Craniomandibular dysfunction (CMD) - the jaw joint and its pitfalls

CMD and TMJ - What are they?

Craniomandibular dysfunction, or CMD for short, describes one of the most common functional disorders of our time and refers to a functional disorder of the jaw joint. This is often referred to as Temporomandibular Joint Disease, or TMJ. This can affect the opening or closing of the jaw. A cracking sound in the jaw joint may be the first indication of an incorrect load or misalignment in the joint. Muscular tension caused by grinding or simply “biting” or “clenching” the teeth at night can also be a reason for muscular overexertion and, in the long term, lead to overload in the temporomandibular joint.

What symptoms do a disorder of the jaw joint cause?

The symptoms of CMD/TMJ can be very varied. Those affected often report ear pain. In most cases, however, previous ENT examinations did not reveal any abnormal findings in the ear.

But it is not only earaches that can occur. Rather, headaches, tinnitus, hearing loss, dizziness, neck and back pain, even knee pain can be a sign of a functional disorder in the jaw joint.

Those affected often seek advice from dentists, orthopedists, ENT specialists, neurologists, etc. to clarify the cause of their disorders. However, in most cases, no organic causes can be found by the aforementioned specialists. Often, a psychosomatic complaint is diagnosed without considering functional disorders.
Diagnosis of CMD/TMJ

First of all, it is important to evaluate the existing symptoms using conventional medicine. Depending on the symptoms, a wide range of disciplines are involved. These most often include ear, nose, and throat specialists, dentists and orthodontists as well as neurologists and orthopedists. If the causes of an organic disease have been ruled out here based on the range of symptoms, functional complaints also need to be considered.

Depending on the level of knowledge of the individual disciplines, initial functional evaluations are already carried out during the organic examination. In order to gain a deeper insight into the symptoms, additional training in manual medicine and osteopathy is required. These enable the assessment of the function of individual joints, muscles and even the connective tissue such as the so-called fascia. Movement patterns, restrictions in the extent of joint movement, or even pathological muscle tension are revealed by this and can often establish connections between individual symptoms.

Manual medical examinations also include checking so-called bite splints. If a splint is inserted in a jaw that was already “crooked” before the dentist took the impression, it can solidify the issues or, in the worst case, even intensify them.

Therefore, the fit of the splint should always be checked by a manual physician / osteopath after it has been made, and checked by the dentist. If necessary, further adjustments to the splint may be necessary until a static balance is achieved throughout the body.

The causes of sudden hearing loss seem to be multifactorial. Patients often report an occurrence in particularly stressful situations coupled with neck or back pain. But is it the stress? Is it the tension? Or can other causes be found?

One of the most common causes of a one-sided hearing loss is a so-called earwax plug. This can occur spontaneously or, far more often, through the use of ear sticks, and, depending on its severity, can cause hearing loss-like symptoms.

However, if this is not the case, it is important to rule out other causes of unilateral hearing loss. Other causes of sudden hearing loss can be divided into organic, functional and psychological components.

Why can back or knee pain come from the jaw joint?

You are probably thinking: “That’s not possible! Chronic back pain or knee pain originating from the jaw joint – there’s no connection there! They are too far apart for there to be a connection!”

Unfortunately, this is not true. In order to understand the origin of disorders in our body, the following aspects should be considered. Our axial skeleton is an interconnected system of bones and joints. All tissues connected to the axial skeleton (tendons, muscles, fascia, etc.) can influence it or are influenced by it.

Disturbances in the posture of our body can influence the position and mobility of organs in the body cavities and thus affect their function.

Due to these conditions, a disturbance, e.g. a malposition in a joint, inevitably leads to changes in the entire system.

Why can back or knee pain come from the jaw joint?

You are probably thinking: “That’s not possible! Chronic back pain or knee pain originating from the jaw joint – there’s no connection there! They are too far apart for there to be a connection!”

Unfortunately, this is not true. In order to understand the origin of disorders in our body, the following aspects should be considered. Our axial skeleton is an interconnected system of bones and joints. All tissues connected to the axial skeleton (tendons, muscles, fascia, etc.) can influence it or are influenced by it.

Disturbances in the posture of our body can influence the position and mobility of organs in the body cavities and thus affect their function.

Due to these conditions, a disturbance, e.g. a malposition in a joint, inevitably leads to changes in the entire system.

CMD/TMJ - The experiment

I find the following example very nice to illustrate these facts. By the way, you can also try this experiment at home.

Take a towel that is as large as possible – preferably a beach or sauna towel, one that is about as big as you are. With the help of another person, stretch the towel out lengthwise by holding the corners. Note the tension on each side, the feeling of support, the stability and balance of the towel in this state. Now lay this flat on the floor, bed or a couch. Now tie a knot in one of the corners of the towel, so that there is still a small tip of the corner sticking out. Now stretch the towel again by grabbing the corners of the towel again. Take notice of it again. Something has changed – right? Ask the person at the other end of the towel once if anything is different than before. You will notice that even the person at the other end notices a slight change in the balance of tension. You will also be able to see the wrinkles in the towel, which are not limited to the knot in place. Rather, they extend far into the towel.

The towel is, in fact, you. A change at the farthest corner of our body can lead to a change at the other end. In this process, the changes become less overall as the distance increases, but several changes such as muscle tension with joint changes and overuse as well as stress are all “nodes” in our body and affect it. The more disturbances occur, the greater the symptomatology. Thus, symptoms often can only be noticed years after a disorder has occurred because the initial changes were too small. If, however, the initial cause of a complaint is overlooked, this can possibly lead to a lack of improvement despite numerous but merely symptom-oriented therapy approaches.

Since all muscles of the body are connected via joints and tendons, a tension in the jaw joint, for example, can cause a blockage of the cervical vertebrae via a tension in the neck muscles. This in turn can act as a so-called descending chain along the spine into the pelvis and ultimately cause knee and ankle joint strain. The development of such pain rarely occurs spontaneously, but is usually associated with a prolonged overload. However, if the cause of the initial discomfort is found, even if it is far away from the actual point of pain, it may be possible to bring about lasting relief.

Finding these points of origin is the basis of manual medicine / osteopathy and also of applied kinesiology.

What therapy options are available?

The therapy options depend on the symptoms and their causes and can be treated by a variety of approaches. In addition to the classic ENT & dental as well as orthodontic and orthopedic approaches to organic disorders, complementary therapy options include:
Which form of therapy is right for you will be decided in a consultation with the physician treating you. It is important to exclude contraindications for one or the other method and to find the right approach for you individually. In most cases, it is not just one method that has to be the right one. Rather, it can be the combination of the individual therapy methods that makes the difference.