. Feel for any left/right differences in the anteriormovement of the mandibular condyles as the jaw begins to open. The tighter lateral pterygoid willusually be on the side that moves earlier or more.


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LATERAL PTERYGOID RELEASE TECHNIQUE

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TEAM PLAYERS

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Til Luchau is a lead instructor at Advanced-Trainings.com Inc., which offers continuing education DVDsand seminars throughout the United States and abroad. Til is a Certified Advanced Rolfer and on thefaculty of the Rolf Institute of Structural Integration.

Bethany Ward is certified in Advanced Myofascial Techniques. She is also a Certified Advanced Rolfer

and Rolf Movement Practitioner, and a Rolf Institute faculty member. She and lead instructor, LarryKoliha, will be teaching Advanced-Trainings.com workshops in Australia throughout October 2012.

Contact them at [email protected] or on Advanced-Trainings.com's Facebook page.

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i Though still existent, amphioxus are thought to be an evolutionary predecessor to the modern vertebrates

they resemble.ii

Isong U, Gansky SA, Plesh O. Temporomandibular joint and muscle disorder-type pain in U.S. adults: the

National Health Interview Survey. J Orofac Pain. 2008 Fall;22(4):317-22.iii Deng YM, Fu MK, Hgg U. Prevalence of temporomandibular joint dysfunction (TMJD) in Chinese

children and adolescents. A cross-sectional epidemiological study. Eur J Orthod. 1995 Aug;17(4):305-9.

Review. PubMed PMID: 8521924.iv Schleip, R. Fascial plasticity a new neurobiological explanation: Part I. Journal of Bodywork and

Movement Therapies (2003) 7(1), 11-19v Due to their location, there has been some debate about whether or not the lateral pterygoids can be

palpated intraorally. (See: Tuerp JC, Minagi S. Palpation of the lateral pterygoid region in TMD--where isthe evidence?, J Dent. 2001 Sep; 29(7):475-83, and Stratmann U, Mokrys K, Meyer U, et. al. Clinicalanatomy and palpability of the inferior lateral pterygoid muscle, J Prosthet Dent. 2000 May;83(5):548-54 ).A more recent study (Stelzenmller W, Weber N-I, zkan V et al. Is the lateral pterygoid muscle palpable?A pilot study for determining the possibilities of palpating the lateral pterygoid muscle. InternationalPoster, Journal of Dentistry and Oral Medicine 2006; 8(1):Poster 301), employing MRI andelectromyogram verification, concluded that the lateral pterygoid's "muscle structure and pain sensation can

be determined by digital palpation and subsequently treated by functional massage...". This outcome is

consistant with our clinical experience that addressing this area is an effective approach to alleviating TMD

symptoms. (Thanks to Dr. Leon Chaitow.)viLippold C, Danesh G, Schilgen M, Derup B Hackenberg L. Relationship between thoracic, lordotic, and

pelvic inclination and craniofacial morphology in adults. Angle Orthod. 2006;76:779-85.vii

Rocabado Seaton, Mariano & Iglarsh, Z. Annette. The Musculoskeletal Approach to Maxillofacial Pain.

NY: Lippincott Williams & Wilkins, 1990viii Cuccia A, Caradonna C. The relationship between the stomatognathic system and body posture. Clinics

2009;64(1):61-6.

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