Temporomandibular Disorders: Why Physiotherapists Should Look Beyond the Jaw

Explore the relationship between the temporomandibular joint, cervical spine, pain, movement and clinical reasoning in physiotherapy management.

BREMJ Aca-Physio

8/4/20262 min read

CLINICAL RESOURCE • MUSCULOSKELETAL REHABILITATION

Understanding the Temporomandibular Joint

Temporomandibular disorders, commonly referred to as TMD, involve more than the jaw joint alone. Symptoms can be influenced by the temporomandibular joint, surrounding muscles, the cranio-cervical region and other factors affecting pain and function.

For physiotherapists, assessment therefore benefits from considering the wider clinical presentation rather than focusing only on the location of pain.

The temporomandibular joint is part of the musculoskeletal system and, like other joints, can be affected by changes in movement, loading and surrounding tissues.

Patients may report jaw pain, difficulty with opening or closing, clicking, muscle discomfort, headache or symptoms extending into the head and neck.

Understanding how the joint functions provides an important foundation, but clinical assessment also needs to consider the person's symptoms, movement and functional difficulties.

Looking Beyond the Jaw

The temporomandibular joint does not function in isolation.

Assessment may also consider the relationship between the jaw, cervical spine and surrounding musculoskeletal system.

This becomes particularly relevant where patients experience overlapping symptoms such as headache, cervical discomfort or movement-related symptoms.

Myogenous & Arthrogenous Presentations

TMD presentations may involve different contributing structures and mechanisms.

Some presentations may be predominantly associated with muscular factors, while others may relate more closely to the joint itself.

Distinguishing between different clinical presentations can help the physiotherapist organise assessment findings and guide an appropriate management approach.

Key Considerations in TMD Assessment

Nature and location of symptoms
Jaw opening and closing
Symptom behaviour during movement
Muscular tenderness or dysfunction
Joint-related findings
Headache symptoms
Cervical spine involvement
Relevant red flags
Functional difficulties such as chewing or speaking
Psychosocial factors that may influence the presentation

Treatment Is More Than One Technique

Physiotherapy management of TMD may involve a combination of approaches depending on the assessment findings.

These can include education, exercise, neuromuscular re-education, stretching, soft-tissue techniques and joint mobilisation where appropriate.

Treatment selection should be guided by clinical reasoning rather than applying the same technique to every patient. Patient education and, where appropriate, collaboration with other healthcare professionals may also form part of a broader multidisciplinary management approach.

The Role of Clinical Reasoning

Similar symptoms do not always mean the same underlying presentation.

Physiotherapists therefore need to interpret the patient's history, physical examination and response to treatment together.

Clinical reasoning helps determine which findings are meaningful, which interventions may be appropriate and when another healthcare professional should be involved.

What This Means in Clinical Practice

TMD assessment should not stop at the jaw.

Considering the cranio-cervical region, pain presentation, functional limitations and individual factors can provide a more complete clinical picture and support more appropriate rehabilitation planning.

Key Takeaways

TMD is a musculoskeletal presentation that can involve both joint and muscular factors.
The cervical region and headache symptoms may be clinically relevant.
Assessment should consider the whole presentation rather than a single structure.
Education, exercise and manual approaches may all have a role depending on clinical findings.
Clinical reasoning is central to choosing an appropriate management strategy.