What exercises are recommended for a patient with temporomandibular joint (TMJ) dysfunction to improve mobility and reduce stiffness?

Temporomandibular Joint Dysfunction Exercises

Start immediately with supervised jaw exercises and stretching combined with manual trigger point therapy—these interventions provide the strongest evidence for pain reduction and functional improvement in TMJ dysfunction. 1

First-Line Exercise Interventions (Strong Recommendations)

The 2023 BMJ clinical practice guideline provides the most robust framework for TMJ exercise therapy, based on systematic review and network meta-analysis. 1

Jaw Exercise and Stretching

• Supervised jaw exercise and stretching programs deliver approximately 1.5 times the minimally important difference in pain reduction and should be initiated early. 1, 2
• These exercises improve jaw mobility, reduce stiffness, and provide substantial functional benefits with minimal harm. 1
• Jaw exercises can be performed as isolated interventions or combined with stretching and trigger point therapy for enhanced effect. 1

Manual Trigger Point Therapy

• Manual trigger point therapy delivers one of the largest reductions in pain severity among all conservative interventions. 1, 2, 3
• This technique releases tension in specific muscle points and should be incorporated early in treatment. 2, 3
• Approximately 85-90% of TMJ disorders are muscular in origin, making trigger point therapy particularly relevant. 4

Therapist-Assisted Jaw Mobilization

• Therapist-assisted mobilization provides substantial pain reduction comparable to trigger point therapy. 1, 2
• Manual therapy and jaw mobilization are strongly recommended first-line interventions for restricted TMJ mobility. 4
• This intervention works best when supervised by a trained therapist. 1

Postural Exercise

• Supervised postural exercises targeting head, neck, and shoulder alignment reduce compensatory muscle tension. 1, 2, 3
• Postural correction addresses biomechanical contributors to TMJ dysfunction. 1, 3
• These exercises should focus on improving postural awareness and alignment. 5

Second-Line Exercise Interventions (Conditional Recommendations)

Manipulation Techniques

• Joint manipulation for realignment has moderate evidence for effectiveness when first-line exercises provide inadequate relief. 1, 3
• Manipulation combined with postural exercise may provide additional benefit. 1
• This should only be performed by trained practitioners. 1

Jaw Exercise Combined with Mobilization

• The combination of supervised jaw exercise with mobilization has conditional recommendation in favor. 1
• This approach may be considered when isolated exercises are insufficient. 1

Exercise Program Structure

Immediate Implementation

• Conservative management including exercises should be initiated immediately and continued for at least 4-6 weeks before considering escalation. 2
• Start with jaw rest and activity modification to minimize TMJ stress during the acute phase. 2
• Implement a soft diet to reduce mechanical loading on the TMJ. 2

Coordination and Isometric Exercises

• Gentle isometric (static) exercises improve TMJ function and reduce pain. 5
• Coordination exercises enhance jaw movement patterns and reduce dysfunction. 5, 6
• Mobilization exercise including voluntary jaw exercise appears promising for myalgia and arthralgia. 6

Resistance Training

• Muscle strengthening exercises (resistance training) can be incorporated as tolerated. 6
• These exercises build jaw muscle endurance and stability. 6

Monitoring and Progression

Assessment Parameters

• Measure lateral jaw movement bilaterally (normal ≥7mm, asymmetry >2mm suggests dysfunction). 4
• Assess forward mandibular movement (normal protrusive range ≥7mm). 4
• Observe opening pathway for deviation or deflection indicating disc displacement or structural asymmetry. 4
• Document baseline measurements and track changes at each follow-up visit. 4

Timeline for Reassessment

• Reassess at 2-4 weeks with addition of second-line interventions if no improvement is seen. 2
• Continue conservative exercise management for 8-12 weeks before considering minimally invasive procedures. 2

Critical Pitfalls to Avoid

• Never proceed to invasive procedures before exhausting 3-6 months of conservative exercise options—this risks permanent changes in range of motion, facial nerve weakness, and local infection. 2, 3
• Do not use exercises simultaneously; employ them sequentially to assess individual effectiveness. 7
• Avoid premature surgery or irreversible splints, which may result in serious permanent harms. 2
• Do not combine NSAIDs with opioids, as this increases risks without clear additional benefits. 2

Adjunctive Considerations

When Exercises Alone Are Insufficient

• Add cognitive behavioral therapy (augmented with relaxation or biofeedback) if pain persists beyond initial exercise treatment—this provides the largest reduction in chronic pain severity. 2, 3
• Consider acupuncture, which shows moderate certainty evidence for TMJ pain relief. 2, 3
• NSAIDs can be used for pain and inflammation control, particularly when combined with cognitive behavioral therapy. 2, 3

Splint Therapy

• Occlusal splints may be beneficial for persistent symptoms, particularly if bruxism is present, but only after exercise therapy has been attempted. 1, 2, 3
• Splints are considered reversible, safe, and low-cost interventions. 1, 3

Heat and Cold Therapy

• Apply heat and/or cold therapy to reduce pain and inflammation in the affected area as an adjunct to exercises. 2