We all likely know someone who experiences jaw pain. Many, myself included before specializing in body mechanics, often mistakenly say, “I live with TMJ!” This is a common misconception, albeit a humorous one in a nerdy way, because everyone possesses Temporomandibular Joints (TMJs). TMJ simply refers to the jaw joint itself; if you're chewing enough food to fuel your day, you definitely have two TMJs.
What people actually mean is, “I live with TMD!” This stands for Temporomandibular Joint Disorder, a condition affecting the jaw joints and surrounding muscles.
TMD can be a debilitating condition, manifesting in various ways. You might experience a sensation akin to something exploding inside your ear, making it difficult to chew solid foods and leading to a diet primarily of smoothies. Chronic muscle tension can create a vice-like grip around your face, a feeling I personally know and would not recommend. The severity of TMD can vary greatly, with some individuals experiencing symptoms far more intense than mine, such as their jaw literally locking shut or, less commonly, open, particularly in those with hypermobility.
For those who don't experience TMD, it's easy to overlook its impact. However, nearly a third of people will experience TMD at some point in their lives (Valesan, et al, 2021). While each body adapts uniquely to posture, this article will explore how seemingly unrelated factors, like not wearing appropriate shoes, can contribute to poor posture and subsequent chronic pain, specifically affecting the temporomandibular joint.
It's important to clarify that no single posture is inherently "bad." Instead, the goal is postural diversity. Remaining in any single position for too long can be detrimental. Our bodies are designed for pliability and adaptability; neglecting this mobility can lead to progressively restricted joints and reduced freedom of movement without pain.
This article doesn't suggest that changing your footwear is a standalone treatment for TMD. For comprehensive care, it's crucial to consult with a qualified Chiropractor, Physical Therapist, or another holistic healthcare provider who understands these connections and collaborates with a dentist. However, the intricate relationship between the jaw and the rest of your body, particularly your lower extremities, is fascinating. Understanding how footwear influences this connection can be pivotal in uncovering the root cause of your pain, reminding us that the body functions as a tensegrity structure. Chronic alterations in muscle, bone, and ligament relationships caused by many "comfortable" shoes can exacerbate daily pain, whether it's low back pain, pelvic pain, foot pain, or tmj pain. To delve deeper into the link between footwear and pelvic floor muscles and rehabilitation, please read this.
The jaw joint showcases remarkable engineering, unlike any other joint in the human body. Its movement involves an initial rotation followed by a hinging action on a disc, similar to a complex version of our spines or knee menisci. This can be likened to the two-stage swing mechanism found in some cabinets, allowing for smoother and more efficient function. The intricate opening of the jaw is meticulously controlled by muscles that extend deep into the back of your face, behind your nose and above the upper palate.
To feel your own jaw joint, gently place your fingers in your ears and open your mouth; you'll notice the joint separate and move. Observe its proximity to your ears. Beyond hearing, our ears are crucial for balance and spatial orientation, controlled by fluid movement within six semicircular canals of the vestibular system. These can be imagined as liquid levelers used by builders, indicating an object's relationship to its surroundings.
While the scientific community doesn't yet fully comprehend the vestibular system, this "leveler" analogy helps explain why placing something between your teeth can alter the engagement of your foot and calf muscles (Valentino, 1991). Your leveling system is affected by your jaw position, which in turn sways your ear position, and subsequently the position of your vestibular canals—like subtly changing the headings on a compass. This shift necessitates specific muscular coordination throughout your entire body to maintain upright posture. In essence, we are all personal gyroscopes or gimbals, highlighting the tensegrity structure of our connective tissues, where every part is intimately connected to every other part.
Another prevalent theory suggests a more stepwise connection between the jaw and feet. The jaw sits directly in front of our first spinal vertebra. Chronic tightness in these tissues can subtly shift the alignment of the upper spine, creating a domino effect that impacts all subsequent articulating spinal segments below, reinforcing the tensegrity concept (D'Attilio et al, 2005). When one part of this intricate system changes, the entire system is compelled to adapt. As your high school physics teacher might have explained, every action has an equal and opposite reaction – unless you want to lose your balance. Our bodies are remarkably adept at making subtle, short-term compensations, often without us even noticing, until these turn into chronic postural deviations and pain.
Furthermore, a tight jaw can significantly increase the activity of muscles that pull the neck forward, by up to 33 times (Ehrlich et al, 1999). This chronic forward head posture not only causes neck pain but also forces the lower back to over-curve to compensate. This, in turn, tilts the pelvis forward into an anterior pelvic tilt, where the front of your belt line is closer to the floor than the back. To counteract this, your hips must flex more, altering the lines of pull for your glutes and calf muscles, thereby decreasing their ability to effectively propel you (Garstka et al, 2022).
This illustrates a kinetic chain approach to understanding the body, where each segment influences the ones above and below. This interconnectedness likely explains why a recent study found that individuals with dysfunctional jaws were more prone to pelvic joint restrictions and exhibited reduced control over sideways stabilizing movements of the foot (pronation & supination) (Garstka et al, 2022) (Ohlendorf et al, 2014).
Here are some other compelling findings supporting this kinetic approach:
Voluntarily clenching your teeth can lower the arch of your foot (Cuccia, 2011)
Clenching for 90 seconds significantly reduces hip range of motion, and conversely, releasing your jaw increases hip motion (Fischer et al, 2009)
Jaw position has been shown to influence walking speed and stability (Fujimoto et al, 2001)
Asymmetrically placing something between the teeth of rats for one week literally induced scoliosis or curved spines (D'Attilio et al, 2005)
The next two studies focus on the concept of ‘centric relation’ of the jaw. This seemingly complex term simply refers to the lower jaw being in its most neutral, centered, forward, and raised position (Palaskar et al, 2013).
(Understanding this concept is an excellent litmus test for your jaw care providers. If they appear confused when you discuss it, seek a different professional who has a comprehensive understanding and offers diverse treatment options before considering jaw adjustments, surgery, or injections.)
The complexity arises because this central jaw position may not always align with how your teeth fit together, especially if you've had orthodontic work, or where your muscles are most relaxed. However, positioning the jaw in this 'centric relation' can lead to greater running symmetry and improved balance throughout the entire body below (Maurer et al, 2015) (Bracco et al, 2004).
What does this mean for you? Two key takeaways. While many studies explore the jaw's influence on the feet, it's equally true that foot position affects the jaw, the "levelers" in your ears, and your spinal curves. Why add extra stress to these structures by balancing on unstable cushions or altering lines of pull with high heels all day? When our muscles cannot support us as designed, we risk developing pain conditions from overloading passive structures, such as plantar fasciitis, knee pain, and low back pain, thereby increasing injury risk. If you experience TMD, carefully consider your footwear choices and how they might contribute to the compensatory tension in your head, poor posture, and your ability to find pain relief.
Choosing less invasive and bulky shoes can facilitate a more correct standing posture, reducing the likelihood of developing these long-term problems. However, if you have severe foot problems or deformities, this advice may not be suitable, so always consult your healthcare provider for an accurate diagnosis. A word of caution: be skeptical of overly prescribed custom orthotics and steroid injections.
Secondly, pay close attention to your jaw position during daily activities, such as working at the computer or lifting weights. Many of us unconsciously clench our jaws due to stress, unaware of its impact on our performance. The most relaxed jaw position involves keeping your lips together, your tongue resting on the roof of your mouth just behind your front two teeth (the "N" sound position), and your teeth gently separated. Make it a habit to return to this relaxed jaw position throughout the day, and observe the decrease in jaw pain, surrounding tissue tension, and downstream improvements in stability and alignment.
For more movement tips on cultivating adaptable, "good" posture in your healing journey, explore our Youtube and Instagram for quality ideas.