Question
I have been struggling TMJ and lower back pain the last year.  I went to see a Chiropractor a couple of times but stopped after she caused me considerable pain by applying the Chrio's "activator" directly on my jaw.  Really rang the pain bell.  Anyhow - I'm will to have her try again (without the activator!)  I suspect that the root of my jaw pain (chin pain, jaw pain ear pressure, sinus pain, deep tooth pain, headache) actually has its roots in the lower back.  Sometimes there is pain in the lower back too although less often and less severe than last summer when pain would even wrap around to the thighs.  When I sit for long periods (say six hours straight at work) my top and bottom back teeth seem to separate and then pain starts in.  A night sleeping on my back fixes everything until my next long sit-a-thon.  

What should I expect of my Chiropractor in terms of understanding the connection between lower back and the jaw and being able to fix?  And is there anything I could ask of her to get the most out of my sessions?  How many sessions should it take to fix a condition like this?  Thank you.

Answer
Michael,

Firstly, I would never advocate manipulation of the TMJ by hand or with an instrument. As you found out, it is quite painful, and typically, useless. The TMJ is a richly innervated joint, and is very sensitive to disturbance.

Secondly, I am not aware of a strong connection made in any study between TMJ pain and low back pain, although it is certainly possible to have both simultaneously, but perhaps without one necessarily causing the other.

Thirdly, suffering from period and exquisite TMJ pain myself, I can sympathize with your problem. Seeking intervention from a practitioner of manual therapy, such as a chiropractor, massage therapist, or acupuncturist, in my opinion, should focus on finding a practitioner who is well-skilled in manual myofascial trigger point therapy. Trigger points contribute to TMJ problems, and need to be addressed when attempting to deal with the TMJ.

Please see these links for additional information on TMJ trigger points:

http://www.triggerpointbook.com/tmjdisor.htm

http://www.youtube.com/watch?v=-GereefVn68

http://www.youtube.com/watch?v=zhWTB94OBi8&feature=related

In severe cases, trigger points of the TMJ musculature may need to be injected with an anesthetic and an anti-inflammatory agent. This is typically done by a medical physician or a dentist who is experienced in dealing with TMJ problems.

For those who brux (or grind their teeth) at night, a bite guard may be needed. A dentist can fit the patient for a bite guard; there are also over-the-counter varieties available.

A muscle relaxer and anti-inflammatory oral medication, prescribed by a medical physician, may also be helpful for short-term use while undergoing manual treatment of trigger points.

With any manual therapy, it is important to stay properly hydrated and reducing pro-inflammatory substances in the diet by reducing alcohol, caffeine, and sugar consumption, and increasing water intake. In general, stress reduction techniques are also very helpful, since most sufferers of TMJ disorders tend to grind or clench their teeth when they are under stress. Tai chi, yoga, stretching, and quiet times of rest, prayer, or meditation are often helpful from a general stress-reduction point of view.

TMJ problems can be problematic and difficult to treat; therefore, a multi-disciplinary approach is often the most helpful, with a properly orchestrated team of health care professionals working together for the benefit of the patient.

I hope that this helps to answer your question.