February 2, 2021 • 11 mins
I talk to Cathy Gordon, a specialist in TMJ, Temporomandibular Joint Disorders, called TMD, about the impact improving your posture can have on that condition. Cathy is a co-founder of the Association of Chartered Physiotherapists in Temporomandibular Disorders, ACPTMD.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
James Crow (00:08):
Hello, I'm James from posturestars.com. And
thanks for joining this PostureStars podcast. Today we'll be
talking about posture for TMJ,which is your temporomandibular
joint and temporomandibular typedisorders, which is a bit of a
mouthful, but that's what we'reall talking about today. So I'm
joined by Kathy Gordon, who's cofounder of the Association of
(00:30):
Chartered Physiotherapists inTemporomandibular Disorders,
ACPTMD. And she works inCheshire, England, in the heart
of our, very wealthy andbeautiful part of England. So as
you our listener, you'll findthis useful if you've got jaw
pain, or you grind your teeth,have jaw locking problems or
(00:51):
difficulty opening your mouthfully. Or maybe you get
headaches, or jaw tension. Sohello, Cathy.
Cathy Gordon (00:59):
Hi, James.
James Crow (01:00):
We're going to talk about the relationship today of
good posture to TMJ issues.
Treatments for Temporomandibularjoint issues such as muscle and
joint treatments, manualtherapy, heat, relaxation
techniques, avoiding eating hardor chewy foods, all of those can
help. But what's therelationship between posture and
TMJ problems?
Cathy Gordon (01:23):
Right, okay. Well, it's a very good question. The
jaw joints, or the moretechnical term temporomandibular
joints, are located very closeto the neck and to the rest of
the spine. So the optimalalignment of the jaw joints,
where the jaw muscles, jointsand teeth are in their best
position, depends on good spinalalignment and good posture.
James Crow (01:41):
Very good. That's what we like to hear, we're all
about good posture here. So howcommon are these problems?
Cathy Gordon (01:46):
Okay, so TMD refers to temporomandibular
disorders, and this consists ofany pain or dysfunction, or any
of the jaw regions of the jaw,and the lower facial areas,
originating from the jaw joints,muscles and dental areas. So
these problems are more commonthan people think. And they do
affect approximately 10% of thepopulation.
James Crow (02:06):
Wow, that's loads. I didn't realise it was that many.
Cathy Gordon (02:08):
Yeah, it is very, very common in this day and age
when a lot of people arestressed with work, and there's
a lot more demands on everydaylife, these problems are quite
common.
James Crow (02:18):
Okay, so I was about to ask, what sort of things
caused these problems is itmainly stress and anxiety?
Cathy Gordon (02:24):
I would say so, that many problems I see are
caused by stress and anxiety.
And so therefore, the mostcommon structures affected are
the muscles of the jaw, or themasticatory muscles. The
problems with these musclesoccur when people grind or
clench their teeth. And thereare also other common habits,
such as nail biting, chewingyour lip, chewing gum, that are
all kind of causes of facialpain as well. So you can also
(02:45):
get problems with the jawjoints, or the disc within the
joints. And also trauma to thejaw area can also cause pain.
And these can also causesymptoms, such as clicking and
locking of the jaw.
James Crow (02:58):
Well yes, that sounds very painful.
Cathy Gordon (03:00):
And there's also a very close mechanical area of
mechanical relationship betweenthe jaw and the upper neck. So
this is due to the proximity ofthe two areas, but also the
nerve links between the twoareas. So it's very common to
feel neck pain as well as jawpain.
James Crow (03:14):
Oh, that's interesting. Now often when I'm
working with people whopresented with neck pain, there
does tend to be a lot of jawtension going on there. And I
think that's a relationshipbetween the anxiety and stress
that they have. That's probablyfitting into the sorts of work
that you do as well.
Cathy Gordon (03:29):
Yes, absolutely.
Yes, these are these are very,very common causes.
James Crow (03:33):
So what sort of signs should people look out
for? You've mentioned clickingand problems with closing the
jaw. What sort of signs wouldindicate to someone that they've
got a TMJ problem?
Cathy Gordon (03:45):
Okay, well, I find the most common symptoms are
pain that's when people come toyou and want to want to seek
medical advice. So clicking andjaw locking is also very common,
as well as some peopleexperience difficulty opening
the mouth as well. People who doexperience muscle pain in the
face, usually they clench theteeth at night or in the day or
both. And this again, is verycommon with stress occurring
(04:08):
alongside stressful situations.
Headaches are also quite common.
And this is due to the linksbetween the jaw joints and the
neck and also the fact that thestructures in the neck and the
jaw do refer pain into parts ofthe head as well.
James Crow (04:20):
What's the relationship between dentists
and physiotherapy fortemporomandibular joint
problems?
Cathy Gordon (04:25):
Okay, well, we do work quite closely with
dentists. Dentists are becomingmore aware of our role in the
management of TMD. About 10years ago, I set up or I
founded, co-founded theAssociation of Chartered
Physiotherapists inTemporomandibular Disorders with
a dentist who's very highlyrecognised as one of being the
most prominent TMD specialistsin the UK. So we set this group
(04:47):
up to promote physio and also towork alongside. To enable us to
train physio's and to workalongside dentists so that we
can actually really form a teamin this area because we both
play very important roles.
James Crow (05:00):
Excellent, that's good to hear that you're working
together, we like a combinedapproach. So is there much that
the dentist can do inassociation with you? Do you
liaise with them and assignexercises? Or is it more about
spotting what's going on?
Cathy Gordon (05:12):
Well, quite often, the dentists are the first line
professionals that see thesepeople coming in with jaw
problems, because they oftenassess the jaw when they're
looking at teeth. They eitherrefer their patients usually
back to the GP to be referred tophysio, or they sometimes refer
to the dental hospital. In oursituation, patients tend to get
referred to the dental hospitalin Manchester. And then they
access physio through the dentalhospital if they need to.
James Crow (05:34):
I got you. So people refer to you from the dental
hospital or in person by thedentist themselves.
Cathy Gordon (05:40):
Yes, yes, that's right. Quite often the patients
have, especially if they grindtheir teeth, they've already had
splints made and they've beenwearing for a while before we
actually get to see them. So wedo find that that does help to
reduce a lot of the you know,the pain. And then we come in by
restoring normal mechanics tothe joints and the muscles and
also the neck as well. And wealso look further down into the
(06:01):
thoracic spine, or even thepelvis area, if we feel there
any problems there that arecontributing to the patient's
symptoms.
James Crow (06:07):
Oh, that's great, because that brings me to my
next question, which is howwould you work with someone's
posture to help these issues,
Cathy Gordon (06:13):
The basis of good spinal and jaw alignment depends
on optimum core muscleactivation from around the
pelvis and the abdominal areasas well as the upper spinal
areas. I find that if we canteach the patient to switch on
their core muscles, then we canoften free the upper neck and
the jaw areas as well as thearms and legs because a lot of
people do hold tensionunnecessary tension in these
(06:34):
areas. And I find that unlessyou address globally, the whole
sort of spine and muscles aroundthe spine, and the important
muscles that we need toactivate, we don't often allow
for that lengthening of the neckand the freeing up of the
muscles of the jaw, which areoften over tense and
contributing to people'ssymptoms. I also find that if
people have poor core strength,or don't hold themselves well,
during posture, they tend to fixwith the neck and the jaw
(06:56):
muscles. And again, this canlead to problems as well,
James Crow (06:59):
I see. So the longer they've had these problems, is
it harder to work with as aresult?
Cathy Gordon (07:04):
I find that if we can make the correct diagnosis
early on, that we can actuallyhave quite an impact quite
quickly.
James Crow (07:10):
Oh, that's good.
Cathy Gordon (07:11):
If we're working with the right people, as in the
dentist, if appropriate, to lookat the occlusion and make sure
that the jaw joint muscles andteeth are working you know as as
well as possible, then we reallyneed to be looking at the the
jaw but also in relationship tothe neck and the back and you
know, lower limbs. So once wecan establish what the problems
(07:31):
are, if there's any jointstiffnesses in any of the
joints, spinal joints, or theneck or the jaw, if we treat
that we then can activate themuscles better. And then we can
achieve, you know, good posturein that way.
James Crow (07:43):
That sounds very, very helpful. So for our
listeners here, some of themwill be thinking, "Oh my gosh,
that sounds like me, I've gotthese problems." What advice
would you offer to those peopletoday?
Cathy Gordon (07:54):
If you feel that you have pain and the pain that
shouldn't be there and you feelthat you have any of these
symptoms that I've mentioned orthat you feel that you are
experiencing symptoms thataren't you shouldn't be
experiencing, I would definitelyseek some help. The dentist is
often the first lineprofessional to go visit but you
could also see your GP. If youfeel that a physiotherapist is
appropriate, you could try andaccess physiotherapy earlier on.
(08:16):
We also see patients viamaxillofacial clinics. And that
is another way to accessphysiotherapy as well.
James Crow (08:23):
So how about some psychological help? Would that
be of benefit?
Cathy Gordon (08:26):
I was, I think that's a very important question
to ask. And, and it's a veryimportant part of a
multidisciplinary approach totreating TMD. Quite often a
professional such as a physio ora dentist or a maxillofacial
surgeon, if they feel that'sappropriate, they can make those
referrals. If you feel that yoursymptoms are caused by excessive
stress, and you feel that youneed help in this area to talk
your problem through to somebodyI think seeking advice from a
(08:49):
psychologist, a clinicalpsychologist or a counsellor is
very appropriate and would bevery beneficial.
James Crow (08:55):
Yeah, I think that sounds like a good idea if
that's one of the primary causesof TMJ issues.
Cathy Gordon (09:00):
Yes, absolutely.
It's really a matter of takingan approach and actually
treating all the causes. And asI say, because stress and
tension is a big cause of jawpain, that it's a very valid
route to follow.
James Crow (09:12):
Yeah, that's, that's good to hear. And there are lots
of ways that we can reducestress and anxiety and tension
in our lives such as exercising,going for walks, taking therapy,
taking time for ourselves,having enough sleep. Yes, of
course, looking after yourselfposturally, so that you're
breathing well and you'redigesting well. Listening to
podcasts with myself and Cathy,that's always a nice way to
(09:34):
reduce tension.
Cathy Gordon (09:35):
Yes, absolutely.
There are also apps such asheadspace, again, can also be
very useful in teaching you howto breathe and how to relax as
well. And these can be carriedout on a regular basis.
James Crow (09:46):
That's right.
Headspace is a very popular app,isn't it? That's a mindfulness
app that people can downloadfrom the Apple store or from the
Android store. Yes, it's verypopular with a lot of my clients
as well and although I can'tlisten to it myself, as I like
to do my meditations on my own,those people who do use
headspace have said very goodthings about it.
Cathy Gordon (10:05):
Yes, I've had good reports, too.
James Crow (10:07):
There you go. You heard it here first go out and
meditate guys get your posturesorted, sort out your TMJ
problems, the world will be abetter place. Great. So there
are loads of ways to find yourhelp. It's just a case of people
getting off their butt withtheir terrible neck and jaw
posture and finding help andseeking a solution and getting
themselves sorted.
Cathy Gordon (10:25):
Yes, absolutely.
James Crow (10:26):
Yes. That's good to hear. I hope that's useful for
listeners today. There's lots ofuseful information there from
Kathy. It's up to you as thelistener if you're having these
problems to go and seek help. Itdoesn't sound from what I've
looked at and seen on theinternet that there's that much
out there that you can do foryourself. So I would advise you
to go and get some help there.
And it just remains for me tosay thank you very much, Cathy,
(10:48):
for taking the time to talk tous today. It's been really
enlightening. I've learned somegood stuff there. I do hope our
listeners find this useful. Sothank you very much for being on
the show.
Cathy Gordon (10:59):
Thank you for inviting me.
James Crow (11:01):
It's been a pleasure. Cheers, Cathy.
Cathy Gordon (11:03):
Bye
Hello, I'm James from posturestars.com. And
thanks for joining this PostureStars podcast. Today we'll be
talking about posture for TMJ,which is your temporomandibular
joint and temporomandibular typedisorders, which is a bit of a
mouthful, but that's what we'reall talking about today. So I'm
joined by Kathy Gordon, who's cofounder of the Association of
(00:30):
Chartered Physiotherapists inTemporomandibular Disorders,
ACPTMD. And she works inCheshire, England, in the heart
of our, very wealthy andbeautiful part of England. So as
you our listener, you'll findthis useful if you've got jaw
pain, or you grind your teeth,have jaw locking problems or
(00:51):
difficulty opening your mouthfully. Or maybe you get
headaches, or jaw tension. Sohello, Cathy.
Cathy Gordon (00:59):
Hi, James.
James Crow (01:00):
We're going to talk about the relationship today of
good posture to TMJ issues.
Treatments for Temporomandibularjoint issues such as muscle and
joint treatments, manualtherapy, heat, relaxation
techniques, avoiding eating hardor chewy foods, all of those can
help. But what's therelationship between posture and
TMJ problems?
Cathy Gordon (01:23):
Right, okay. Well, it's a very good question. The
jaw joints, or the moretechnical term temporomandibular
joints, are located very closeto the neck and to the rest of
the spine. So the optimalalignment of the jaw joints,
where the jaw muscles, jointsand teeth are in their best
position, depends on good spinalalignment and good posture.
James Crow (01:41):
Very good. That's what we like to hear, we're all
about good posture here. So howcommon are these problems?
Cathy Gordon (01:46):
Okay, so TMD refers to temporomandibular
disorders, and this consists ofany pain or dysfunction, or any
of the jaw regions of the jaw,and the lower facial areas,
originating from the jaw joints,muscles and dental areas. So
these problems are more commonthan people think. And they do
affect approximately 10% of thepopulation.
James Crow (02:06):
Wow, that's loads. I didn't realise it was that many.
Cathy Gordon (02:08):
Yeah, it is very, very common in this day and age
when a lot of people arestressed with work, and there's
a lot more demands on everydaylife, these problems are quite
common.
James Crow (02:18):
Okay, so I was about to ask, what sort of things
caused these problems is itmainly stress and anxiety?
Cathy Gordon (02:24):
I would say so, that many problems I see are
caused by stress and anxiety.
And so therefore, the mostcommon structures affected are
the muscles of the jaw, or themasticatory muscles. The
problems with these musclesoccur when people grind or
clench their teeth. And thereare also other common habits,
such as nail biting, chewingyour lip, chewing gum, that are
all kind of causes of facialpain as well. So you can also
(02:45):
get problems with the jawjoints, or the disc within the
joints. And also trauma to thejaw area can also cause pain.
And these can also causesymptoms, such as clicking and
locking of the jaw.
James Crow (02:58):
Well yes, that sounds very painful.
Cathy Gordon (03:00):
And there's also a very close mechanical area of
mechanical relationship betweenthe jaw and the upper neck. So
this is due to the proximity ofthe two areas, but also the
nerve links between the twoareas. So it's very common to
feel neck pain as well as jawpain.
James Crow (03:14):
Oh, that's interesting. Now often when I'm
working with people whopresented with neck pain, there
does tend to be a lot of jawtension going on there. And I
think that's a relationshipbetween the anxiety and stress
that they have. That's probablyfitting into the sorts of work
that you do as well.
Cathy Gordon (03:29):
Yes, absolutely.
Yes, these are these are very,very common causes.
James Crow (03:33):
So what sort of signs should people look out
for? You've mentioned clickingand problems with closing the
jaw. What sort of signs wouldindicate to someone that they've
got a TMJ problem?
Cathy Gordon (03:45):
Okay, well, I find the most common symptoms are
pain that's when people come toyou and want to want to seek
medical advice. So clicking andjaw locking is also very common,
as well as some peopleexperience difficulty opening
the mouth as well. People who doexperience muscle pain in the
face, usually they clench theteeth at night or in the day or
both. And this again, is verycommon with stress occurring
(04:08):
alongside stressful situations.
Headaches are also quite common.
And this is due to the linksbetween the jaw joints and the
neck and also the fact that thestructures in the neck and the
jaw do refer pain into parts ofthe head as well.
James Crow (04:20):
What's the relationship between dentists
and physiotherapy fortemporomandibular joint
problems?
Cathy Gordon (04:25):
Okay, well, we do work quite closely with
dentists. Dentists are becomingmore aware of our role in the
management of TMD. About 10years ago, I set up or I
founded, co-founded theAssociation of Chartered
Physiotherapists inTemporomandibular Disorders with
a dentist who's very highlyrecognised as one of being the
most prominent TMD specialistsin the UK. So we set this group
(04:47):
up to promote physio and also towork alongside. To enable us to
train physio's and to workalongside dentists so that we
can actually really form a teamin this area because we both
play very important roles.
James Crow (05:00):
Excellent, that's good to hear that you're working
together, we like a combinedapproach. So is there much that
the dentist can do inassociation with you? Do you
liaise with them and assignexercises? Or is it more about
spotting what's going on?
Cathy Gordon (05:12):
Well, quite often, the dentists are the first line
professionals that see thesepeople coming in with jaw
problems, because they oftenassess the jaw when they're
looking at teeth. They eitherrefer their patients usually
back to the GP to be referred tophysio, or they sometimes refer
to the dental hospital. In oursituation, patients tend to get
referred to the dental hospitalin Manchester. And then they
access physio through the dentalhospital if they need to.
James Crow (05:34):
I got you. So people refer to you from the dental
hospital or in person by thedentist themselves.
Cathy Gordon (05:40):
Yes, yes, that's right. Quite often the patients
have, especially if they grindtheir teeth, they've already had
splints made and they've beenwearing for a while before we
actually get to see them. So wedo find that that does help to
reduce a lot of the you know,the pain. And then we come in by
restoring normal mechanics tothe joints and the muscles and
also the neck as well. And wealso look further down into the
(06:01):
thoracic spine, or even thepelvis area, if we feel there
any problems there that arecontributing to the patient's
symptoms.
James Crow (06:07):
Oh, that's great, because that brings me to my
next question, which is howwould you work with someone's
posture to help these issues,
Cathy Gordon (06:13):
The basis of good spinal and jaw alignment depends
on optimum core muscleactivation from around the
pelvis and the abdominal areasas well as the upper spinal
areas. I find that if we canteach the patient to switch on
their core muscles, then we canoften free the upper neck and
the jaw areas as well as thearms and legs because a lot of
people do hold tensionunnecessary tension in these
(06:34):
areas. And I find that unlessyou address globally, the whole
sort of spine and muscles aroundthe spine, and the important
muscles that we need toactivate, we don't often allow
for that lengthening of the neckand the freeing up of the
muscles of the jaw, which areoften over tense and
contributing to people'ssymptoms. I also find that if
people have poor core strength,or don't hold themselves well,
during posture, they tend to fixwith the neck and the jaw
(06:56):
muscles. And again, this canlead to problems as well,
James Crow (06:59):
I see. So the longer they've had these problems, is
it harder to work with as aresult?
Cathy Gordon (07:04):
I find that if we can make the correct diagnosis
early on, that we can actuallyhave quite an impact quite
quickly.
James Crow (07:10):
Oh, that's good.
Cathy Gordon (07:11):
If we're working with the right people, as in the
dentist, if appropriate, to lookat the occlusion and make sure
that the jaw joint muscles andteeth are working you know as as
well as possible, then we reallyneed to be looking at the the
jaw but also in relationship tothe neck and the back and you
know, lower limbs. So once wecan establish what the problems
(07:31):
are, if there's any jointstiffnesses in any of the
joints, spinal joints, or theneck or the jaw, if we treat
that we then can activate themuscles better. And then we can
achieve, you know, good posturein that way.
James Crow (07:43):
That sounds very, very helpful. So for our
listeners here, some of themwill be thinking, "Oh my gosh,
that sounds like me, I've gotthese problems." What advice
would you offer to those peopletoday?
Cathy Gordon (07:54):
If you feel that you have pain and the pain that
shouldn't be there and you feelthat you have any of these
symptoms that I've mentioned orthat you feel that you are
experiencing symptoms thataren't you shouldn't be
experiencing, I would definitelyseek some help. The dentist is
often the first lineprofessional to go visit but you
could also see your GP. If youfeel that a physiotherapist is
appropriate, you could try andaccess physiotherapy earlier on.
(08:16):
We also see patients viamaxillofacial clinics. And that
is another way to accessphysiotherapy as well.
James Crow (08:23):
So how about some psychological help? Would that
be of benefit?
Cathy Gordon (08:26):
I was, I think that's a very important question
to ask. And, and it's a veryimportant part of a
multidisciplinary approach totreating TMD. Quite often a
professional such as a physio ora dentist or a maxillofacial
surgeon, if they feel that'sappropriate, they can make those
referrals. If you feel that yoursymptoms are caused by excessive
stress, and you feel that youneed help in this area to talk
your problem through to somebodyI think seeking advice from a
(08:49):
psychologist, a clinicalpsychologist or a counsellor is
very appropriate and would bevery beneficial.
James Crow (08:55):
Yeah, I think that sounds like a good idea if
that's one of the primary causesof TMJ issues.
Cathy Gordon (09:00):
Yes, absolutely.
It's really a matter of takingan approach and actually
treating all the causes. And asI say, because stress and
tension is a big cause of jawpain, that it's a very valid
route to follow.
James Crow (09:12):
Yeah, that's, that's good to hear. And there are lots
of ways that we can reducestress and anxiety and tension
in our lives such as exercising,going for walks, taking therapy,
taking time for ourselves,having enough sleep. Yes, of
course, looking after yourselfposturally, so that you're
breathing well and you'redigesting well. Listening to
podcasts with myself and Cathy,that's always a nice way to
(09:34):
reduce tension.
Cathy Gordon (09:35):
Yes, absolutely.
There are also apps such asheadspace, again, can also be
very useful in teaching you howto breathe and how to relax as
well. And these can be carriedout on a regular basis.
James Crow (09:46):
That's right.
Headspace is a very popular app,isn't it? That's a mindfulness
app that people can downloadfrom the Apple store or from the
Android store. Yes, it's verypopular with a lot of my clients
as well and although I can'tlisten to it myself, as I like
to do my meditations on my own,those people who do use
headspace have said very goodthings about it.
Cathy Gordon (10:05):
Yes, I've had good reports, too.
James Crow (10:07):
There you go. You heard it here first go out and
meditate guys get your posturesorted, sort out your TMJ
problems, the world will be abetter place. Great. So there
are loads of ways to find yourhelp. It's just a case of people
getting off their butt withtheir terrible neck and jaw
posture and finding help andseeking a solution and getting
themselves sorted.
Cathy Gordon (10:25):
Yes, absolutely.
James Crow (10:26):
Yes. That's good to hear. I hope that's useful for
listeners today. There's lots ofuseful information there from
Kathy. It's up to you as thelistener if you're having these
problems to go and seek help. Itdoesn't sound from what I've
looked at and seen on theinternet that there's that much
out there that you can do foryourself. So I would advise you
to go and get some help there.
And it just remains for me tosay thank you very much, Cathy,
(10:48):
for taking the time to talk tous today. It's been really
enlightening. I've learned somegood stuff there. I do hope our
listeners find this useful. Sothank you very much for being on
the show.
Cathy Gordon (10:59):
Thank you for inviting me.
James Crow (11:01):
It's been a pleasure. Cheers, Cathy.
Cathy Gordon (11:03):
Bye
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