TMJ (TemporoMandibular Joint) (January 2006)

ORIGINAL QUESTION:

From Jackie Doumanian AYT Grad January '93 Fresno, CA

I have a new student who has TMJ (TemporoMandibular Joint) problems. and when we do Balasana or Padahastasana it causes her pain in her jaws. It seems any inversion causes pressure in those joints. She's only been to 3 classes and didn't tell me until after the second class so I've been helping her with some simple modifications. Have any of you dealt with this and do you have any suggestions?

ANSWERS:

From Iswari Brockschmidt, AYT 2002, Portland Oregon

Dear Jackie,

I have had TMJ problems since I was in my teens. I personally have not had issues with padahastasana, but I have had issues with many other postures that involve the neck.

If she is having trouble with inversions I would also be careful with other postures that involve the neck.

Some postures I have dealt with in my own practice are:

1. Jathara Parvatasana - I always keep my neck in a neutral position. I do not turn my head. Adding the extra element of the twist in the neck puts unnecessary pressure on the TMJ joint.

2. Restorative Balasana - If you've been teaching a restorative version of this pose (which has the student turn the head to one side), it is absolutely killer on the neck & TMJ. I spent many hours experimenting with various additional props (towels & such) to prop my forehead up so my face could be facing the floor. I essentially made a face cradle. If you have no reason to teach this restorative type of pose to your student I would skip it.

3. Bhujangasana (and Salabhasana etc... where you start on your tummy)- The rest position before and after these poses also has the student turn the neck to one side. I've found this very uncomfortable for the TMJ if held to long. When I do the posture myself I rest only momentarily with my head turned to the side and then I either do another pose, or rest in savasana on my back. I don't do long visualizations lying on my tummy.

4. Ustrasana (and sputa-vajrasana) - These two poses require strength in the neck to hold the head up appropriately. This can put tons of tension on the TMJ joint especially if it is too strenuous on the neck and you are straining.

5. V-pose - To avoid creating too much tension in the neck you need to have core strength! (Incidentally, you might also check your warm-up's. Any type of sit-up, especially the pilates type exercises, if you don't have strength in the core will overstress the neck and then the TMJ. Look for core strengthening exercises that don't over tax the neck!)

6. Other inversions - Shoulder stand etc... I am able to practice these, but I am vigilant about having the appropriate neck supports!

7. AWLAYS WARM UP THE NECK! I start every one of my routines with neck warm-ups. It may seem boring and dull, but I've found that if I don't do them I have trouble.

Here's how I do it: After pranayamas while we are all sitting on the floor I do neck movements with the breath:
* Inhale center, exhale look left, Inhale center, exhale look right, repeat once
* Inhale center, exhale tip ear to the left shoulder, Inhale center, exhale tip right, repeat once
* Exhale, drop chin to chest, inhale with light tension in the back of the neck raise had upwards, exhale, relax back down (this is one of the energizations), repeat twice
* Bring fingers to shoulders and do a few shoulder rotations

Then you can move onto other warm ups appropriate for the class etc...

Hope that helps! Many Blessings,
Iswari

From Lisa Powers, AYT since 1982

I tried a couple of interesting modifications after your description of what caused her pain. I tried Padahastasana where, in the finished position in the relaxation phase of the pose, with my elbows on my thighs and hands on either side of my jaw/face, the forearms supporting the weight of my head with the elbows pressing into the thighs. My fingers stabilized my Mandibular area as I gently pressed back toward the ears to support the jaw.

Try it? If any inversion at all is uncomfortable, have her do Paschimotasana with a strap.

Balasana may best be experienced with a stack of blankets under the head so that the spine ends up parallel with the floor. As she lowers her head down she can make a fist with both hands, and resting the fists down on the blankets - outside of the hand down (thumb side up) rest the middle of her forehead on one fist, and her chin into the other. She may need to move them around ever so slightly to find the comfortable spot, but I found this quite comfortable (not having TMJ myself). You could get more elaborate and try creating the same type of "head rest" as is on a massage table when lying face down. Use a rolled towel, still on top of a few folded blankets or pillows, creating a "donut" shape so her nose is above the open space so she can breathe, the chin and perimeter of her face supported by the towel.

Good Luck!

From Nicole DeAvilla Whiting AYT 1984, Kentfield CA

Dear Jackie,
 
I have had TMJ problems.  It can be treated by a specialist.  Mine was so bad that I was having trouble chewing - even French bread caused such a sharp pain I could not eat it.  It can have different causes.  Some people clench their teeth at night and can cause or aggravate it for example.  I have a slipped disc in mine. (The "disc" is actually in the jaw (TMJ) joint.  That is what the dental surgeon who treated me called it.  The technical name for it is interarticular fibro-cartilage.) The disc still dislocates when I open my mouth wide but I was able to avoid surgery and become pain free from a specially fitted mouth guard worn at night.  Some people can find relief from an inexpensive football players mouth guard worn at night.  You could mention this to your student.  Untreated it has the potential to get worse and/or wear the teeth down unevenly too.  
 
I would also have her try some of the restoratives that release the upper back and neck - both in class and on her own.  If the "home" treatments and yoga do not eliminate the problem, then I would suggest to her that she see a specialist for it.
 
JOY!
Nicole