Trigger Point and Nerve Involvement in TMJ/ Headache

1 02 2012

The “X’s” represent the TrPs and the red shaded areas are the pain referral patterns.

Do you experience migraines, headaches or face pain? There is a direct “cause and effect” link between jaw problems, face pain, and headaches. Jaw problems can, and often do, cause headaches and/or face pain through the trigeminal vascular complex, which consists of the trigeminal nerve system and related blood vessels.

The trigeminal nerve is the largest cranial nerve, and is one of the major pain signaling entities of the brain. The main function of the trigeminal nerve is to transmit feelings of pain to your central nervous system. In addition, it also conducts the motor functions of chewing, biting, and swallowing. Lastly, it controls arterial blood flow inside the brain.

These three (trigeminal) nerve branches, or pathways, join into a singular, large nerve root called the trigeminal ganglion, which is physically located next to the Temporomandibular joint (TMJ). It is this nerve root that enters the brainstem, and transmits pain impulses.

Trigger points (TrPs) within the muscles entrap nerves and blood vessels, causing pain. Pain in any of the branches or pathways can cause migraines and other types of headaches, as well as pain in the face, mouth, sinuses, eyes, teeth, head, face, ears, and neck. Once TrPs are treated and released, the muscles relax back to a “normal” state and release any entrapment of nerves and blood vessels, most times providing immediate relief of pain symptoms.

According to the National Institute of Dental and Craniofacial Research, the most common form of TMJ is myofascial pain. Myofascial pain is pain that originates from the muscles and connective tissue, caused by a trigger point(s). A TrP is an irritable spot in a muscle that is locked into a deep and painful spasm…a strong state of painful contraction. Once the muscle freezes in this state, it creates a self-perpetuating cycle of pain and spasm. TrPs within the muscles of mastication, otherwise known as the chewing muscles, are responsible for creating the myofascial pain associated with TMJ, headaches, and facial neuralgias. Inactivating the TrPs is the only way to achieve long-lasting pain relief. Myofascial pain and TrPs are one of the most overlooked problems when diagnosing head, face, and jaw pain.

Trigger points are palpable contraction knots or taut bands within the muscle and fascia that will ultimately change or alter muscle tension. These intense spasms cause the muscle to pull on bony attachments such as the TMJ and/or any of the eight cranial sutures in your skull. In addition to pulling on bony attachments, weakening the muscle, and decreasing range of motion, one of the most important side effects of TrPs are the referral of pain they cause. This means that pain is felt not only in the TrP, but also in areas remote from the site of the TrP. This is known as referred pain. By eliminating the TrPs in the muscle, you also eliminate the pain in the faraway area as well. The good news is that these pain patterns are predictable and they are the same for all people. Drs’ Janet Travell and David G. Simons, MD published, Myofascial Pain and Dysfunction: The Trigger Point Manual, in which they diagrammed and described these pain patterns all over the body including inside the mouth! Their research has enabled healthcare professionals from many disciplines to track the pain patterns of their patients, and help eliminate the pain by treating the source of where the pain originates. In the case of head, face, and jaw pain, it’s important that we also treat the TrPs in the muscles of the neck and shoulders, as they too, refer pain into the head.
Not only is it vital to inactivate the TrPs and release the entrapment of blood vessels and nerves, but also to teach the patient about perpetuating factors that continue this pain/spasm cycle, such as poor posture, etc. Patients should also be taught how to self-treat so they know how to eliminate their own pain when a TrP comes back. Inactivating a TrP requires the application of direct, sustained pressure to the TrP until it moves, melts or disappears, and any tenderness involved is gone. Professional clinicians refer to this treatment protocol as ischemic pressure. This simply means that you are removing the blood flow for a period of time, and once the TrP is released, allowing the blood flow to come back and return muscles, nerves and blood vessels back to normal function.

There are many self-help massage tools on the market today, and the one for the use of self treating intra-oral TrPs is known as the MyoFree® Solution. You can find such tools by searching the Internet with keywords such as self-help massage tools, intra-oral therapy, etc. The products I use are made by the Pressure Positive Company and the tools come with instructions. These are effective and reliable tools to have in your self care therapy arsenal to help to keep you functioning  pain free.

Yours in health,
Gail Falzon, RN and Inventor of the MyoFree® Solution


Personal Story of Gail Falzon:
My name is Gail Falzon a registered nurse and I have suffered from TMJ for most of my life. I have experienced all the painful symptoms associated with TMJ, including difficulty chewing and opening my mouth, horrible headaches, earaches, face pain, and constant muscle spasms. So I know how much it hurts, and I know how much the pain of TMJ can literally take control of your life.

My struggle with TMJ began at 14 when I got braces. Since that time, I’ve tried pain relievers, multiple bite splints, and after suffering a whiplash injury from a car wreck, I had my jaws surgically reconstructed and wore braces again for two years. But the medications, the bite splints, the surgery and braces didn’t relieve my pain.

After all this, I was completely frustrated and felt like there was no hope.

It was then that I decided to put my clinical background as a registered nurse to use. I researched jaw disorders and treatment options. What I discovered astounded me…I learned that deep muscle spasms inside my mouth were the underlying cause of my pain.

Then I learned how to relax those muscles through an effective treatment called “myofascial trigger point release therapy.” Based on my research, I developed the MyoFree® tool and the Inside-Outside™ technique to effectively self treat and relieve TMJ pain.

Over the years, I have helped hundreds of people with TMJ pain find relief. Most everyone who has used my system has learned how to become and stay pain free without drugs or surgery. It is my personal mission to help the millions who suffer from TMJ, headaches and face pain. I want to empower you with the knowledge and techniques so you can set yourself free. You can take back your life!


This research is a review of the literature and is not a claim about the function or performance of any products sold by Pivotal Health solutions.





New Revenue Streams For Massage Therapists

12 10 2011

In this day of economic uncertainty and tough times it is more important than ever to maximize every opportunity to earn while helping others with your healing work. No, that does not necessarily mean that you should raise your rates or focus more on those that can afford your services versus those who need your services. What I mean is offering your clients products that will compliment your healing work, be of use to your clients and create new revenue streams that your spa, practice, or office may not have had before.

Some therapists may be hesitant to offer clients anything other than their healing services, but your clients will appreciate the fact that you have taken the time to research and offer helpful products for them to use when not in your care. Retailing products to your clients does not mean you have to hop up on a soap box and yell “step right up and witness the amazing powers of the…”, all that is needed is a small shelf system or table top to display them on. Your clients will notice, they may ask a couple of questions about them and may not purchase that day, but will know that if they or someone they know wants a particular item where to find it.  A good product or tool will not only be helpful to your client between sessions, but also will be a talking point that will, in fact become an advertisement for your practice. Self care tools such as the Backnobber II and Omni Pillow are both very effective at giving relief to your clients between therapy sessions and are easy to use. These products as well as other product lines offer professional pricing specifically so that therapists, spas and offices can earn more by simply offering products that you believe in and are of use to your clients. As you grow your practice by offering new modalities and services you should also look to grow your practice with offering of products.

So in this time it is more important than ever to diversify your services and product offerings. I hope this is helpful as I not only wish for your practices to survive, but thrive.

Post by David Fried, Custom Craftworks

Next week we at Custom Craftworks, the massage therapy division of Pivotal Health Solutions will be in Portland, OR for the AMTA National Convention. I hope you will stop by our booth, #601 to say hello.





Traveling this Labor Day weekend?

2 09 2011

Like many Americans, I will be traveling  this Labor Day weekend. In fact, I travel quite often for both  work and pleasure. One of the great things about what I do for a living is that I get the chance to try and own some really great tools that help make my traveling experience more comfortable. I thought I’d share a few with you.
I always travel with an Omni Cervical Relief Pillow. My father in law is the one who actually showed me how to  use it to support the neck while sitting up in an airline seat for long periods of time. It’s light and easy to pack in my carry – on. The crescent pillows used on massage table face rests make great neck pillows, too. Keep the vinyl  from sticking to you by covering with a soft cotton face rest cover.

Recently, I began tucking  Pressure Positive’s  Backnobber 2 into my carry-on as well. It breaks down into two pieces so it’s easy to take anywhere,  and while I am waiting to board, I can self -massage and apply pressure my  neck, shoulders, low back, anywhere there is tightness. I find that other passengers often ask to borrow it for a moment. I can wipe it clean easily with those handy sanitary wipes. If you are really pressed for space, you can toss an Index Knobber2 into your laptop bag instead. It’s  very small and can be used in much the same way.

You can’t take a massage with you, but I highly recommend if you have a long enough layover that you get a massage instead of heading to the airport bar. You will be less dehydrated and more refreshed and relaxed when you arrive at your destination. I have found that a quick 10-15 minute chair massage , although not a full therapeutic massage, can help release areas of tension  and provide a mental break  from the stress of travel. If you are stuck in the middle seat for a portion of your trip,  you usually spend the  entire flight in a “tightened” state, trying not to go over your arm rests, accommodating your laptop, etc., A quick airport massage can provide a “reset” for the next leg of your journey.

Wherever  you travels take you,
I wish you good health!
Teri Sura 








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