TMJ and the Upper Neck - Cause or Effect?
If you have been dealing with TMJ problems, here is an important study that may help you with the underlying cause of the problem. A recent study highlighted a strong link between dysfunction of the jaw (temporomandibular joints, or TMJ) and the joints in the upper neck (aka upper cervical spine). To quote the study: There is moderate and strong evidence that patients with [TMJ dysfunction] present lower endurance of extensor neck muscle, global and upper neck hypomobility, worse self-reported neck disability, however, their craniocervical posture is similar to individuals without TMD, based on a moderate to excellent methodological quality. I want to highlight the two parts in bold-face: 1) lower endurance of extensor neck muscle and 2) upper neck hypomobility.
What do the neck muscles have to do with TMJ?
Neck extensors are the group of muscles that are involved with bringing the neck back into extension, like looking upwards to change a lightbulb. The prime movers are a group of muscles called the erector spine, which anchors into the base of your skull and neck and runs continuously all the way down to your pelvis and tailbone. These muscles are also assisted by a secondary group of muscles that assist with neck extension called the splenius muscles, and also the elevator scapula, which attaches your shoulder blade to the vertebrae in your upper neck.
“Lower endurance” of these muscles means that they aren’t working as efficiently as they are designed. The consequence is that they fatigue easier and may contribute towards head and neck problems including neck pain, shoulder pain, headaches, or even migraines. So it is not simply a case of “tight muscles” with TMJ dysfunction, it is a case of weak or fatigued muscles.
How can weak neck muscles cause a TMJ problem?
Well, it may be possible that the neck extensor muscles are working overtime in order to compensate for something else. And that “something” else could possibly be a deeper injury to the ligaments and joints that stabilise the vertebrae in your neck. You see, if you ever suffer a head, neck, or whiplash injury - even if you don’t have any broken bones, bleeding, or bruising, it does not always mean that you don’t have internal damage that affects the small muscles and ligaments that support the alignment of the vertebrae in your neck.
These muscles are commonly known as “the core,” which are involved with stabilising the weight of your head atop your neck. The problem is that if these muscles are injured, it does not matter how much you strengthen, a stretch of rehabilitating them: they will not be working as efficiently as possible. If that happens - because your brain isn’t dumb and your body isn’t weak - your muscles will compensate by requiring the next layer of muscles in your neck to do the extra work to maintain the balance.
These would be the erector spinal muscles.
In other words, it may be that the reason for fatigue and weakness in the neck extensor muscles is the consequence of a deeper injury that is interfering with the normal function of the core muscles. What types of TMJ problems could it cause? So what does that have to do with TMJ problems? Well, the muscles that support your TMJ anchor to the base of the skull. So if there is an injury of the muscles that support the base of the skull, this imbalance can be transferred into the TMJ muscles themselves.
True, it may also happen the other way around where the TMJ creates problems in the neck. However, this simple physical link may illustrate how a problem in the upper neck due to physical injury and weakness can contribute towards TMJ problems:
What does upper neck movement have to do with TMJ?
“Hypomobility” means that the normal movement in the upper neck is not as good as it is supposed to. The top vertebra in your neck, called the atlas or C1, supports the weight of your skull and is responsible for 50% of the total movement of moving your head up-and-down. The second vertebrae in your neck, called the axis or C2, is the pivot point that allows you C1 to turn and is responsible for 50% of the total movement in rotating your side-to-side.
We’ve previously mentioned how a head, neck, or whiplash injury can cause muscle damage. Let’s look now if that same injury damages the ligaments that facilitate the normal motion in your upper neck. If the ligaments that guide these movements are compromised - again, even if there are no broken bones, bleeding, or bruising - it affects the way that you are able to move your head. Your body will attempt to compensate but overloading the lower joints, which may also lead to the same muscle fatigue that we talked about earlier. However, there are also important structural and neurological links.
What types of TMJ problems could it cause?
Foremost, the normal alignment of the joint in the upper neck between your skull, atlas, and axis corresponds with the normal orientation of your TMJ. Therefore, if the joints in your upper neck and misaligned are do not move properly (i.e., hypomobility), it may disrupt the normal motion of your TMJ itself, which can also lead to a number of potential TMJ problems:
- Grinding (aka Bruxism)
In addition, the nerve receptors in the upper neck and TMJ tie into may of the same centres of the brain for three primary sensations:
- Proprioception (i.e., your body’s sense of balance)
Therefore, it may be possible that if a “wire gets crossed” in how your brain processes information (called the dysafferenation hypothesis), it can misinterpret what is actually an upper neck problem for what it felt like a TMJ problem.
- TMJ Pain
- Vertigo or Dizziness
Upper Cervical Care and TMJ
So we see that there is a profound relationship between the health of the TMJ and also the health of the upper neck. In reality, it is a two-way street where the TMJ affects the upper neck, and the upper neck affects the TMJ. In this article, we’ve explored the role that the upper neck has on the TMJ. This is especially important if you have been suffering a TMJ problem for a long time with all types of therapies focussed on your TMJ but not experiencing the results you expect.
It is because the problem may well be coming from somewhere else. Here is where a unique approach to healthcare known as Blair Upper Cervical care may able to assist. (And if you’ve never heard of it before, I’m not surprised because there are only 5 practitioners in all of Australia). Blair Upper Cervical Care is a special division of chiropractic with a specific scope of practice: i.e., the relationship between the vertebrae in the upper neck - the atlas and axis - and the nerve system.
The premise is simple. When the atlas and axis are properly aligned, the brainstem is free to communicate and function correctly with the rest of the body. However, if either the atlas or axis is misaligned, it can interfere with the normal function and therefore produce problems in the body … TMJ pain and problems included! In this way, Blair upper cervical care is a natural approach to healthcare that does not use drugs or surgery.
Also, unlike general spinal manipulation, there is no twisting or cracking the neck! A Blair upper cervical chiropractic doctor will have completed an advanced study before providing care. The process involves a focused physical and neurological assessment, and also a series of precise, customised x-rays that allow the practitioner to identify the exact direction and degree of any misalignment in your next that could be affecting your nerve system and which may be contributing to your TMJ problem.
With this level of detail, and Blair upper cervical chiropractic doctor is then able to recommend an individualised course of care that requires only a light impulse, using no more than the force you would use to feel your pulse in order to restore normal motion through the joints in the upper neck and thereby allow the body to do what it does best: heal itself!
Blair Upper Cervical Chiropractic and TMJ
At Atlas Health Australia, located in North Lakes (north Brisbane), we provide specific upper cervical chiropractic care for people looking for natural, long-term solutions for chronic health challenges, including TMJ problems, Our focus is on the relationship of the upper neck as one core element to health and wellbeing. Out principal chiropractor, Dr. Jeffrey Hannah is an Advanced Certified practitioner and instructor with the Blair Upper Cervical technique. He is an international author, lecturer, and recognised leader in the field of upper cervical chiropractic.
We hope that you have found this article valuable and informative. So if you have been dealing with a TMJ problem and would like further information, we are happy to offer a complementary over-the-phone consultation with Dr. Hannah to discuss your condition and to answer any questions you may have so that you can decide if care is right for you. To accept this offer, simply click the Contact Us, or call our office direct at 07 3188 9329. It is our privilege to assist you, and we look forward to hearing from you. Atlas Health Australia - “Hope, healing, and wellbeing from above-down, inside-out.”
Burgess JA, Kolbinson DA, Lee PT, Epstein JB. Motor vehicle accidents and TMDS: assessing the relationship. J Am Dent Assoc. 1996 Dec;127(12):1767-72; quiz 1785. doi: 10.14219/jada.archive.1996.0138. PMID: 8990747.https://pubmed.ncbi.nlm.nih.gov/8990747/
Calixtre LB, Oliveira AB, de Sena Rosa LR, Armijo-Olivo S, Visscher CM, Alburquerque-Sendín F. Effectiveness of mobilisation of the upper cervical region and craniocervical flexor training on orofacial pain, mandibular function and headache in women with TMD. A randomised, controlled trial. J Oral Rehabil. 2019;46(2):109-119. doi:10.1111/joor.12733. https://pubmed.ncbi.nlm.nih.gov/30307636/
Chinappi AS Jr, Getzoff H. The Dental-chiropractic cotreatment of structural disorders of the jaw and temporomandibular joint dysfunction. J Manipulative Physiol Ther. 1995 (Sep);18 (7):476–81. https://www.ncbi.nlm.nih.gov/pubmed/8568431
Delgado de la Serna P, Plaza-Manzano G, Cleland J, Effects of Cervico-Mandibular Manual Therapy in Patients with Temporomandibular Pain Disorders and Associated Somatic Tinnitus: A Randomized Clinical Trial. Pain Med. 2019 Oct 29. pii: pnz278. doi: 10.1093/pm/pnz278. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/31665507
Cuenca-Martínez F, Herranz-Gómez A, Madroñero-Miguel B, et al. Craniocervical and Cervical Spine Features of Patients with Temporomandibular Disorders: A Systematic Review and Meta-Analysis of Observational Studies. J Clin Med. 2020;9(9):E2806. Published 2020 Aug 30. doi:10.3390/jcm9092806. https://pubmed.ncbi.nlm.nih.gov/32872670/
Ferreira MP, Waisberg CB, Conti PCR, Bevilaqua-Grossi D. Mobility of the upper cervical spine and muscle performance of the deep flexors in women with temporomandibular disorders. J Oral Rehabil. 2019;46(12):1177-1184. doi:10.1111/joor.12858. https://pubmed.ncbi.nlm.nih.gov/31292981/
Garcia R Jr, Arrington JA. The relationship between cervical whiplash and temporomandibular joint injuries: an MRI study. Cranio. 1996 Jul;14(3):233-9. doi: 10.1080/08869634.1996.11745973. PMID: 9110615. https://pubmed.ncbi.nlm.nih.gov/9110615/
Giacalone A, Febbi M, Magnifica F, Ruberti E. The Effect of High-Velocity Low Amplitude Cervical Manipulations on the Musculoskeletal System: Literature Review. Cureus. 2020;12(4):e7682. Published 2020 Apr 15. doi:10.7759/cureus.7682. https://pubmed.ncbi.nlm.nih.gov/32426194/
Greenbaum T, Dvir Z, Reiter S, Winocur E. Cervical flexion-rotation test and physiological range of motion - A comparative study of patients with myogenic temporomandibular disorder versus healthy subjects. Musculoskelet Sci Pract. 2017 Feb;27:7-13. doi: 10.1016/j.msksp.2016.11.010. Epub 2016 Dec 11. https://www.ncbi.nlm.nih.gov/pubmed/28637604
Grondin F, Hall T, von Piekartz H. Does altered mandibular position and dental occlusion influence upper cervical movement: A cross-sectional study in asymptomatic people. Musculoskelet Sci Pract. 2017 Feb;27:85-90. doi: 10.1016/j.math.2016.06.007. Epub 2016 Jun 15. https://www.ncbi.nlm.nih.gov/pubmed/27847242