Wednesday, 20 February 2013

Face Pain: Nerd Out With Pterygoids

Gibert's TMJ is at the top left of this pic,
just where the blue tape starts, which
indicates his Lateral Pterygoid. 
I love Latin and Greek; it makes everything in Anatomy sounds so cool! Today we are going to nerd out with your Pterygoids; pronounced TER-ri-goids. According to Basic Clinical Massage Therapy, the word in greek means "Winglike" as it radiates from the jaw.

The Temporomandibula Joint (TMJ) is the joint you can feel move when you open and close your mouth. If you lightly place your finger just in-front of you ear, then open and close your mouth you will feel it move. If you feel both sides at the same time you may feel discrepancies between the two sides and this can mean that you may have restrictions within the joint itself.

Back view of Lateral Pterygoid.
The TMJ can cause a lot of problems and face pain can be linked to this area in a very predictable way. I want to start today with Pterygoids as I feel they are over looked as part of a whole approach to face and headache treatments. They are small, deep, not easy to reach and so not many therapists treat them or ask their clients to work on them at home. So, you and I are going deep into the mouth to work them out; both anatomically and treatments wise.

You have two Pterygoids each side of you jaw; your medial/internal and your lateral/external.

The lateral/external Pterygoid (see the photos with the blue tape marking it out), is a multi tasker as it can raise and lower your mandible (lower jaw), move it so it juts in and out, and open your mouth (depress) it as well. Also, it makes the grinding action by moving the mandible to the opposite side.

The back view of the Medial Pterygoid
The Medial Pterygoid (all photos with red tape) allows you to take the jaw to the opposite side, lift your jaw when you close your mouth and jut your chin out. The medial Pterygoid has a close relationship with another muscle, your Masseter, which I have touched on before but we will be looking at it again soon. So, when we treat the Masseter, we should always remember the Medial Pterygoids as they are effected at the same time.

It is said by Finando and Finando that "Most patients with temporomandibular dysfunction suffer primarily from a muscle disorder that includes the involvement of the Pterygoids". I would agree with the rest of the comments made in their book which state that they shouldn't be treated on their own, instead, all the masticatory muscles (the mouth muscles) should be treated to help TMJ pain.

Maybe it is the English prudish nature that stops treatments taking place on these muscles as it involves massaging the inside of the mouth, between the cheek and teeth. It is vital, in my mind, that the massage therapist gets involved in treating this area as so much pain can be related to it.

The trigger point based pain patterns that these muscles can get radiate out causing general pain in the throat, mouth, and TMJ. Sore throats, difficulties in chewing, talking, yawning, and all action that means opening and closing the mouth will hurt and can be associated with the Pterygoids. Also, the jaw may swing to one side or the other, causing problems with teeth later on.

Side View of the Medial Pterygoid. 
TMJ dysfunction can produce symptoms such as clicking in the jaw, problems in chewing, teeth grinding, too much mucus can be formed in the maxillary sinus, which can feel like sinusitis, as well as tinnitus. Also, your jaw may really, really hurt! It's best to get a diagnosis from your dentist or general medical practitioner as although you massage therapist may be able to treat it, they wont be able to diagnose it for you.

At home you can do a lot for yourself to help. Pop your thumb in your mouth and place it between your teeth and cheek, so your fingers are on the outside of the cheek. Then gently close your mouth. Gently move your thumb to the back of the mouth and you will feel a bone like structure which you can gently rub up and down, but it may be very sensitive so go easy! Then lightly pinch, rub and roll your thumb and fingers around the whole cheek area (which will also treat your Masseter). There maybe painful spots which through pain patterns around your face and head, stay with them and make sure they are worked with a light but positive touch. Don't rush as you can do this three or four times a day for 3 mins each side. Little and often helps loads.

To stretch your Pterygoids, simply place a hand under your chin and open your mouth. The hand should provide a bit of resistance to the mouth opening action. Count five breaths and relax, then just repeat it twice more. Then simply chew up and down for a bit to ease it out.

So, I hope this has been a good start for you all to see how Face Pain can be looked at by going right down deep into the anatomy around the mouth. We shall be looking at some bigger and more accessible muscles later on, but I wanted to kick off with some that are A) pretty cool B) some of the hardest to write about C) some of the least treated.

Happy chewing and I look forward to writing to you next time!


Of course the I didn't come up with the anatomy, information, treatments or stretches on my own; I had a lot of help from these great books:

Trail Guide To The Body 4th Edition By Andrew Biel

Basic Clinical Massage Therapy, Integrating Anatomy and Treatment, Second Edition by Lippincott, Williams and Wilkins

Trigger Point Therapy for Myofascial Pain, The Practice of Informed Touch by D. Finando and S Finando.

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