Results of any specific TMJ protocol would be minimal without first releasing the core distortion pattern with the pelvic balancing protocol.

Briefly outlining the basis of TMJ (tempromandibular joint), and the necessary components of successfully applying therapeutic bodywork techniques to treat this syndrome, will hopefully alleviate much of the confusion about TMJ and approaches for treating it.

I often refer to the core distortion pattern found in everyone I have ever seen in over 25 years of practice. This distortion includes rotated iliums and shoulders, and an imbalance of the cervical spine and cranium. The entire body is involved in this core distortion. To better understand TMJ and its treatment with SET, we will take a closer look at the components of the core distortion pattern

The cranium has bones that relate to the bones of the pelvis. There is a direct relationship between the iliums of the pelvis and the temporals and greater wings of the sphenoid of the cranium. If the greater wings of the sphenoid and temporals are rotated anteriorly on one side, then the ilium on that same side will also be rotated anteriorly. There is also a direct relationship between the occiput and sacrum. The direction in which the occiput is tipped is the same direction of tippage seen in the sacrum. Key in cranial motion is a flexion/extension movement of the occiput and the sphenoid. When the cranium moves evenly into flexion/extension without tippage or rotation, then the iliums and sacrum are level and offer a balanced support for the body. When the flexion/extension motion of the sphenoid and occiput is torqued, an uneven movement of the cranium in flexion/extension is created, which results in a torquing of the ilium and sacrum, mirroring what takes place in the cranium. While this is technical, it is important to recognize this since it is the primary torsion found in the core distortion pattern and in TMJ Syndrome.

Using applied kinesiology and a right arm for muscle testing, this core distortion can be verified by testing the client with the mouth open wide. If TMJ is present, the muscle tests weak, as will additional tests involving the structure of the pelvis. Consequently, it is easy to see that the TMJ Syndrome is synonymous with the core distortion of the entire body, and the pelvis and cranium need to be brought back into balance in order to effectively treat TMJ.

Another consideration is the curvature of the neck, which is also a result of this distortion, and the imbalance found here helps support and lock up the dysfunctional TMJ pattern. So the TMJ syndrome needs to be looked at as a structural balance problem with the TMJ being a distortion that is a result of the core distortion of the full body.

As you can see from the discussion above, TMJ distortion stems from the imbalance of the pelvis, spine, and cranium. So when seeking long-term correction of the TMJ problems, it’s necessary to treat the entire distortion pattern. If bodywork and Cranial/Structural techniques (not to be confused with craniosacral techniques) are applied only to the cranium, then the distortion in the rest of the body will eventually bring the distortion back into the cranium and the TMJ, and you will be back where you started. If, however, there is a balancing of the pelvis, a reduction of the scoliotic curve caused by the imbalanced pelvis, a reduction of the reverse curvature of the neck, and a balancing of the cranium, then the positive changes to the TMJ can be maintained long-term.

TMJ problems are often accompanied by many emotional blockages that have become chronic, and often manifest as a thickening and tightening of the soft tissue. They can exist throughout the structure, but especially in the pelvis, abdomen, thorax, neck, and jaw. These emotional blockages can, and often do resist soft tissue changes that are necessary to balance the structure. It is important for the client to be able to release the trapped emotional energy so the chronically tightened soft tissue can relax and release the old core distortion holding pattern.

When balancing the core distortion pattern and working with TMJ, I prefer to integrate a number of techniques. First, I initiate the torsion release throughout the core distortion pattern by using Cranial/Structural techniques. Then, once the torsion is released from the cranium, the soft tissue of the entire body starts to unwind and release, which greatly facilitates the balancing of the structure. There are usually many areas where this unwinding of the structure is limited due to the myofascial holding pattern, adhesions, and scar tissue. The proper application of the SET three-step deep tissue technique allows the therapist to effectively work deeply in the various layers of fascia to continue the unwinding process initiated by the Cranial/Structural work.

Releasing the torsion in the cranium allows a balancing of the bones in the cranium, and consequently a balancing in the TMJ. I have found that in balancing the cranium using Cranial/Structural techniques, many of the TMJ problems will be profoundly minimized or disappear entirely with minimal work on the actual muscles that are directly related to the TMJ, i.e. masseter, pterygoid, and temporalis. However before I will work with the specific muscles of the TMJ, I seek a balance between the pelvis and the cervical spine, and release the musculature of the neck and shoulder. By doing this, I achieve maximum results in a minimum amount of time when working in the muscles directly related to TMJ. This will usually take 3-4 sessions of balancing the structure, including the neck, before doing deep efficient work with the muscles associated with the bones of the TMJ.

When addressing the cervical spine, I release the anterior muscles first and then the posterior muscles, and concentrate more on the SCM and scalenes because they tend to hold the neck in a distorted curvature. Often much more work is necessary on the muscles of the anterior neck than the muscles directly connected to the bones of the TMJ, even though the pain is felt in the area of the muscles of the TMJ.

When working with the muscles directly associated with the TMJ, I check the cranium first using kinesiology to be sure that optimum balance and mobilization of the cranial motion is present. Then, after treating the anterior neck and posterior neck, I release the soft tissue over the scalp and face. Next, I release the masseter and its attachments externally. I then work with the musculature inferior to the mandible, paying special attention to the tissue around the angle of the mandible, to where it attaches in the back of the TMJ. After having released both sides of the mandible, I now work intraorally on the masseter including its attachments on both sides. At this point the pterygoids are about the only muscles affecting the TMJ that have not been addressed. Since they are located at the back of the mandible, releasing them tends to be uncomfortable for many clients. However, by releasing everything else first, there will be no resistance from the other musculature of the mandible that would diminish the release of the pterygoid. Consequently, the amount of time and pressure necessary to fully mobilize and balance the TMJ by working on the pterygoids will be minimized.

It is important not to try to do too much in any one session when working with TMJ because clients will have a significant shift throughout their structure, and the structural shift needs time to integrate as it balances. Additionally, TMJ problems are often at the top of client’s lists as far as being painful, so it’s necessary to be mindful of always working within their pain threshold.

-Don McCann, founder Structural Energetic Therapy