08/17/2026
Myofascial Release and TMJ Therapy
By Barry R. Gillespie, D.M.D., M.S.D., and John F. Barnes, PT
In the 1970s and 1980s, TMJ syndrome established itself in the
medical field as a serious disorder. Patients presented with moderate to severe pain symptoms with tension headache, migraine, ear pain, jaw pain, neck pain, tinnitus, dizziness and a host of other symptoms. Invariably they had been examined by many doctors at the best medical centers without avail. The best technology could not decipher their problem.
The TMJ field has come a long way since Costen reported his finding in the 1930s. Work has been presented showing the importance of:
1) The occlusion - bite has a key role in TMJ structural difficulty.
2) Jay to jaw bony relationships - structure alignment and its
importance to health.
3) The internal function of the TMJ disc and components.
4) The TMJ ligaments - the stylomandibular and stylohyoid in
particular.
5) The TMJ neuromuscular system.
Recently John F. Barnes, PT, among others, has brought to the medical consciousness the importance of fascia. This tissue connects us from head to toe and can exert a pressure of approximately 2,000 pounds per square inch. When the fascia is traumatized from a physical cause, a tremendous force may be encased in the physical body by the fascia! system causing pain symptoms.
As we examine the TMJ hard structures, not only are there many
fascia connections within the direct TMJ structures, but there are
connections throughout the body that may strain these structures.
Thus a trauma to one part of the body may affect another part.
Clinically we may see this after a car accident where the patient has
whiplash. Because of the strain in the back and/or neck, the fascial
sheaths traverse into the head and jaw area causing symptoms. Even though there may not have been a direct blow to the TMJ structures,they may have been adversely affected due to strain in another part ofthe body.
In examining a TMJ patient, proper diagnosis is necessary before
treatment commences. The physician, dentist or therapist should be
able to feel a strain pattern in the TMJ tissues that also may be
affected by problems outside the TMJ area. Because the fascia plays
such a critical role in health and disease, we recommend specific
treatment techniques to ease the sprain and strain on the TMJ soft
tissues. The following key areas are important for proper diagnosis
and treatment:
1) The temporo-occipital area just posterior to the TMJ - this area is
chronically affected and is especially important in an accident case.
The final occlusal position is critically affected by the tension in this
area.
2) The mandibular area - Because of the pathologic strain patterns in
the soft tissues, a calm, unstrained final occlusal position cannot be
attained until this area is treated successfully.
3) The maxillary area - The upper half of the TMJ complex may be
involved. In the same manner, the maxillary area must be treated
and unstrained for proper TMJ health.
4) The hyoid area - Often a forgotten area for treatment, suprahyoid
area will strain the mandible in a pathologic direction. This area must
be clear for TMJ tranquility.
5) The TMJ complex - The disc itself is attached by soft tissue, and
strain patterns that are present may create an abnormal functioning
disc. Every attempt to non-surgically correct this situation should be made by the therapist.
In summary, the TMJ complex consists of more than teeth, jawbones and muscles. The fascia! soft tissue component can exert tremendous pressures on the TMJ structures causing pain and other symptoms. With proper diagnosis and treatment of the fascial soft tissue structures, one can greatly enhance and expedite TMJ therapy.
Dr. Gillespie receives referrals from across the nation at my Myofascial Release Treatment Center in Paoli, Pa., from physicians, dentists and therapists for the resolution of complex head, neck and TMJ problems in adults and pediatrics. A primary purpose of this organization is to encourage research on oro-facial, craniomandibular, cervical pain and temporomandibular joint disorders.
Dr. Gillespie and I have also just designed a new seminar, "Myofascial Release and TMJ Therapy" that he will be teaching nationwide starting this fall. Dr. Gillespie has the most talented, sensitive hands of anyone I've ever encountered and is highly skilled in delicate TMJ and myofascial release techniques.
I would like to take this opportunity to share with you a myofascial
mandibular technique that he and I use quite regularly with consistent effectiveness. The myofascial mandibular technique that I am about to describe can be effective in reduction pain and strain and restoring the range of motion and critical balance in the temporo-mandibular area. When we are hurt, scared or angry, or when we are under sustained stress, our primitive responses tend to increase the tone of our masseters, our temporalis and our pterygoid musculature. This tightness can become a conditioned response over time. Occlusal discrepancies, upper cervical dysfunctions and/or forward head posture over time also create increased tone or spasm in those areas.
Trauma, inflammatory processes, or this increased stress can cause
the above-mentioned fascia! system to shorten and become restricted, acting like a "straight jacket" compressing and imbalancing the TMJ mechanism.
So even though this technique has the label "mandibular," please also consider using this technique for mandibular pain and dysfunction, headaches and with anyone that has been experiencing pain or stress anywhere in their body.
Myofascial Mandibular Technique
Phase I - Compression
Lie your patient on their back or, if you are a dentist, tilt your dental
chair back as far as it will go. Make your patient as comfortable and
as well supported as possible with pillows under their knees. If they
have forward head position, place a pillow or two under their head.
You should sit at the head of the table and slide your finger around the angle of the mandible until you feel the anti-gonial notches. Slip one or two fingers into each notch as a handhold.
If the patient has a TMJ appliance, he or she should wear this
appliance during treatment. In some TMJ patients, the retro-discal
tissue can be as hot and tender as a boil, so if the cephalad pressure causes discomfort or the patient experiences locking problems due to menisci dysfunction, do not perform these techniques. However, most patients will tolerate this well.
Phase II - Decompression
After slowly and gently removing your pressure, place your hands flat
on the sides of the face just in front of the ears over the TMJ
mechanism with your fingertips pointing towards the patient's feet.
Once your hand placement is correct, apply gentle medial pressure so that your hands don't slip on the skin.
Next apply gentle pressure with your hands towards the feet (caudad). You will quickly feel the resistance of the first fascia! barrier. In other words, the motion will come to a complete stop. Do not try to force through the fascia! barrieri it can't be done.
One of the keys to effective Myofascial Release is gentle but sustained pressure against the barrier.
Eventually, you will feel a softening like taffy stretching and then
motion moving your hands to the next barrier. Most of our patients
have multiple barriers that have developed over time, so it is wise to give the decompression phase at least three to four minutes or longer without letting go of the pressure. Repeat the technique over a series of treatments.
Always remove your pressure slowly to avoid a rebound effect of the musculature. It is usually advantageous to precede treatment with appropriate modalities and then give the patient proper instructions in head and general body posture and mechanics, coupled with an individually tailored exercise program to maintain and maximize the increased range of motion you have just accomplished for them.
Listed below are contraindications for myofascial release. These are
very straightforward and as long as these precautions are followed,
you will never injure your patient.
Do not hesitate to use Myofascial Release anywhere on the body.
These techniques are safe, easily accepted by your patients and they will see and experience immediate improvement in range of motion, as well as decreased spasm and pain.
Please consider adding these techniques to your treatment repertoire. I think you and your patients will be very pleased with the results.
John F. Barnes, PT
1. Katake, K.: The strength for tension and bursting of human
fasciae: J. Kyoto Pref. Med. Univ., 69: 484-488, 1961.
Contraindications
Unhealed fractures, osteoporosis, tumors, recent surgical repair,
inflammatory processes on a patient who is medically unstable.
The above description of this technique is designed to give you a good
starting point.
As with all "hands-on" techniques it is best to refine
your skills and the proper feel by an experienced instructor at a
"hands-on" seminar.
