Massage and Bodywork Magazine for the Visually Impaired - Working with the Masseter

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September/October 2013 Issue

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Working with the Masseter

By Til Luchau
[Myofascial Release]

The masseter bites, chews, and clenches. It’s active in talking, in neck stabilization, and whenever your jaw isn’t hanging open. When it is overly active or tight, the masseter is indicated in temporomandibular joint (TMJ) disorders, jaw pain, teeth grinding, headaches, whiplash pain, breathing and sleep disturbances, and more. Since touching and pressing the masseter is an instinctual response to jaw pain or tightness (Image 1), can skilled touch help relieve any of the many conditions related to the masseter?

I’ll address this question, but first, let’s review some interesting masseter facts. The word masseter is from the Greek μασ?σθαι(masasthai, “to chew”). The word massage is thought to arise from a similar but distinct Greek verb, μ?σσω (mass?, “to handle, touch, to work with the hands, to knead dough”). Attaching to the zygomatic bone (cheekbone), the masseter inserts at the rear of the mandible (jawbone), where it works to elevate, or raise, the mandible. 

The masseter is sometimes said to be the strongest muscle in the body. This is probably true, at least in terms of the amount of pressure it produces. (The soleus typically pulls strongest overall; the gluteus maximus is the bulkiest; and the heart, eye, and tongue muscles are the most active.) With all muscles of the jaw working together, the masseter can close the teeth with a force as strong as 55 pounds on the incisors or 200 pounds on the molars. And, according to the Guinness Book of World Records, in 1986 Richard Hofmann of Lake City, Florida, achieved a bite strength of 975 pounds for two full seconds.

The masseter gets its extraordinary strength from its leverage on the mandible and its complex “multipennate” arrangement—its layered muscle fibers converge diagonally on several internal tendons, analogous to a three-dimensional, many-layered feather with multiple shafts. This arrangement allows many more fibers to attach to each tendon, making it a powerful “low-gear” muscle with extra-strong pull over a short distance. 

Besides being anatomically constructed for strength, the masseter has some of the highest resting tone in the body. This is related to two facts:

1.
When we are upright, the jaw is held closed mostly by muscular function (i.e., tension) in the masseters, along with the temporalis and medial pterygoids. Since we are usually upright when we are awake, the jaw muscles are working a very high percentage of the time, resting only when we sleep or allow our mouths to open (Image 2). 

2.
Neurologically, this high level of resting tone also keeps the masseters on near-constant alert. The low level of tension in the masseter continuously stimulates the muscle spindles within the belly of the masseter, reinforcing a constant, low-level stretch reflex, like the one tested when the patellar tendon is tapped with a reflex hammer. And like a patellar ligament tap, this reflex loop makes the masseter reactive and fast acting, helping it adapt and adjust quickly during the motions of biting, chewing, and talking—and in its role as a stabilizer of the anterior neck (Image 3).

Of course, a tense and reactive masseter has drawbacks. Tension here is a contributor to TMJ pain, headaches, sleep disturbances, bruxism (teeth grinding), and other conditions. And the masseter itself is often a primary source of pain. Several studies conclude that the masseter ranks as either the most common, or the second most common, of all the places where painful myofascial trigger points appear.1

Does a coffee buzz make you grit your teeth? In vitro experiments have shown that masseter muscle cells are chemically more sensitive to caffeine than other muscles in the body, due to their low reactivity threshold.2 Caffeine intake (as well as alcohol, nicotine, surgical anesthetics, and other drugs) has been observed to increase masseter tonus and/or worsen TMJ symptoms. 

So far, we’ve listed anatomical, functional, neurological, and chemical causes of masseter tension. As if those aren’t enough, there are also clear body-mind dimensions of jaw tightness as well. Although the clichéd formula of “jaw tension = anger” is sometimes derided as an oversimplification of the nuanced and highly individualized ways that emotions are reflected in the body, even mainstream medical literature commonly cites stress, anxiety, and anger as significant contributors to bruxism, jaw tension, and TMJ problems. For example, the Mayo Clinic lists “anxiety, stress, tension, anger, frustration, and an aggressive or competitive personality type” among the causes of bruxism.3

So, can hands-on work help? Skilled manual therapy can moderate masseter tension and resulting conditions in at least three ways:

1.
By gently releasing myofascial restrictions in the muscle itself.

2.
By reducing the level of resting tone via the relaxation caused by direct pressure and massaging of muscles, and by stimulation of Golgi tendon reflexes that help balance muscle-spindle reactivity.4 

3.
By reducing overall stress and sympathetic nervous system activation.

To help you apply this information, I’ll describe two techniques from Advanced-Trainings.com’s Advanced Myofascial Technique seminars and training DVDs. Both of these techniques appear simple at first glance. If they already seem familiar, take a moment to look for a new or forgotten aspect. Each of these has subtlety and detail that at first may not be apparent.

Masseter Technique (Intraoral) 

There are many ways to work with the masseter from outside the mouth (for example, see “The Temporomandibular Joint, Part 1,” Massage & Bodywork July/August 2009, page 110). But working intraorally (inside the mouth) allows access to different parts of the masseter and surrounding tissues, especially its tendinous attachments on the mandible and zygomatic arch where Golgi tendon organs are concentrated.

When using this technique, all the customary considerations about intraoral work apply. Be sure to explain the purpose for working this way to your client, and get explicit permission first. Practice sanitary procedures such as glove disposal and hand washing, ask about latex allergies, and be familiar with any local scope-of-practice stipulations (some states require specific training or endorsement to be qualified to work within the mouth, and a small minority prohibit it outright). 

Keep in mind that the mouth is the only place we work that is even more sensitive than your hands—your clients are feeling you even more acutely than you’re feeling them. Move slowly, deliberately, and gently; find a comfortable, supported stance that allows you to keep your neck, back, shoulders, and arms relaxed.

Try working on the opposite side from where you’re standing—in other words, when standing on your client’s right, use your right hand to work intraorally on his or her left masseter (Image 4, page 115). This allows the curve of your hand to better fit the shape of your client’s jaw and avoids the “fishhook” effect of pulling the mouth open when working the same side. 

Gently slide your forefinger along the top teeth, back into the cavity between the teeth and the masseter muscle (Image 5, page 115). Your finger pad is against the teeth, and the nail side is against the medial side (inside) of the masseter. Ask your client to firmly clench his or her teeth together. If you’re in the right place, this will squeeze your finger between the masseter and the teeth. Try it on yourself now—this is the best way to understand the placement and active participation needed.

Once you’re in position with your forefinger, use the fingertips of your outer hand to press the masseter against the inside finger. Gently roll this finger to feel for tissue restrictions within the masseter itself. When you find a denser area, wait for it to soften. Your client can clench and unclench to aid this process. Work along the masseter’s length and width, paying special attention to the muscle’s attachments: superiorly, up under the zygomatic arch (be gentle, as a branch of the trigeminal nerve exits the skull here), and inferiorly, on the lateral mandible. Gently press into these attachments and wait for the overall reduction in muscle tone that signals a Golgi tendon organ-induced shift in resting tone. Repeat on the other side. 

Since the masseter’s angle gives it a small amount of lateral pull, this technique will be indicated when you see the jaw pull to one side upon opening (work the masseter and temporalis on the same side as the jaw pulls toward, and recheck. For more, see the previously mentioned July/August 2009 Massage & Bodywork article).

Mandibular Fascia Release 

Although it can be helpful to focus on one side of the jaw at a time, as in the Masseter Technique above, functionally, the jaw’s two sides always work together. Finish and balance your work with the masseter by addressing both sides simultaneously. The Mandibular Fascia Release Technique (from Advanced-Trainings.com lead instructor Larry Koliha) is a great option. 

Begin by using the palms and thenar eminences of both hands (Image 7) to feel into just the outer layers of skin and superficial fascia over the masseters and jaw (Images 8 and 9). Use a gentle downward (caudal or inferior) pressure to sense and release any restrictions or side-to-side differences, but just in the outer layers of tissue. Don’t use cream or lotion (at least not yet), as you’ll need a bit of friction to feel these superficial layers—with a lubricant, you may be working the muscles themselves, but you’ll be sliding over the outer layers, which are a big part of the jaw’s structural makeup. 

Once the outermost layers feel released and even side-to-side, repeat this technique, but engage a slightly deeper tissue layer each time. With practice and sensitivity, you can often feel into each of these layers in turn: 

1.
The skin and subdermal layers (which have varying amount of adipose cells within them). 

2.
The parotid fascia (a continuation of the chest and neck fascia associated with the platysma muscle, which contains its own muscle fibers parallel to the platysma’s [Image 8]).

3.
Posteriorly, the parotid glands and ducts that the parotid fascia surrounds (gentle pressure here is usually well tolerated). 

4.
The masseter muscles, which themselves have two or three layers (depending on which anatomy text you consult), with the outer layer usually the most textured and tendinous, and the inner layer the softest and most muscular.

5.
Deep and anterior to the masseters, the deeper mucosal layers of the mouth cavity.

6.
And finally, the teeth, gums, and bones of the upper and lower jaw.

Once you’ve slowly worked down to the level you want, you’ll be passively depressing (opening) the jaw with your slow, sliding movement. If you feel your client resist this opening, slow down, come back out a layer, ask for breath, and wait for the masseters to let go. 

Of course, masseter issues do not exist in isolation. The jaw, being very mobile and suspended primarily by soft tissue, is particularly vulnerable to imbalance and strain elsewhere in the body. For example, jaw tension is one response to the instability of a whiplash injury to the neck, as the masseter, temporalis, and other jaw muscles attempt to brace and stabilize the injured area. 

As always, be sure to address whole-body patterns, since issues such as hip pain,5 pelvic angle, pelvis muscle tension,6 posture,7 and spinal curves have all been shown to correlate with jaw function. A whole-body approach will yield more sustainable results and more satisfying outcomes. 

 

Notes

1. J. G. Travell et al., Myofascial Pain and Dysfunction (Baltimore: Lippincott Williams & Wilkins, 1999), 330.

2. P. J. Adnet et al., “In Vitro Human Masseter Muscle Hypersensitivity: A Possible Explanation for Increase in Masseter Tone,” Journal of Applied Physiology 80, no. 5 (1996): 1,547–53.

3. Mayo Foundation for Medical Education and Research, “Bruxism/Teeth Grinding,” accessed August 2013, www.mayoclinic.com/health/bruxism/DS00337/DSECTION=causes. 

4. R. Schleip, “Fascial Plasticity—A New Neurobiological Explanation, Part I,” Journal of Bodywork and Movement Therapies 7, no. 1 (2003): 14.

5. M. J. Fischer et al., “Influence of the Temporomandibular Joint on Range of Motion of the Hip Joint in Patients With Complex Regional Pain Syndrome,” Journal of Manipulative and Physiological Therapeutics 32, no. 5 (2009): 364–71.

6. C. Lippold et al., “Relationship Between Thoracic, Lordotic, and Pelvic Inclination and Craniofacial Morphology in Adults,” Angle Orthodontist 76, no. 5 (2006): 779–85.

7. A. Cuccia and C. Caradonna, “The Relationship Between the Stomatognathic System and Body Posture,” Clinics 64, no. 1 (2009): 61–6.

Til Luchau is a member of the Advanced-Trainings.com faculty, which offers distance learning and in-person seminars throughout the United States and abroad. He is a Certified Advanced Rolfer and the originator of the Advanced Myofascial Techniques approach. Contact him via info@advanced-trainings.com and Advanced-Trainings.com’s Facebook page.

To read this article in our digital issue, click here.



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