Disclaimer:
Any medical/health information in this post is provided for general informational and educational purposes only and does not substitute for professional advice. Accordingly, before taking any actions based on such information, I encourage you to consult with the appropriate professionals. The use or reliance of any information contained in this course is solely at your own risk.
In any joint in the body, there are limits to how far the joint can go. For example, if you stretch your wrist backwards, you’ll feel a tightness at the front of the wrist. Or, if you straighten your knees, you’ll feel a point at which you can’t go any further.
The body has natural checks and balances to keep joints where they belong, which protects joints from injury.
We refer to these checks and balances as a joint’s stability. The stability of a joint limits the joint’s mobility, or how much the joint can move.
Every joint in the body has a certain amount of stability and mobility, controlled by three main components:
1) The shape of the bones of the joint
For example, the hip joint is a very deep ball and socket, so there’s less movement than there is in the shoulder joint, which is a shallow ball and socket).
As you can see above, the hip has more bone around it, which limits its movement. This is why most people can put their arm overhead, but very few people can put their leg overhead!
2) The joint capsule and ligaments
The next source of stability in a joint is from the capsule and ligaments. Think of this as a trampoline with a net around it. You can travel around on the trampoline, but if you try to leave the confines of the trampoline, the fabric of the net or the surface on which you stand will give a little, but ultimately keep you inside.
3) The muscles around the joint.
The last source of stability is from the muscles around the joint.
Try this - hold your left hand limp. Then, use your right hand to grab your left hand, and while your left hand remains relaxed, move it around using your right hand. Now, make a strong fist with your left hand. Try to move it around using your right hand, but notice how much harder it is to move. This is because the muscles around the wrist joint are now contracted, creating stability to the joint and limiting its mobility.
How does this apply to the jaw?
In the jaw joint, we also have stability created by the bones, capsule and ligaments, and muscles.
Some individuals, however, have less stability in the capsule and ligaments.
This can be due to a number of factors, including genetics, repeated overstretching, or hypermobility conditions such as Ehler’s Danlos Syndrome or Hypermobility Spectrum Disorder.
In these cases, a person’s jaw joint might experience too much mobility, because their joint is missing stability from the “trampoline” component (capsule and ligaments).
In this case, a person might experience a condition called subluxation.
Subluxation is a when the TMJ is too mobile. The jaw travels too far during opening, and often results in a popping or clicking noise when in a wide open position. This is often accompanied by a sensation of the joint going out of place.
Sometimes, people feel they have to maneuver or press on their jaw to get it to “go back in.”
As you can see in the photos below, the photo on the left shows normal opening. There’s a little “bump” on the top bone where the red arrow points. This bump is called the articular eminence. The jaw joint is supposed to stay behind the articular eminence, even when your mouth is fully opened. The photo on the right demonstrates a joint that has subluxed - or traveled too far forward. You can see that the jaw is now in front of the articular eminence.
When the jaw travels over the articular eminence, it often makes the clicking or popping sound heard when opening.
When the jaw starts to close, there is often another click or pop as the jaw travels back over the articular eminence again, returning to its normal “joint home.”
This excessive travel is not ideal for the joint’s health, because the joint is continually overstretched and travels onto tissues that are not meant to support a joint’s movement.
Often, when this condition is present, it’s common to have other problems also arise as their body tries to compensate for the lack of stability. Remember - there are three main components to stability - bone, capsule and ligament, and muscle.
While we can’t change the bone, our muscles will often pick up the slack. The jaw muscles will frequently work overtime to create more stability. This overworking can often lead to muscle-related pain.
Treatment for subluxation is centered around creating more stability and reducing the excessive motion of the joint, as well as treating any downstream effects and pain resulting from the body’s compensation.
A full evaluation is often necessary to diagnose what may be contributing, and to determine the best plan for treatment. Reach out to us via the “Contact Us” page and we’ll call you to discuss if we’re a good fit for an evaluation!
Cheers,
Dr. Rebecca Salstrand, PT, DPT
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