Muscle News Vol I.12:  Masseter  
Is A Jaw Muscle Causing Your Toothache, TMJ or Ringing of the Ears?
When it comes to pain we'd rather live without. Toothache and TMJ (Jaw Joint) pain certainly rank among the least tolerable.  

The pain nerves in these areas of the mouth and face are very sensitive, which means pain in a tooth or the TMJ can be exquisite.  The pain is also hard to avoid.  Difficulty opening the mouth or pain on biting can cause you to realize just how often you use your jaw and teeth to chew, talk or even yawn!  

Fortunately, a common culprit is often responsible for these symptoms:  A powerful jaw muscle within the rear of the cheek, named the Masseter.
Above is a drawing of the referred pain caused by trigger points in the Masseter.  Notice that pain affects both the top and bottom molars, the jaw, the cheek bone, above the eyebrow and the central ear.  Trigger points in the Masseter can also cause ringing of the ears (Tinnitus) and difficulty opening the mouth (Trismus), because the Masseter is the strongest jaw clenching muscle.  

All total, trigger points in the Masseter have shown to be the cause of:
1.  Toothache
2.  Headache
3.  TMJ Pain
4.  Ear Pain
5.  Tinnitus (Ringing of the Ears)

6.  Trismus (Small Mouth Opening)
7.  Bags Under the Eyes (due to Restricted Venous Flow)

Fortunately, trigger points in the Masseter can be treated by a trigger point therapist or by you at home!  If anyone you know suffers from these symptoms, have them perform the following quick tests and self-care tips below to identify possible trigger points and myofascial dysfunction in the Masseter.

*The information in this article is not intended to diagnose or treat any medical condition and does not substitute for a thorough evaluation by a medical professional.  Please consult your physician to determine whether these self-care tips are appropriate for you.
(2) Quick Self-Tests to Tell if You have Trigger Points in Your Masseter:

Follow the instructions below to test whether myfoscial trigger points in your Masseter might be causing your tooth, jaw or ear symptoms.

TEST 1:  Two-Knuckle Test 
Let your mouth open fully without straining.  With the jaw relaxed and open, attempt to place both knuckles of your dominant hand (index and middle knuckle) between your upper and lower teeth (as shown).  A Passing result is if both knuckles fit easily through the mouth opening.  A  Not Passing result is if both knuckles do not fit easily. Let your mouth open fully without straining.

TEST 2:  Masseter Palpation

As always, palpation (the medical term for pressing, feeling and squeezing to evaluate body tissue) is often the most effective test to identify myofascial trigger points in your Masseter.   

The Masseter can be palpated by pressing with your finger tip on the on the outside of the cheek over the muscle.  Start by feeling your cheek bone and then falling off just beneath it.  That spot is the top of your Masseter.  Or using a "pincer" technique, the Masseter can be pinched from the inside and outside of the cheek (as shown).  Press gently to tolerance and cover the entire span of the muscle.  Feel for taut bands of muscle tissue and notice if any pain or other symptoms (such as tinnitus) increase.

Simple Self-Care Remedies

Here are simple self-care tips for relieving myofascial pain and dysfunction in your Masseter:

Step 1:  Warming Up with Moist Heat

To relax and warm up the fibers of the Masseter muscle, run warm shower water down the sides of your face or place moist heat such as a Fomentek bag over your cheek for 10-15 minutes. 

Step 2:  Compression

We suggest the Jacknobber to perform compression on the Masseter from the outside of the cheek, or finger tips in the pincer technique.

When performing self-care on the Masseter from the outside of the cheek, always support the opposite side of the jaw with your other hand.  Positioning your self-care tool as shown, start just below the cheek bone and cover the entire length of the Masseter, pressing in from front to back.  Feel for taut bands and tender spots.  When you find a tender spot, press into the muscle to pain tolerance ("good pain" - not pain that is sharp or makes you want to withdraw).  Hold for 10 seconds while completing at least two full breaths in and out.  Then continue searching for more trigger points.  

Step 3:  Stretching the Masseter

Stretching the Masseter can be as simple as gentle slow full opening and closing of the mouth.  10 repetitions three times per day is recommended.  Additionally, here is a is an excellent contract and relax stretch recommended by President Kennedy's physician, Dr. Janet Travell:
Contract and Relax for the Masseter
Position yourself so that your chin is propped on your palms or on your fists.  Open the mouth to a comfortable amount, just to where some tension and resistance is felt in the jaw muscles.  Then, apply isometric pressure (stationary, not moving) bewteen your jaw and your hands.  It should feel as though you are trying to open your mouth more but your hand are resisting your jaw from moving.  Hold for 7-10 seconds, take a breath in, and as you exhale let your hands relax slowly allowing your jaw to open more fully.  Perform these steps 3 times and see how far your jaw opens as the Masseter relaxes and stretches.  Never push the jaw to open beyond comfort.  This stretch can be performed 2-3 times per day.

Perpetuating Factors:  One of the major perpetuating factors that causes trigger points to return in the Masseter is forward head posture.  A remarkable contributor to chronic forward head posture comes from the feet, which we discussed in our Muscle News Issue on Morton's Foot.  
If you haven't checked your feet for the "Long Second Toe" condition that causes so many problems with posture and pain, we highly recommend reviewing this previous issue or making an appointment for a quick foot evaluation!


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NAMTPT LOGO National Association  of Myofascial Trigger Point Therapists

The MyoFree Solution: TMJ and Headache Self Care Tool
The MyoFree Solution: TMJ and Headache Self Care Tool is a conservative and effective at home treatment endorsed by Dr David G. Simons, first author of Myofascial Pain and Dysfunction: The Trigger Point Manual by Simons, Travell & Simons, 1999 second edition of Vol. 1.
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