Ironing Out the Jaw

When's the last time you really spent some time on a client's jaw? It can seem like a distraction when you've got plenty of other work to do, but what if it could be the key to solving a constellation of problems? What if it could make your practice stand out in a sea of other practitioners?

The technique I'm about to describe is based on myofascial release, but don't let that term worry you. It just means we're going to move slowly and consider the tissue broadly rather than focusing on any individual muscle. But first, when should you use it?

The Why

I ask about the jaw any time my client describes neck or head pain, especially if there are multiple components involved. For instance, if a client tells me they have neck pain, and further investigation reveals headache and neck stiffness, my next question will be, "Is there anything going on with your jaw?"

I'll also jump immediately to jaw work if a client reports having headaches that are primarily in their temples. That's based on my own clinical experience, but studies do indeed show a strong correlation between jaw disorders and headaches in general.

Jaw problems will vary widely from client to client, but don't feel like you need to have the answer to why their jaw pops, or be able to recognize any specific dysfunction. We won't be changing any muscle in particular or trying to force a new configuration of the joint. Instead, we're going to approach this from a myofascial perspective and let the client's body make the change for us.

Note: If a client mentions new or unusual jaw pain or dysfunction, refer them to their doctor or dentist for evaluation.

The How

For this technique, start by envisioning the course of the masseter muscle. This thick, two-headed sheet of muscle runs from the zygomatic arch (the cheek bone) down to the angle of the mandible. Now, think of the temporalis: starting with a wide, fanlike origin along the side of the cranium, it dips down through the zygomatic arch to latch onto the coronoid process of the mandible.

Got those in mind? OK. . . now mostly forget about them. The point here isn't to go from origin to insertion, or to work with attachment sites, or anything like that. Instead, we're going to work with the broad sheets of fascia these muscles are embedded in (see video above).

Start by sitting at the head of the table with your client supine. Use clean hands to avoid introducing more oil (and to prevent breakouts!), and go through this sequence:

1. Place your fingertips along both sides of the bottom of the jaw, applying minimal pressure.
2. Draw your hands up toward the top of the client's head, dragging the tissue superiorly.
3. Wait patiently, allowing your contact to slowly make the journey up the face and into the scalp. This should take 1-3 minutes.
4. (Optional) Repeat, this time with the client slowly opening and closing their jaw. Ask them to use a small, pain-free range of motion.

What we're doing here is taking the tissue along the sides of the face and displacing it upward, then waiting for movement to happen. If you use no oil or lotion (which I recommend), this can take a while! No need to press hard or force anything; think of it as slowly ironing out the fascia.

While it can be tempting to dig into the masseter and try to blast those painful points to pieces, I find that approach can just lead to more tightness and sensitivity. Instead, we're trying to gradually convince the client's nervous system that so much tension and sensitivity isn't necessary. This can take a number of sessions, so set expectations accordingly.

Where to Go Next

Once you've seen how prevalent jaw pain is, and how effective a little work there can be, there are a lot of useful directions to explore. Start by getting more specific with the muscles of the anterior and lateral neck. The sternocleidomastoid and scalenes, for instance, can have an interesting relationship with pain in the area, and are worth investigating.

From there, think broadly about muscles that affect the neck, shoulders, and posture. Look for tight trapezius and pectoral muscles, and even the rotator cuff. The more I try to pick apart "where pain comes from," the more I realize how interrelated it all is.

There are some other muscles, like the pterygoids, that can only be accessed intraorally. That can be worthwhile (and it's a useful skill to learn via continuing education), but I get excellent results from the noninvasive technique above. I find that working broadly can have deep effects, all without having to get too specific.