Headaches have plagued mankind throughout recorded history. Over 50 million American annually have headaches so severe that they seek medical help. Most of these people state that their head pain is a major disruptive force in their daily lives. The majority of these patients suffer from Temporomandibular Joint Disorders (TMJ/TMD).

TMD is a group of separate, but related disorders of the temporomandibular joint and all the associated muscles, ligaments, nerves etc. Unfortunately, TMDs are the most frequently misdiagnosed of the medical/dental conditions. Two facts account for this sad state of affairs.

First, few doctors (physicians, dentists, chiropractor, osteopaths etc.) have proper training in the diagnosis and treatment of TMD. Secondly, these disorders have many overlapping symptoms, which mimics many other conditions. The most common symptoms are head pain (headache) and clicking or popping of the jaw joints, but the eyes, ears, neck and shoulders, the mouth, teeth and throat may be affected.

The TMJoints are considered the most complex joints in the human body because they must provide for rotational movements, sliding movements and an infinite range of combined movements.

The nerve to the TMJoints called the trigeminal nerve because of its three branches. It is the largest of the 12 Cranial Nerves and makes up more nerve tissue than the other 11 combined. The trigeminal nerve plays a very important role in the brain's identification and reaction, both physically and emotionally, to not only head pain, but for the rest of the body, too.

The trigeminal nerve cells group together in the brain stem to form the trigeminal nucleus (TN). The trigeminal nucleus gets branches sent to it from pain nerves originating in every part of the body.

When a patient feels chronic pain, the trigeminal nucleus gets "heated up". The TN also contains a structure known as the reticular activating system (RAS). The brain cells act as the awaking center of the brain. Patients with injured TMJoints will have the RAS become hyperactive. This accounts for the sleep disturbances suffered by chronic pain patients. The trigeminal nerve can also suffer injuries that create nerve pain (neuralgia). Trigeminal neuralgias are considered among the most pain afflictions in the history of mankind.

Movements of the TMJs are provided primarily by four pairs of muscles. These are the masseters, the temporalis, the lateral pterygoids and the medial pterygoids. All of the muscles of the neck and shoulder girdle are involved in jaw function such as jaw posturing and swallowing. The muscles are considered "accessory muscles" of TMJoint function. The need for all of these muscles to work in a coordinated manner is one of the keys to understanding TMJoint disorders. When the joints are injured, the ligaments rarely heal completely. A damaged TMJoint ligament can cause a dislocation of the articular disc and the condyle. The muscles that support the joint may become painful to touch and in function.

The unique internal design of the joint is the reason that it is affected like no other joint in the body. Behind the condyle lie several structures. One is the posterior band, a loosely structured ligament that is highly elastic. It acts as a rubber band to pull the disc backward in jaw closing movements. Like all joints, the TMJoints contain a large, intricate complex of nerves telling the body, on a subconscious level, information about the position and condition of the joint. Surrounding the posterior band is a complex of blood vessels. When the jaw is closed, these vessels are compressed like a sponge. When the mouth opens and the condyle moves forward, the blood vessels expand to fill the vacated space. When the condyle is pushed to far backwards in the joint, it can slip off the cartilage disc and onto these nerves and blood vessels. This is a posteriorized condyle. Posteriorized condyles cause several bad things to happen in the joint.

1. The blood vessels and nerves are compressed with the constant movement of the jaw. This injures these delicate structures and causes inflammation and pain. This pain is signaled to the brain. Additionally, all blood vessels contain smooth muscle in their walls. All smooth muscles have nerves. These nerves are damaged by the constant grinding of the condyle. They send low level pain signals to the brain. These constant pain signals heat up the pain pathways in the central nervous system.
2. Posteriorized condyles function at the edge of the joint range of movement. It is at the extreme ranges of movement that all joints have pain nerves. This is nature's way of telling the body that it is doing a bad thing to the joint. The TMJoints have these pain nerve cells like every other joint. With posteriorized condyles, every time the mouth is closed, low level pain signals are sent to the brain. With time, this constant barrage of pain signals sensitizes (heats up) these pathways and the brain becomes conscious of the pain.
3. Distalized condyles are an abnormal condition that throws the fine delicate relationships of the head and neck muscles out of balance. This leads to muscle tension, strain and fatigue.
4. Distalized condyles damage the disc itself. Improperly positioned condyles can even wear through the disc and the bones of the jaw and skull start to break down as they rub together. This causes an arthritic type of breakdown of the bones themselves.

Keep in mind the constant agitation of the central nervous and the strain on the muscles controlling the joint as you read the symptoms below. The connection between the physical strains of the joints and the symptoms starts to become apparent.