Do you have a nagging pain in your jaw when eating or talking? Does your jaw click or pop every time you open your mouth? You could be suffering from Temporomandibular Joint Dysfunction (TMD).
Almost one out of every three people have a clicking jaw. While it can happen at any age, it is three times more common in women than men and most frequently affects people between the ages of 20 and 50. Even though you may not have pain yet, a clicking jaw is usually the first symptom of TMD.
What is a temporomandibular joint (TMJ)?
These joints are found just in front of your ears and connect your jawbone (mandible) to your skull. They are the most hardworking joints in your body; every time you speak, swallow, or chew, these joints and their surrounding muscles are at work. The TMJ is a complex joint complex that relies on a small piece of cartilage called a “disc” to act as a shock absorber and ensure smooth movement.
I have a clicking jaw – How did it happen?
Temporomandibular disorder, or TMD, happens when there’s a problem with the muscles that move your jaw and your temporomandibular joints. Jaw clicking is only one symptom of TMD and happens your TMJ doesn’t move properly. Your jaw joint is supposed to work like a sliding hinge. To keep it moving smoothly, there is a small piece of cartilage called a “disc” that acts as a shock absorber. This complex movement pattern is controlled by a multitude of small muscles all around the TMJ.
The clicking sound occurs when the disc is displaced (usually pulled too far forward). When you open your mouth, the jaw bone slides forward to recapture the disc, creating an audible click or pop. While the click itself is a mechanical, or movement, glitch, the pain usually comes from swelling and inflammation inside the joint when it becomes irritated.
Causes of a clicking jaw
The exact cause of TMD isn’t always clear, but several factors contribute to the condition. These include:
- Bruxism: Grinding or clenching your teeth, especially at night.
- Injury: A direct blow to the jaw, whiplash, or other trauma can damage the joint.
- Arthritis: Both osteoarthritis and rheumatoid arthritis can affect your TMJ, causing inflammation and degeneration.
- Stress: Emotional stress can lead to muscle tension in the jaw, neck, and shoulders, contributing to TMD symptoms.
- Poor Posture: Holding your head forward for long periods, can strain the muscles of the face and neck.
- Misalignment: An improper bite or misaligned teeth can put extra stress on the jaw joint.
How severe is my jaw problem?
At first, you will only notice occasional clicking or popping in the jaw. You will have some with mild discomfort around the joint that eases with rest. In the mornings, you will feel tension in your jaw muscles, but this resolves quickly with a bit of movement.
If left untreated, the clicking and popping will happen more often. There will be some tenderness over and around the joint, especially after eating hard foods. Sometimes, the click or pop will be painful, and you might notice that you can’t open your mouth all the way.
The next stage is when the pain becomes the main problem. A dull pain in front of your ear will become your constant companion. You will have frequent headaches, and your face will feel swollen and sensitive on the side of your painful TMJ . At this point, you will start to avoid eating anything hard or chewy, and even yawning will be painful.
Diagnosis
Physiotherapy diagnosis for a Clicking Jaw
Our physiotherapists are experts at diagnosis joint-, muscle-, and nerve problems. To make a diagnosis, we use movement tests, palpation, and a detailed history.
Movements tests are used to assess the mobility or your TMJ. We also use palpation to evaluate the joint for tenderness, swelling, inflammation, and muscle spasm. Another crucial part of clicking jaw treatment is taking a thorough history of the problem. This allows us to identify contributing factors, like posture, sleeping position, breathing patterns, or teeth grinding.
We understand the physiological healing stages you’ll go through, and custom-fit your treatment program.
X-rays
X-rays are usually not necessary for a clicking jaw, unless you had a significant injury, like a direct blow. This imaging only shows the bones, so will not give us any additional information about the movement of your jaw.
Your physiotherapist can refer you to get x-rays taken if necessary.
Diagnostic ultrasound
Diagnostic ultrasound can be used to show the presence of a swelling and inflammation around your jaw. It can also give us more information about other soft tissue structures in the area.
If you need an ultrasound, your physio will refer you.
MRI
An MRI scan is rarely indicated for a clicking jaw, but might be necessary if we suspect other, underlying conditions. In these cases, your physiotherapist will refer your to the right specialist.
Why is the pain not going away?
The disc in your TMJ is largely avascular, meaning it has poor blood supply. Limited blood supply also means limited ability to heal. If the underlying problem isn’t addressed, your clicking jaw can progress to a locked jaw, where the disc gets “stuck”. In the long run, this increases your risk of osteoarthritis. Without treatment, about 18.4% of people with a clicking jaw eventually suffer from a locked jaw.
Problems we see when patients come to us with a clicking jaw
Specific Muscle Weakness and Bite Force Reduction (Likelihood: ~35% – 72%)
Muscle weakness and localized fatigue are hallmark secondary effects of chronic TMD. Clinical studies demonstrate that patients with TMD exhibit a mean maximum bite force of 75 N, representing a 35% reduction compared to healthy controls
Joint stiffness, particularly upon awakening, is a persistent complication for 10% to 15% of adults with TMD
Physiotherapy treatment
Our priority is to determine the extent of the problem behind your clicking jaw. We test the structures surrounding your jaw and neck to get a clear picture of your problem. At the start of treatment and right through the treatment protocol, we assess the muscles, joints and nerves that contribute to your pain. Initial treatment is focused on addressing pain and inflammation, and restoring joint mobility. Once your pain allows, and joint mobility improves, your rehabilitation program will include exercises and home advice to target the compensation patterns and retrain the motor control around the joint.
Your physiotherapist will guide you through the whole recovery process and continuously monitor your progress.
Phases of rehabilitation
Phase 1: Protection (Week 0 – 1)
Pain and Inflammation Control (1-2 weeks): The initial focus is on reducing pain and inflammation through rest, ice or heat therapy, and over-the-counter pain relievers.
Rest the Jaw: Avoid chewing gum, eating very hard foods, or opening your mouth too wide when you yawn .
Soft Food Diet: Eating softer foods for a few weeks gives the joint time to heal .
Stress Relief: Learning to relax your jaw muscles and improving your sleep can stop you from clenching your teeth at night .
The initial stage focuses on reducing acute inflammation and muscle guarding through non-invasive, reversible “self-management” strategies. Patients are prescribed a 2-to-4-week regimen of a strict soft-food diet, local thermal therapy (moist heat or ice packs), and jaw rest to minimize mechanical loading . Pharmacological support typically includes non-steroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants to break the pain-spasm cycle, alongside education on identifying and avoiding parafunctional triggers like clenching or nail-biting `[1, 2]`. Most patients with mild symptoms see significant relief during this phase as the joint environment begins to stabilize .
The following non-surgical, 12-week physiotherapy program for Temporomandibular Disorders (TMD) follows a phased approach to restore joint health and neuromuscular function.
The initial phase focuses on calming the inflamed joint environment through “jaw rest” and gentle, non-aggressive unloading. Clinical interventions include cryotherapy (ice packs applied for 10–15 minutes) to induce vasoconstriction and Grade I–II Maitland oscillatory techniques to inhibit pain and resolve local edema `. Patients are educated on adhering to a strict soft-food diet and identifying parafunctional triggers, such as clenching or wide yawning, to prevent mechanical irritation `. **Functional Outcome:** Stabilization of the joint with a measurable reduction in acute resting pain intensity (VAS scores) and resolution of inflammatory swelling “.
Phase 2: Restore mobility (Weeks 1 – 2)
Restoring Normal Range of Motion (2-4 weeks): Gentle stretching and jaw exercises are introduced to improve flexibility and restore normal jaw movement.
active physical and behavioral therapies designed to restore range of motion and correct neuromuscular imbalances. This phase incorporates professional manual therapy for joint mobilization and Orofacial Myofunctional Therapy (OMT) to retrain tongue posture and swallowing mechanics . Custom intraoral stabilization splints are often introduced at this stage to decompress the joint space, while behavioral interventions such as stress management or sleep hygiene address psychosocial “perpetuating factors” like bruxism . Functional improvements in mouth opening and chewing quality are typically measurable by the end of this 8-week block “.
Once acute pain is regulated, the protocol transitions to restoring joint and cervical range of motion using Rocabado’s 6×6 exercise protocol and myofascial release of the masseter and temporalis muscles `. Physiotherapists employ manual therapy for joint mobilization alongside postural training—specifically chin tucks and scapular stabilization—to realign the craniocervical complex and reduce tension in the masticatory system `. **Functional Outcome:** Immediate improvement in mandibular mobility, typically manifested as an increase in painless maximum mouth opening (MMO) by 4–6 mm “.
Phase 3: Motor control and coordination (Weeks 2 -4)
Strengthening and Stabilization (4-6 weeks): Exercises to strengthen the jaw muscles and improve joint stability are incorporated into the treatment plan.
This phase prioritizes active strengthening and Orofacial Myofunctional Therapy (OMT) to retrain tongue posture and swallowing mechanics, addressing the root biomechanical causes of dysfunction `. Techniques such as electromyography (EMG) coupled with biofeedback are utilized to help patients regulate muscle activation and perceive optimal resting postures, effectively breaking the cycle of chronic clenching `. **Functional Outcome:** A reported 55% to 75% reduction in overall pain intensity and a significant increase in perceived chewing quality “.
Phase 4: Start strengthening (Weeks 4-6)
Posture and Habit Correction (Ongoing): Addressing underlying issues such as poor posture, teeth grinding, and stress is crucial for long-term management.
Phase 4: Strength and Coordination Integration (Weeks 9–10)
Rehabilitation advances to progressive loading and eccentric muscle actions to enhance neuromuscular coordination and endurance under mechanical stress `. Therapy sessions focus on refining complex movements, such as lateral and protrusive glides, to ensure the condyle-disc complex moves smoothly without “condylar jumps” or deviations `. **Functional Outcome:** Restoration of normal mandibular movements (45–55 mm) and the elimination of audible joint sounds or mechanical “catching” sensations “.
Phase 5: Long term maintenance and retraining (Weeks 6+)
Advanced Therapies (As needed): In some cases, more advanced treatments such as physical therapy, splints or mouth guards, or injections may be recommended.
The final phase targets the consolidation of gains and a controlled return to all daily activities, including the reintroduction of harder food textures `. Patients establish a long-term home maintenance program and lifestyle adaptations—such as ergonomic workspace adjustments and stress management—to ensure continued jaw health without conscious effort `. Functional Outcome: Achievement of full masticatory function, characterized by comfortable eating and extended talking without jaw fatigue, with clinical success rates reaching 87% to 92% “.
Maintenance and Prevention (Long-term): Continuing with exercises, stress management techniques, and good posture habits is essential to prevent recurrence.
Healing time
The healing time for TMD can vary depending on the severity of the condition and the individual’s response to treatment. With proper care and rehabilitation, most people can experience significant improvement within a few weeks to a few months.
If you are experiencing any of the symptoms of TMD, it is important to seek professional medical advice for an accurate diagnosis and appropriate treatment plan.
Physio protocol time frame for healing (weeks/months)
- A full recovery and return to sport will take longer and should not be confused with the healing period.
- It takes about 3 to 4 months to return to exercise and sports.
- You will need physiotherapy treatment twice a week for the first two weeks.
- After this, your treatment sessions can be …
- Remember: “Non-operative Treatment” or Non- Surgical Not
conservative
Other forms of treatment
- Medication: Your GP can prescribe anti-inflammatory medication or muscle relaxants.
- Dentist: If you also have toothache as well as a clicking jaw, your dentist should assess if there are any underlying dental conditions causing your pain.
- Occlusal splints: Your dentist can prescribe a bite plate to help relieve pressure on your temporomandibular joint at night.
- ENT: An ENT specialist can treat underlying problems that make it difficult to breathe through your nose.
- Psychologist: Stress and anxiety are a major contributors to jaw pain, so seeing a mental health professional may be beneficial.
Is surgery an option?
Major surgery is extremely rare and is only used under very specific conditions. These conditions include:
- Persistent pain and functional impairment that does not respond to non-surgical treatment in 6 months.
- Significant structural abnormality visible on MRI or CT scans.
- Jaw locking that prevents normal daily activities like eating or speaking.
