Face Pain - Rosy Cheeks

Good morning and welcome to the forth installment of the Face Pain series.

Over the past two posts I promised different things for today's issue, so I am going with the original: Help for pian around the eyes and cheeks, and then we can go to the throat and neck later in the week. I apologize for the confusion as a couple of people have pulled me up on it, and quite rightly too!

Where Your Masseter Is 

We looked at the Masseter muscle a while back in the Head and Neck Pain series, (if you click the link you will find out about it half way down the page). The Masseter is the cheek muscle that goes all rosy when you are in the cold and the one that gives the face a beautiful rounded appearance when we smile. As it exerts 140 pounds worth of pressure when we bite down I have always seen it as a very powerful little bit of tissue and because of this it needs a lot of care and attention.


Pain Patterns And Case Study

The pain your Masseter produces can give you a false toothache in the back of the mouth, cheek pain and earache, problems in the TMJ as well as issues with opening your mouth. (I have also read that it can cause tinnitus, but it's generally assumed that the main muscle for that is the sternocleidomastoid.) In Clare Davies' book, The Trigger Point Therapy Work Book (second edition), there is a wonderful case study presented on page 67:

Gilbert showing off his cheeks!
The Masseter Muscle. 

"Mary, age twenty-nine, was a dentist who was frustrated in the treatment of some of her patients who complained of tooth pain but had no problems that she could find. She also had a pain in her own jaws and in her own perfectly healthy teeth. She suspected the pain was myofascial but she didn't feel competent to diagnose or treat it. In dental school, they'd been told about  trigger points but hadn't spent much time on them. 
A clue to Mary's own trouble lay in the chronic headaches and neck pain that she had suffered from dental school, caused by leaning over all day and twisting to look into mouths. 
The strain of her work had caused trigger points in her sternocleidomastoid muscles, which in turn were generating secondary trigger points in her masseter muscles. Her headache were coming from her sternocleidomastoids, but the pain in her jaws and teeth from her masseters."

The reason I like this case study about Mary is that it not only tells us clearly where pain is based and how it can be stimulated, but it also shows that pain is rarely just one muscle that is causing the problem; it is a link between the structures that therapists and clients have to address. We need to see the story of the how the body is moving to understand how the pain has developed and where it could be.

If you have face pain that is based around the eyes, then working the masseter may help you quite a bit. One pain path that trigger points produce from this muscle is around the whole eye, under it as well as the actual eye brow. So, if you are constantly trying to pinch your eyebrows or stroking your sinuses under your eyes to try to get the pain to go away, then Clare Davies suggests that you may want to massage your masseter instead.

How to treat it at home. 

Masseter massage goes hand in had with your Pterigoid massage from the first blog.

• With a clean hand (!) rest the palm of your hand against the opposite cheek so that the fingers are pointing towards your ear. 
• Slip your thumb into your mouth so it is between the teeth and the fleshy part of the cheek and now close your mouth. (This allows you to massage both the superficial and deep layers of the muscle.)
• Gentle press the fingers and thumb together, making sure that you can feel the pressure but it's not a pinch. 
• Now massage around the whole cheek, finding out the where the tender parts are, gently pressing them until the pain dissipates, or the volume of the pain goes down. 
• Work around the whole area on both sides twice a day and see if it helps the pain you are feeling.