Temporomandibular Joint Dysfunction
TECHNIQUE
William H. Koch
DC
At the top of the kinetic chain of lateral joints is the temporomandibular joint (TMJ). The TMJ affects more of our neurology than any other joint. It is a bi-arthrodial hinge joint that is said to allow the complex movements necessary for life.
That may sound like hyperbole to anyone who has not studied the TMJ or had any personal experience with it as either a doctor or patient. However, I assure you that temporomandibular joint dysfunction can be among the most physically and emotionally disturbing conditions. The TMJ works in conjunction with the upper cervical spine. It is the top link in the kinetic chain of lateral joints. It can affect or be affected by any of the other components of the chain, which means it can influence much of the body, directly or indirectly.
The action of the TMJ is complex and important. It exercises the micro movement of the sutures of the skull. The importance of that cannot be overstated because it prevents the buildup of excessive intracranial pressure that occurs if the skull is locked up. The opening and closing of the TMJ keeps the eustachian tubes open, preventing pressure and fluid buildup in the middle ear. Closure of the eustachian tube due to TMJ dysfunction causes otitis media, a very painful condition.
The TMJ Is a Critical but Often Overlooked Complex Joint Condition
Many patients have TMJ dysfunction that sabotages them structurally and neurologically, causing a variety of disturbing symptoms. Unfortunately, very few doctors are trained and proficient in the correction of this critical joint. The corrective procedures I teach have been distilled from 40 years of experience and study of the TMJ through craniopathy and SOT training with chiropractic TMJ specialists, dental TMJ specialists, and maxillofacial surgeons.
Koch Protocol for Temporomandibular Joint Dysfunction
Evaluation of the TMJ
• Some TMJ dysfunctions are asymptomatic, and some are extremely painful.
• Begin by palpating the TMJ, feeling for the action and equality of the left and right hinge joint as the patient slowly opens and closes the mouth. Feel for tenderness over the jaw joint, which is an indicator of TMJ dysfunction.
• While still palpating the jaw joint, have the patient with the mouth slightly open slowly move the chin side to side, feeling for equality of movement. One side being more restricted than the other is another indicator of TMJ dysfunction.
• Ask the patient to bare their teeth. Observe how the space between the upper and lower medial incisors line up to one another. If the lower space is either right or left of the upper space, then the mandible has shifted to that direction. This jams the condyle of the mandible into the socket of the temporal bone on that side. It is another indicator of dysfunction.
• The next thing to look at is how the mouth opens. That may be done with the patient supine with the doctor standing directly headward, but it is best done with the patient seated. Place your thumb on the center of the patient’s chin as a marker, have the patient slowly open the mouth, and observe the motion. The motion should be smooth, and the lower jaw should open directly footward. If it shifts right or left, and especially if there is a ratcheting or jerking in that movement, it indicates TMJ dysfunction and the need for correction.
Treating the TMJ
The method I used successfully for over 40 years is a rather complex intra-oral procedure. It is time consuming and can be uncomfortable for the patient. However, I have found it well worth doing for patients with clear TMJ dysfunction.
You can find detailed step-by-step instructions for this procedure in my book Koch Functional Whole-Body Chiropractic.
A Revolutionary Change in TMJ Correction For decades, I have used that procedure, and it has proven to be the key to solving some difficult and complex cases that had eluded many other good physicians. It always worked well for me.
That changed in late 2020 when a 47-y ear-old woman was referred to me with severe, unrelenting headaches and extreme TMJ dysfunction and pain. She explained that her condition began 30 years earlier when, as a 17-year-old cheerleader, she jumped from the top tier of a pyramid, and her teammates failed to catch her. She landed with full force on her sacrum from a height of over 10 feet. The extreme impact of this fall radiated up her spine, causing a cerebral concussion and cervical whiplash injury. It also caused a severe shift of her mandible to the left, resulting in ratcheting and joint crepitus, pain, and dental malocclusion whenever she opened or closed her mouth.
After two months of weekly visits, my attempts to correct her TMJ were failing, and her headaches and neck pain were only marginally improved. Then I realized I had to do something else. My normally successful threepart TMJ correction was not doing the job.
I had to think outside the box. I began to experiment with muscle testing the TMJ.
What evolved was a simple testing and treatment procedure using the VibraCussor instrument.
Following is a description of the muscle testing and instrument-assisted correction I now use. It is incredibly simple and very comfortable for the patient. Some actually say it feels good. I have incorporated this procedure into my initial examination. It has allowed me to discover many cases of asymptomatic TMJ dysfunction that had in some cases been silently sabotaging otherwise good adjustments, not only of the cervical spine but also of other components of the kinetic chain of lateral joints.
TMJ Correction Using the VibraCussor
• The muscle test for the TMJ is done with the patient seated facing the doctor.
• The patient is instructed to extend both arms straight in front of them and to resist the doctor’s superior to inferior challenge on command to confirm their neutral strength.
• Next, the patient is instructed to shift their chin/jaw to the right without turning their head. The doctor then performs another muscle-test challenge with the jaw in that position.
• This is then repeated with the jaw shifted left.
• TMJ dysfunction will be revealed by a weak muscle test in one direction while the other remains strong.
• The side of weakness indicates that the mandibular condyle is jammed into the glenoid fossa of the temporal bone.
• The TMJ correction is done with the VibraCussor instrument fitted with the wide, soft, padded attachment.
• The patient is instructed to open their mouth about halfway and shift their jaw toward the side that muscle-tested strong.
• On the side of the jaw that muscle-tested weak, the doctor contacts the jaw joint with the instrument set on an intermediate speed and proceeds to glide the instrument smoothly and gently down the ramus of the mandible to just lateral of the chin.
• Repeat about three times. This should take about 20 to 30 seconds.
• This procedure should be painless.
In the event that muscle testing the jaw indicates weakness on both sides, it strongly indicates that the patient is habitually clenching their teeth. This is a common cause of TMJ dysfunction, which requires the patient to self-monitor to eliminate this habit.
• The correction procedure in this case is the same as above, with the doctor making three passes with the instrument but on both sides, alternating with the chin held first in one direction and then the other.
I urge you to learn and practice this simple protocol. It works extremely well and allows you to provide a specialized service to your patients that few other doctors can offer.
Dr. William H. Koch is a 1967 Cum Laude graduate of Palmer College of Chiropractic in Davenport, Iowa. He practiced in the Hamptons of Eastern Long Island, New York for 30 years and in the Bahamas for 15 years aboard his motor yacht, The Coastal Chiropractor. He is licensed to practice in New York, Florida and The Bahamas and currently splits his time between Abaco in The Bahamas and his newest practice in Mount Dora, Florida.
Now, wanting to give back to the profession he loves, he offers courses on "The Koch Protocols for Integrated, Advanced, Chiropractic Techniques." Simple, Effective, No Nonsense and Hands On. He may be reached on DrWilliamHKoch.com or by email [email protected].
