What are the recommended treatments for a sore jaw muscle likely caused by temporomandibular joint or masticatory‑muscle strain?

Treatment of Sore Jaw Muscle

Start with supervised jaw exercises and stretching combined with manual trigger point therapy, as these interventions have the strongest evidence for pain relief and functional improvement with minimal harm. 1, 2

First-Line Conservative Management

The vast majority (85-90%) of jaw muscle pain is muscular in origin rather than true joint pathology, meaning conservative therapy is highly effective for most patients. 3

Strongly Recommended Initial Interventions

• Jaw exercise and stretching programs should be initiated immediately, as they provide significant pain reduction and functional improvement 1, 2
• Manual trigger point therapy delivers substantial pain relief and should be incorporated early in treatment 1, 2
• Postural exercises targeting neck and shoulder alignment are strongly recommended, particularly since masticatory muscle dysfunction often involves these regions 1, 2
• Patient education and reassurance about the benign, self-limiting nature of most jaw muscle pain is essential, as symptoms often resolve over time 1

Additional Conservative Measures

• Heat or cold application to the affected muscles can provide symptomatic relief 1
• Soft diet and jaw rest by avoiding wide mouth opening, excessive chewing, and aggravating activities 1
• Massage of the masticatory muscles may reduce muscle tension 1

Pharmacologic Options

• NSAIDs are recommended for pain and inflammation control, particularly when combined with cognitive behavioral therapy 1, 2
• Avoid acetaminophen with or without muscle relaxants, as these have uncertain benefits 2
• Never use opioids combined with NSAIDs due to important harms and strong recommendations against this combination 1, 2

Cognitive-Behavioral Approaches

• Cognitive behavioral therapy (CBT) with or without biofeedback is strongly recommended, particularly when pain persists beyond initial conservative treatment 1, 2
• Stress management and relaxation techniques may be beneficial, as psychological factors like anxiety and depression can exacerbate jaw muscle pain 1

Second-Line Interventions (If Initial Treatment Fails After 4-6 Weeks)

• Therapist-assisted mobilization has strong evidence for effectiveness 1
• Manipulation techniques for joint realignment have moderate evidence supporting their use 1, 2
• Acupuncture has moderate evidence for effectiveness and may be considered 1, 2

Splint Therapy Considerations

Occlusal splints should only be used for specific indications, not as routine first-line therapy:

• Consider splints only if there is documented bruxism or clinically significant masticatory impairment with documented pain and loss of function 2
• Splints are reversible, safe, and low-cost, but evidence for routine use is limited 1, 2
• Avoid irreversible oral splints entirely, as there is a strong recommendation against their use 1

Interventions to Avoid

The following have uncertain benefits or potential harms and should not be used routinely:

• Botulinum toxin injection - conditional recommendation against 1, 2
• Low-level laser therapy - conditional recommendation against 1, 2
• Transcutaneous electrical nerve stimulation (TENS) - conditional recommendation against 1, 2
• Biofeedback or relaxation therapy alone (without CBT) - conditional recommendation against 1, 2
• Trigger point injections - conditional recommendation against 1
• Corticosteroid injections for routine muscle pain - conditional recommendation against 1, 2
• Benzodiazepines and β-blockers - conditional recommendation against 1

Critical Pitfalls to Avoid

• Do not proceed to invasive treatments (arthrocentesis, injections, surgery) before exhausting 3-6 months of conservative options, as only 5% of cases involve true joint pathology requiring such interventions 3, 2
• Do not perform irreversible procedures such as occlusal adjustments or surgery, as these have strong recommendations against their use 1
• Do not assume joint pathology when symptoms are present - approximately 50% of patients with jaw region symptoms have complications unrelated to the TMJ itself, emphasizing the importance of accurate diagnosis 3

When to Consider Specialist Referral

Refer to an oral and maxillofacial specialist or TMJ specialist if:

• Symptoms persist despite 3-6 months of comprehensive conservative therapy 2
• There is clinical suspicion of true intra-articular pathology (joint sounds, locking, severe limitation of movement) 3
• Progressive worsening despite appropriate treatment 4
• Suspicion of systemic inflammatory arthritis or other serious pathology 1