Tempomandibular Issues and Temporal Headaches
There is a very interesting bi-directional relationship between the muscles of the jaw and temporal headache presentations. The relationship is bi-directional in that either one can influence the other. This is both very powerful and potentially very confusing.
The Neck and TMJ Relationship: It's Complicated!
How could this be confusing? Here is one example: When researchers inject an irritant into muscles of mastication, it produces discomfort in the upper cervical area. If you had a client with upper cervical pain, you are very likely to treat the muscles in that area, all of which will be quite sensitive. Treating them will not resolve the discomfort in the neck, much to your frustration and to the client. You are likely to use a different treatment approach addressing the cervical muscles. The problem, however, is not the approach used but where you are directing your efforts.
How might you have known this? Most commonly, careful examination of the cervical area will produce many very tender spots, but none of those spots will elicit the "That's it; that's my pain" response from the client. If everything is tender, you are fishing in the wrong waters.
In one research study, subjects with advanced arthritis of the temporomandibular joint were given an injection to anesthetize the joint. Where one would expect the relief to occur is in the area immediately surrounding the joint. In fact, where the greatest relief occured is in the muscles of the neck!
Wouldn't They Tell You?
One would think that if the problem ultimately resides in the muscles of the jaw, the client would recognize that and tell you something about jaw discomfort in their history. That is perfectly reasonable, and it seldom happens.
This is very confusing for client and therapist alike. We have this idea that the original cause should predate the offending symptom, making the relationship obvious. It's a nice idea. . .
The reality is that the therapist must know to look for these relationships when they are not obvious. This knowledge is invaluable in making the therapy truly effective and efficient. It is what we, as soft tissue professionals should know to serve our clients in the best way possible. That is the essence of PNMT.