Temporomandibular joint management: What university didn’t teach you! (part 2)

Many physios can graduate university feeling underprepared to confidently treat Temporomandibular Disorder (TMD) when it shows up in the clinic. It’s a complex area that often gets minimal coverage in undergrad, leaving physios unsure on where to start.

That’s where Dr. Alana Dinsdale’s Practical on Temporomandibular Joint (TMJ) management comes in—bridging the gap between theory and real-world treatment. This blog explores some of the key strategies from Alana’s Practical to help guide your approach to managing TMD effectively.

If you’d like to see exactly how expert physio Dr. Alana Dinsdale manages TMD, watch her full Practical HERE. With Practicals, you can be a fly on the wall and see exactly how top experts assess and treat specific conditions – so you can become a better clinician, faster. Learn more HERE.

Before you start

It’s important to understand that TMJ issues often occur alongside cervical or scapulothoracic dysfunction. Alana emphasises the importance of assessing and addressing these potential contributing areas before jumping into TMJ-specific treatment. As with any condition, having a clear understanding of the patient’s primary issue—whether it’s pain, stiffness, or motor control—is key. This clarity helps guide your treatment and ensures you’re using outcome measures that reflect changes meaningful to your patient, while also helping to build patient confidence and engagement in the rehab process.

Manual therapy

Manual therapy can be a useful tool in the management of TMD. There are several techniques available, and your choice should be guided by what you identify during assessment.

Massage is beneficial for patients who present with overactivity or clenching behaviours. Targeting muscles such as the masseter, temporalis, and suprahyoids can provide noticeable relief and may help patients better tolerate exercise and other treatments. The pterygoids, commonly overactive in clenchers, require intra-oral treatment. Watch Alana demonstrate how she performs a lateral pterygoid release in this short clip from her Practical:

Joint mobilisations are another great tool, especially for improving pain and range of motion. Alana demonstrates a variety of techniques including distraction, posterior-anterior glides, and medial/lateral glides of the TMJ. If you’re unsure which mobilisation is best for your patient, try treatment-directed testing—apply the technique while the patient performs their problematic movement (e.g., jaw opening) and see what provides the most benefit.

Exercise prescription

Like in any musculoskeletal condition, exercise plays a central role in managing TMD. However, the current evidence best supports postural and relaxation exercises, with limited guidance on load-based prescription and dosage for TMD-specific rehab.

Before prescribing exercises, Alana suggests asking yourself a simple question: Does this patient need to relax overactive muscles, or improve motor control? Choosing the wrong approach—for example, prescribing load-based exercises to a patient with muscle overactivity—can worsen their symptoms.

So, for those patients with overactive muscles, it’s really useful to first teach them what a relaxed jaw position feels like. This involves finding the “N” spot—with the tongue resting on the palate, teeth gently apart, and lips either together or slightly apart (whichever feels most natural for the patient). They should practice this position regularly throughout the day to help form a habit. Once they’re comfortable with this, Alana shares a great simple exercise in the below clip from her Practical:

Jaw opening difficulties—such as pain, deviations, or clicking during movement—are a common and often frustrating presentation in patients with TMD. Alana also shares a go-to exercise that can help with this in her Practical, see the below video:

Alana emphasises the importance of selecting exercises which are aligned with the patient’s presentations. For example, if a patient is struggling with end-range mouth opening, the above exercise—which limits range—likely isn’t appropriate. Similarly, if a patient has difficulty with closing movements (e.g., biting down on food), an opening-focused exercise won’t effectively address their problem.

Wrapping up

Effective TMD management relies on a comprehensive and individualised approach. By addressing contributing cervical and scapular factors, choosing manual therapy techniques based on assessment, and carefully selecting exercises aligned with your patient’s needs, you can deliver more meaningful and effective care. Always keep the patient’s goals at the center of your treatment plan—and be ready to adjust as they progress. A thoughtful, targeted approach not only improves outcomes but also helps build trust and confidence between you and your patient, which is particularly important for those more persistent TMD presentations.

If you want to see exactly how experts manage TMD, watch Alana’s full Practical HERE.