We've been discussing the Trigger Point Therapy Workbook like crazy here at GUS.

Some previous discussion can be found in The TPTW and My Aha Moment, Frustrating Chronic Back Pain, and Carpal Tunnel Pain Relief with Kathryn Merrow and the TPTW.

Perhaps because of my long-term efforts at mobility, stability, special stretching, and the fact that I've used a bit of (uneducated) self massage in the past, I've found a lot less active trigger points than I would have expected.

But I've been having a VERY bad pain in my right jaw which hurts worse when chewing. My jaw has felt dislocated and recently it had gotten so bad I could barely eat. I'm pretty sure this is related to my habitual stress response of jaw clenching and the fact that I have a history of TMJ.

I actually had to have my jaw corrected through orthodontics (those rubber band thingys) and that relieved the worst of my TMJ years ago. I've also been working on not clenching my jaw and I've been fairly successful with that. It is difficult because like any type of chronic muscle tension..I'm not aware that I am doing it most of the time.

Well the jaw clenching is much better but THEN comes the pain. Most of us in strength training are familiar with this scenario. The pain comes AFTER you stop doing the stupid thing.

Anyway, it got so bad I had to take pain killers for it so that I could eat. Then I got smart and opened up the Trigger Point Therapy Workbook, went to the section on jaw and face pain and started treating it. Pretty much the whole area could be called one big trigger point.

The first day it actually made it seem worse. I was probably being a little over-zealous with the massage pressure. But the second day the pain was only there when I chewed.

The third day my jaw no longer feels like it is dislocated and my back molars have resumed their previous close relationship. The pain is only very slight and I can eat with no problem.

I will continue to use short sessions massage sessions throughout the day but man, do I feel a lot better.

yeah, my pain is actually back a bit more now. Still better than it was before. I'm just going to keep working on it steadily.

Lateral Pteygoid. That is where the most active and painful trigger point(s) are in my right jaw. This is very hard to get to but I'm working steadily on it.

According the Davies you have to use a finger in your mouth (your own) to get to these. It's way back in the pocket behind your upper molars. And he's right…it is painful as heck. You can't really get to it from the outside although it hurts to press on that general area.

The lateral pterygoid muscle acts to lower the mandible, open the jaw, and help the medial pterygoids in moving the jaw from side to side (mastication).

Unlike the other three muscles of mastication, the lateral pterygoid is the only one that opens the jaw, or depresses the mandible. At the beginning of this action it is assisted by the digastric, mylohyoid and geniohyoid muscles (wikipedia)

Yes, that is actually me.

Still getting better.

Temporomandibular_joint

And, I thought of another thing. The disk in the TM joint is the only one in the body that is capable of regenerating itself. That's good news.

And, sometimes the disk can be displaced. This would occur with a biting "accident", an accident that jars the head and jaw, asymmetry in the body (short leg on one side, or scoliosis) or a forward head posture.

When I displaced the disk with an improper sleeping position, I (because I am always "experimenting" with what bodies can do—and what better model than me?) carefully, slowly opened my mouth in one direction (think stretching the joint.) Nothing changed. And then I carefully, slowly (go slowly because you are observing) moved in another direction (laterally) and when I did, I heard a creaking or squeaking sound as the disk repositioned itself correctly.

If you feel you are still having difficulty opening and chewing is painful, it's possible that your TMJ disk is out of position and you may be able to reposition it by following these steps.

And, also, since you had some orthodontic work done…sometimes the orthodontist makes the correction while the patient is reclining. The correction should actually be made in an upright position (because that's the position we walk, sit, eat in.)

At any rate, you're making progress and that's awesome!

Kathryn Merrow - The Pain Relief Coach

P.S. I know everyone is working on making their backs strong from knees to neck, right? ;-) Those strong muscles allow good posture and help balance the "show off" front muscles. Having a "forward head" and shoulders posture puts a lot of strain on the muscles of the neck and jaw.

Thanks very much Kathryn.

I'm doing some of that right now, lol.

Definitely the pterygoid pocket (for brevity I guess I can call it that) is the most tender from the inside. I am not finding any comparably tender regions above or below the teeth where the muscles meet the bone as you say (sounds like a rock song).

But the cheek muscles, pressed between the thumb and finger are definitely tender, so I'll be working on that.

So repositioning laterally thing. I have been tempted to do that but didn't know if it was a good idea. It hurts to do that and in this case I didn't know if it was a "bad" pain or an expected pain. One thing I can say is that I always feel like may jaw "wants" that if this makes any since. So I will give your instructions a go. Thank you so very much.

Gum chewing is something that makes it worse.

I'm so glad you posted because while the pain is much better I know I am not getting the whole picture yet.

P.S. I know everyone is working on making their backs strong from knees to neck, right? ;-) Those strong muscles allow good posture and help balance the "show off" front muscles. Having a "forward head" and shoulders posture puts a lot of strain on the muscles of the neck and jaw.

Strengthening the posterior chain: Yes, we here at GUS are all over that, you can rest assured. I personally tell traineees that up to 60 percent or MORE of they're strength training should be PC oriented. And we think of the posterior chain as pretty much everything from the knees to the neck.

We also emphasize mobility which is many times the missing element.

Update. My jaw is good to go. The pain is gone completely. Has been for a few weeks now I just hadn't gotten around to updating this thread. I probalby could have erradicated the pain in a week but I was inconsistent with my treatments so that is the only reason it took about three weeks. The pterygoids were the major source of the pain but Kathryns advice about manipulating the jaw made a big difference as well. At first this was very uncomfortable so I was very cautious but even though it hurt the pain started diminishing further.

As Kathryn pointed out my orthodontic work was definitely done in a reclining position. I aslo have no doubt that this will be a continuing problem for me because of my jaw structure so I will have to keep on top of it.

Here is an article by Kathryn that explains this problem and treatment step by step:

TMJ or Jaw Pain: How it Happens and What You Can Do to Make the Pain in Your Jaw Go Away

In the article Kathryn talks about forward head posture. I do not have forward head posture. But I used to have a slight forward head posture before I started learning about mobility and postural alignment. I corrected that quite a while ago but I have no doubt that postural distortions such as these can leave behind lingering problems even after the posture is corrected.

This will probably be my last update in this thread.

My TMJ pain is gone and I am no longer able to illicit pain, or even very much discomfort at all, when applying pressure to the pterygoid muscles as well as the masseters or any other areas.

Pterygoid Muscle: Lateral and Medial Pterygoid Labelled

Lateral Pterygoid Trigger Points

Image ©Publitech, inc. 2010, all rights reserved.

Also see Masseter Muscle: Actions, Location and Trigger Points and Sternocleidomastoid Muscle: Location, Action and Trigger Points. Trigger points in the masseter (a muscle of mastication like the pterygoid but with the opposite role) and the sternocleidomastoid (the major muscle of the front of the neck) can contribute to jaw pain. The masseter being an obvious one, of course.

More will be added as time permits.