Physiotherapy for Jaw (TMJ) Pain

Physical Therapy for the Jaw (TMJ): How to Treat Pain and Restore Normal Function?

Physical therapy can reduce pain and improve jaw movement through exercises, manual techniques, and tailored advice. The temporomandibular joint, or TMJ, connects the lower jaw to the skull, in front of each ear. A review of seven clinical trials reports a reduction in pain with the physical therapy programs studied.¹ Results vary depending on the programs and comparison groups.¹ The improvement in mouth opening is less clear in this review.¹ If you’d like to first understand the various causes of jaw pain, check out our comprehensive guide to jaw pain and TMJ.

Pain while eating, painful clicking sounds, and certain types of headaches can limit your activities. Treatment usually begins with non-surgical options. It is estimated that 85 to 90 percent of jaw disorders can be treated without surgery or permanent changes to the joint². This figure refers to several possible treatments, not the success rate of physical therapy alone.

What is Physiotherapy for the Jaw (TMJ)?

Physical therapy for the jaw helps manage pain and difficulty moving the joints and muscles used for chewing. The physical therapist provides manual therapy, exercises, and advice. They also examine the neck when symptoms warrant it. A 2021 review estimated the prevalence of TMJ disorders at approximately 11% among children and adolescents, and 31% among adults and older adults.³ These estimates do not reflect the prevalence of all types of jaw muscle pain; some joint disorders are painless.

A mouthguard is a device worn over the teeth to protect them. Bruxism refers to the clenching or grinding of teeth. Physical therapy can help manage the pain and associated movements, though it does not guarantee that bruxism will stop. It can also assess work and rest positions that affect your comfort.

How Does Physiotherapy Work for TMJ?

Manual techniques can relieve pain and make it easier to move your jaw. The exercises help you learn to open and move your jaw more easily. The tips help you identify habits you can change, such as clenching your teeth when at rest or chewing gum.¹ In particular, mobilization—gentle movements guided by a professional—as well as supervised exercises and at-home care are recommended for pain that has persisted for at least three months⁴.

Your physical therapist will also examine your neck. Nerve signals from the upper neck—near the first three cervical vertebrae—and from the face travel to some of the same nerve cells. This shared nerve pathway can contribute to pain felt in areas other than the affected tissue. One report describes a 42-year-old woman whose pain in the face, jaw, and elsewhere decreased after surgery to decompress a nerve at the back of the head.⁵ This rare case does not prove that all jaw pain originates in the neck. In a trial involving 61 women with TMJ disorder, five weeks of upper neck mobilization and exercises reduced facial pain and the impact of headaches compared to no treatment. The program did not further improve jaw function or pressure sensitivity.⁶

Who can benefit from TMJ physiotherapy?

A physical therapy evaluation may be helpful if your jaw hurts, is difficult to open, or makes painful clicking sounds. It can also help assess headaches related to jaw movements. Treatment is still an option when symptoms have persisted for more than 12 weeks, or about three months. The choice of treatment plan depends on the problem and your response; the duration of symptoms does not guarantee the outcome.

What conditions does physiotherapy treat?

Physical therapy can help manage jaw muscle pain, movement difficulties associated with certain disc displacements, and TMJ-related headaches. The disc is a small cushion between the joint surfaces. The evaluation also examines the effects of bruxism and neck symptoms, without assuming a single postural cause. Our guide to jaw disorders provides an overview of these conditions and their causes.

Myofascial Pain in the Chewing Muscles

The masseter is the cheek muscle that you feel contract when you clench your teeth. The temporalis is located on the side of the head. The pterygoid muscles are deep muscles near the jaw. Manual therapy and exercises can reduce symptoms; their effectiveness should be monitored with you.

Jaw Joint Disc Displacement

The types of disc displacement are explained in our guide on jaw pain. An isolated click without pain or locking generally does not require treatment, according to the NIDCR, the U.S. National Institute of Dental and Craniofacial Research⁷.

The goal of treatment is to reduce jaw pain and make it easier to use the jaw. Improved function does not necessarily require a perfectly aligned jaw. Exercises and mobilization techniques are selected based on pain levels, jaw opening range, and actual difficulties.

Jaw-Related Headaches

Our guide on jaw pain explains that jaw movements can help guide the evaluation of a headache. The evaluation checks whether these movements or pressure on the muscles trigger your usual headache.

If you have recurring headaches that do not respond to standard treatments, an evaluation can determine whether your jaw is contributing to your symptoms. To learn more, see our guide on headaches and cephalalgia.

The symptoms that require immediate medical attention are described in our comprehensive guide to jaw pain and TMJ.

What to Expect During Your First Assessment?

The initial evaluation includes questions about your symptoms, an examination of your jaw and neck, and a treatment plan discussed with you. The tests assess your range of motion and how it affects your pain. Review the steps involved in the initial evaluation and confirm its duration with the clinic.

Questions Your Physiotherapist Will Ask

Your physiotherapist aims to understand your condition thoroughly. Expect questions about:

• How long have you had the pain?
• What triggers or worsens your symptoms?
• Does your jaw click, crack, or lock?
• Do you experience headaches or neck pain?
• Have you been told that you clench or grind your teeth?
• Has your stress level changed recently?

These answers help the physical therapist understand what affects your symptoms and work with you to choose the right treatment.

Physical examination

The physical exam assesses several aspects:

Observation: The physical therapist observes your posture, facial symmetry, and jaw movements.

Palpation: The physical therapist checks for tender spots in the muscles of the jaw, neck, and shoulders. He or she assesses how you feel when pressure is applied.

Measurement of Movement: The physical therapist measures the mouth opening. According to the criteria for disc displacement without reduction, a mouth opening of less than 40 mm with the therapist’s assistance corresponds to the subtype with limited opening. The therapist measures the gap between the front teeth and adds the height by which the upper teeth overlap the lower teeth.⁸ This threshold alone does not establish a diagnosis. Side-to-side and forward movements are also examined.

Tests that involve the jaw: The physical therapist checks to see if certain movements or pressure reproduce your usual pain. He or she interprets these responses in conjunction with the rest of the examination.

Neck Examination: Neck movements and associated symptoms can help guide treatment decisions.

What Happens Next

At the end of the assessment, your physiotherapist will explain their findings, their understanding of the problem, and the proposed treatment plan. This is your opportunity to ask questions and discuss your goals.

What Treatment Techniques Are Used?

Treatment may combine manual therapy, therapeutic exercises, and guidance on daily activities. Manual therapy uses the hands to work on muscles or move a joint. The choice depends on the examination, your preferences, and the observed results.

External Manual Therapy

External manual therapy targets the muscles that the physical therapist can reach from the outside: the masseter, the temporal, and the neck and shoulder muscles. The techniques vary depending on the tissues being treated. The following descriptions distinguish between the treatments offered and myofascial release.

Myofascial release: This term refers to pressure or stretching techniques that target the muscle fascia. This approach is not among the treatments recommended in this guide.

Treatment of sensitive muscle areas: Appropriate pressure techniques can be part of a treatment plan to reduce pain. This type of treatment is recommended for persistent pain related to the TMJ.⁴ The pressure and its effect are adjusted in consultation with you.

Neck Exercises: The physical therapist gently moves the neck joints. These movements can be combined with exercises when a neck problem is contributing to the symptoms.

Intra-oral Manual Therapy

Intraoral manual therapy is performed inside the mouth. It allows the therapist to work on muscle tissues that are accessible from the cheek. The physical therapist decides whether to use this technique based on the symptoms and the accessible tissues; some people do not need it.

The physical therapist wears gloves and explains the procedure before working inside your cheek. You can agree, refuse, or ask them to stop. The sensation may feel unusual or uncomfortable. Let them know how you’re feeling so they can adjust the pressure. This treatment may be beneficial as part of a care plan, though there is no guarantee of immediate relief.

Joint Mobilizations

The joint itself can be mobilized through gentle and controlled movements. These mobilizations aim to:

• Help the jaw move more freely in its joint
• To make it easier to open and move the jaw
• Decrease joint pain
• Facilitate the movements needed for eating and speaking

The professional adjusts the direction, strength, and intensity based on your symptoms, and then checks to see if the change is helpful to you.

Heating and Other Considerations: What Role Do They Play?

Heat can be used to promote comfort. The other methods listed below are sometimes mentioned in documents on TMJ, but are not recommended in this guide.

• Heat: A warm compress can provide relief or help relax muscles. Protect the skin and stop using it if it becomes irritated. Heat does not repair tissue.
• Therapeutic ultrasound: A device emits sound vibrations that are inaudible to the human ear.
• Dry needling: Needles are inserted into the tissue without injecting any substance.
• TENS: This device delivers low-level electrical impulses through electrodes placed on the skin.

The physical therapy plan focuses on appropriate manual techniques, exercises, and tips you can use in your daily life.

What exercises will the physiotherapist prescribe for me?

Your physical therapist may suggest exercises to relax your jaw, improve its range of motion, and help you gain better control over it, as well as exercises for your neck and shoulders. They will work with you to determine the movements, number of repetitions, and frequency. Not all of the following examples are necessary. Stay within your comfort zone and stop any exercise that makes your symptoms worse.

Jaw Relaxation Exercises

Resting position of the jaw: Keep your teeth slightly apart, your lips relaxed, and your tongue against the roof of your mouth.

Practice this position several times a day. Use visual reminders (stickers, phone alarms) to check your jaw regularly. If you catch yourself clenching your teeth, consciously relax.

Breathing and Relaxation: Breathe slowly, letting your abdomen move freely. As you exhale, let your jaw relax without straining.

Mobility Exercises

Controlled opening: Place your tongue against the roof of your mouth and slowly open your mouth while maintaining that contact. A mirror can help you follow the movement. Do not force the movement to eliminate a clicking sound. Examples of exercises can be found in the Leicester Hospitals fact sheet⁹.

Side-to-Side Movements: Gently slide your jaw to the left, return to the center, then slide it to the right. This movement helps improve your ability to move your jaw from side to side.

Forward movements: Gently move your lower jaw forward, as if to place your lower teeth in front of your upper teeth, then return to the resting position.

Stabilization exercises

Opening Resistance: Place your fist under your chin. Gently open your mouth while applying light resistance with your hand. The Leicester guide recommends holding this position for 5 seconds; adjust this based on the instructions you’ve received and your comfort level.

Lateral Resistance: Place a finger or your hand on the side of your jaw. Gently push against this support without moving your jaw. This exercise works the muscles that control its position.

Postural exercises

A forward head posture can be observed in some people with TMJ disorder. In a study of 145 people, the association between this posture and pressure sensitivity in the trapezius—a muscle in the neck and shoulder—was weak. A more forward head posture was associated with less pressure sensitivity, not more.¹⁰ This observation does not prove a protective effect or a cause of pain. Neck exercises are primarily aimed at comfortable movements and functional abilities.

Tucking the chin: Gently pull your chin back, as if to create a double chin, without lowering your head. You can hold this position for up to 5 seconds if it remains comfortable.

Neck-side stretch: Gently tilt one ear toward your shoulder without pulling with your hand. Hold the stretch comfortably for up to 30 seconds, depending on the instructions you received.

Exercises for the shoulder blades: Your physical therapist can show you pulling exercises to work the muscles between your shoulder blades—the flat bones behind your shoulders. The range of motion and resistance will depend on your abilities.

What is the duration and frequency of treatment?

The programs studied often consisted of 9 to 15 sessions over four to six weeks, but your follow-up will depend on your progress and needs. In a review of seven trials, the average duration was about five weeks; one trial used a single session, while the others spanned several weeks.¹ These program durations are not guaranteed recovery times. The physical therapist will reassess the frequency of your visits with you.

Sample lesson plan to be adapted

Weeks 1 and 2, for example: The assessment helps determine the initial care and exercises. The goals may include reducing pain and making it easier to eat.

Weeks 3 through 6, if treatment continues: The exercises are adjusted based on tolerance and goals. Manual techniques may be incorporated as part of this progression; working deeper into the tissues is not a required step.

Weeks 7 through 12, if necessary: Visits may be spaced out. The focus is on independence, resuming activities, and how to respond if symptoms return.

Factors to Reassess During Care

The Importance of Home Exercises

Do the exercises as often as agreed upon with your physical therapist. Short, regular sessions may be easier to fit into your schedule. Keep track of what helps and what makes your symptoms worse.

Slow progress warrants a discussion about the program, your goals, and other options. It doesn't mean you're not trying hard enough. The exercises can be modified rather than simply made more intense.

How does physiotherapy compare to other treatments?

Home exercises and mouthguards often yield similar results, while adding manual therapy may provide short-term benefits. A 2025 review found no overall superiority of mouthguards over other treatments for pain and mouth opening.¹² A 2024 review reported a statistical advantage of adding manual therapy to home-based care for pain, mouth opening, and sleep. The certainty was low; the differences in pain and mouth opening were not large enough to be considered clinically meaningful for patients, according to the thresholds used by the authors.¹³ This does not rule out an individual benefit; the program and your activities matter in making your choice.

Physical Therapy and Dental Splints

The mouthguard protects the teeth from clenching or grinding. In the 2025 review, it reduced clenching more than the compared treatments. Certain subgroups also favored the mouthguard over counseling alone for pain, and over a placebo mouthguard or counseling alone for mouth opening.¹² A placebo mouthguard is a device used for comparison that does not have the same intended effect. These results do not prove that routinely combining a mouthguard with physical therapy is superior.

The dentist selects the mouthguard and checks its fit. Follow the dentist’s instructions during physical therapy. If the mouthguard causes pain, stop wearing it and consult your dentist, as recommended by the NIDCR⁷.

Physical Therapy and Medications

Anti-inflammatory drugs and certain muscle relaxants can relieve symptoms, depending on the condition and the prescription. The former primarily target inflammation; the latter are medications that can reduce certain muscle contractions. Their benefits and risks vary. Ask your pharmacist, dentist, or doctor for advice.

Physical therapy aims to reduce pain and improve functional ability. Medications may sometimes be used in conjunction with this treatment. Do not change the dosage or stop taking a prescribed medication without consulting the healthcare professional overseeing your care.

Physical Therapy and Surgery

Surgery is generally not the first choice. It may be considered when the joint is severely damaged or when significant symptoms persist despite other treatments. The NIDCR describes these situations and the questions to ask before undergoing surgery⁷. For certain problems inside the joint, three to six months of non-surgical treatment are often recommended before this discussion takes place.² This guideline should not delay an urgent evaluation.

Combined Approach

The treatment plan can combine several therapies based on your needs. Manual therapy combined with at-home exercises provided greater relief from pain during jaw movement and allowed for pain-free opening compared to exercises alone. With this combination, the average reduction in pain scores during jaw movement reached 91.3%. This figure represents a change in score, not the percentage of people who were cured¹⁴. Treatment may include:

• Physical Therapy to Manage Pain and Mobility Issues
• A dental guard should be discussed with the dentist when necessary for tooth protection or due to symptoms
• Stress Management When Stress Is Overwhelming or Accompanies Symptoms
• Collaboration with the dentist regarding teeth, their alignment, and any appliances already being worn

How does Physioactif help you with a TMJ disorder?

Physioactif supports you through an evaluation, goals discussed with you, and a program tailored to your jaw-related issues. The physical therapist also examines your neck when appropriate. If a procedure inside the mouth is recommended, the therapist will explain its benefits and discuss other options with you.

Our Approach

The assessment examines the movements of the jaw, neck, and shoulders, as well as your habits, stress levels, and positions that affect your comfort. This information is used to select treatments and monitor their effectiveness. It does not guarantee a single cause or a lasting result.

What You Can Expect

• An evaluation to understand the symptoms and identify their possible causes
• A clear treatment plan with measurable goals
• Appropriate manual techniques, the benefits of which are verified with you
• An exercise program tailored to your specific needs
• Explanations to help you understand the condition and know how to respond if symptoms return

Collaboration with your dentist

If you wear a mouthguard or have issues related to your teeth or how they fit together, working with your dentist can help coordinate your care. With your consent, healthcare professionals can share information relevant to your treatment plan.

What are some frequently asked questions about TMJ physical therapy?

Frequently asked questions about TMJ physical therapy include pain during treatment, the number of sessions, access to services, exercises, insurance, mouthguards, and the return of symptoms.

Is physiotherapy for TMJ painful?

Manual techniques may cause temporary discomfort, including inside the mouth. Pain is not a goal of the treatment and does not prove its effectiveness. Please report any discomfort you experience; the physical therapist can modify the technique or stop it. Adverse effects have been reported infrequently in several trials, but this does not guarantee their absence.

How many sessions are needed?

In the 2016 review, several programs consisted of 9 to 15 sessions over four to six weeks.¹ The number of visits you need may vary. The physical therapist will provide an estimate after the evaluation and then reassess it based on your pain levels and the movements you are able to perform again.

Do I need a medical referral?

In Quebec, you can see a physical therapist in a private practice without a doctor’s prescription, according to the Quebec Professional Order of Physical Therapy¹⁵. The physical therapist may refer you to a dentist or a doctor. The urgent symptoms described in our guide require immediate medical attention—do not wait for an appointment.

Will the exercises worsen my pain?

Exercises should be tailored to your symptoms. You may experience mild fatigue, but if pain increases or persists, you’ll need to adjust your routine. Stop any movement that makes you feel worse and contact your physical therapist. Do not try to force a locked jaw open.

Is this covered by insurance?

Coverage depends on your insurance policy. Check the amounts, limits, and required documents before your first visit. Some policies may require a referral for reimbursement, even if you have direct access to a physical therapist. The Ordre professionnel de la physiothérapie du Québec explains how physical therapy works¹⁵.

Can physiotherapy replace a night guard?

Physical therapy may be sufficient for certain types of pain and movement difficulties. A mouthguard may still play a role in protecting the teeth. Whether you need one, the other, or both will depend on your specific situation. There is no evidence that a systematic combination of the two is superior for all TMJ disorders.

What if my symptoms return?

If symptoms return, resume the strategies that helped you, provided they remain tolerable. Temporarily reduce activities that worsen the pain, and seek advice if the pain persists. A reevaluation may lead to changes in the treatment plan. New or urgent symptoms should not automatically be attributed to a relapse.

What are the key takeaways?

Physical therapy combines exercises, manual techniques, and advice to reduce pain and make it easier to use the jaw. The benefits vary depending on the problem, the treatments, and how they are combined. Improvement is reported in 70 to 90 percent of patients using dental appliances in combination with other treatments, but there is a lack of high-quality clinical trials. This historical figure does not predict how you will respond to physical therapy².

Persistent pain does not rule out the possibility of improvement. Follow-up visits are meant to help you resume important activities, adjust your treatment, and discuss other options if the program isn’t helping. Participating in the exercises is helpful, but a lack of progress does not mean you aren’t trying hard enough.

To understand all types of head and facial pain, consult our guide on head and facial pain.

References

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2. Scrivani SJ, Keith DA, Kaban LB. Temporomandibular disorders. N Engl J Med. 2008;359(25):2693-705. ↩ Back to text: 1st, 2nd, 3rd citations
3. Valesan LF, Da-Cas CD, Réus JC, Denardin ACS, Garanhani RR, Bonotto D, et al. Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis. Clin Oral Investig. 2021;25(2):441-453. ↩ Back to text
4. Busse JW, Casassus R, Carrasco-Labra A, Durham J, Mock D, Zakrzewska JM, et al. Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline. BMJ. 2023;383:e076227. ↩ Back to text: 1st, 2nd citations
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7. National Institute of Dental and Craniofacial Research (NIDCR). TMD. ↩ Back to text: 1st, 2nd, 3rd references
8. Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: Recommendations of the International RDC/TMD Consortium Network* and the Orofacial Pain Special Interest Group†. J Oral Facial Pain Headache. 2014;28(1):6-27. ↩ Back to text
9. University Hospitals of Leicester NHS Trust. Managing Jaw Joint Disorders. Information for Patients. Leaflet 436. ↩ Back to text
10. Yao Y, Cai B, Xu LL, Wang JW. [Correlation between neck pressure pain threshold and forward head posture in patients with temporomandibular joint disorders]. Zhonghua Kou Qiang Yi Xue Za Zhi. 2021;56(8):759-763. ↩ Back to text
11. Belenda González I, Montero J, Gómez Polo C, Pardal Peláez B. Evaluation of the relationship between bruxism and/or temporomandibular disorders and stress, anxiety, and depression in adults: A systematic review and qualitative analysis. J Dent. 2025;156:105707. ↩ Back to text
12. Zhang Y, Zhang H, Liu R, Jin S, Huo T, Wei H, et al. The efficacy of treatments for temporomandibular disorders using occlusal splints versus other conservative therapies: a meta-analysis of randomized controlled trials. Oral Surg Oral Med Oral Pathol Oral Radiol. 2025;139(5):509-520. ↩ Back to text: 1st, 2nd citations
13. Wang J, Wang R, Zhao P, Zhou X, Guo X. Home-based rehabilitation versus center-based programs in patients with temporomandibular disorders—a systematic review and meta-analysis. J Oral Facial Pain Headache. 2024;38(1):1-16. ↩ Back to text
14. Tuncer AB, Ergun N, Tuncer AH, Karahan S. Effectiveness of manual therapy and home physical therapy in patients with temporomandibular disorders: A randomized controlled trial. J Bodyw Mov Ther. 2013;17(3):302-8. ↩ Back to text
15. Quebec Professional Order of Physiotherapy (OPPQ). Physical Therapy: How Does It Work? ↩ Back to the text: 1st, 2nd mentions

Our physical therapists defined the research strategy, plan, and clinical content of this article. An AI tool assisted with the literature review and text editing to ensure consistency in content and writing style.