C0-C1 Manipulation for the Treatment of TMJ Dysfunction

Temporomandibular joint (TMJ) dysfunction is prevalent in many individuals. TMJ dysfunction goes hand in hand with neck pathology. It is key for health care practitioners to be able to properly evaluate and treat dysfunction versus chasing symptoms/pain.  Considering this perspective, it is vital to understand the relationship between the neck and jaw. The upper cervical more specifically the OA joints have both a mechanical and neurophysiological effect on the jaw.

C0-C1 lateral flexion totals approximately 15° of ROM (8-10° in each direction respectively). If C0-C1 hypomobility is observed then you must consider the influence it has on the resting posture of the TMJ’s. Left Lateral flexion in C0-C1 results in a right glide of the occipital condyles causes relative anterior glide of the left condyle on and a relative posterior glide of the right condyle (illustration below). This tilting results in an offset posture of the head and jaw. This tension created by the offset posture will change the length tension relationships between the multipoint muscles connecting the head, jaw, neck, and scapula (illustration below).  It is widely known that having abnormal length tension relationships in muscles results in compromised flexibility, strength, and coordination leading to TMJ dysfunction and eventually symptoms.

 

 

 

 

 

 

 

 

C0-C1 also has a neurophysiological effect on the TMJ’s. C0-C3 can have effects on pain and muscle dysfunction of muscles innervated by Trigeminal nerve secondary to Trigeminal Cervical Nucleus (TCN), (Illustration below). The Mandibular branch of Trigeminal nerve has motor supply for muscles of mastication (masseter, temporalis, medial/lateral pterygoids). Auriculotemporal branch of the Mandibular branch of Trigeminal nerve supplies TMJ. This shared nucleus binds the fates of the neck and jaw. One dysfunctional region will eventually result in the downfall of the other by way of the TCN.  

 

                The mechanisms that connect the neck and jaw although complicated can result in a very simple and effective approach to curing TMJ and upper cervical. Local treatments to the TMJ such as soft tissue release of the muscles of mastication along with TMJ manipulation can improve symptoms, ROM, and overall function but will not permanently resolve the issue. Given their relationship it is necessary to clear the upper cervical spine to normalize the position of the TMJ relative to mid-line (mechanical influence) and manipulate the upper cervical spine to decrease the afferent signals causing increased tone in the jaw (neurophysiological influence).