Temporomandibular Joint Disorders (TMD)

Temporomandibular Joint Disorders (TMD)

What is Temporomandibular Joint(TMJ)?

TMJ is also called the jaw joint, the only moving joint in the orofacial region. TMJ is a powerful joint with great bite force; this joint helps in biting, chewing, eating, talking, laughing, yawning and other nonverbal communication. There are 2 TMJs, one on the right and the other on the left. TMJ comes under the category of a synovial diarthrodial joint, which means it has two joint cavities per joint, essentially making four joint cavities for 2 TMJs. In addition, TMJ has a large disc, which is critical in joint function and dysfunction, unlike the other synovial joints. Therefore, understanding the TMJ’s anatomy, biomechanics, and neuropathophysiology is important to treat patients with jaw pain.

What is Temporomandibular Disorder (TMD)?

TMD encompasses a group of symptoms that affects the jaw, face, head and neck. It is more common in females compared to males. The symptoms include jaw pain, jaw lock(closed lock and open lock), jaw deviation, and clicking or popping sound while mouth opening/closing. Some may experience ear pain, ear sound, ear fullness, headache, blurry vision, sinus pain and other widespread craniomandibular and orofacial symptoms. Every patient is unique, and the symptoms will vary depending on the structures and pathophysiology involved. Though the prevalence of TMD symptoms is almost 35% in the general population, only 5% need treatment. That means most symptoms are self-resolving, or they won’t affect the day-to-day functionality of the patient. But for a few patients, once the disease is established, they will suffer due to chronic pain and dysfunction. Recovery will take a long time, and some may suffer lifelong chronic TMD pain.

Why is TMD complex to treat?

TMD is one of the tricky joints in the body. It has two joints with four joint cavities. Both TMJ joints are interlinked, so a problem on one side invariably affects the other. The Trigeminal nerve is responsible for sensory motor supply to the joint, but the same nerve governs the head, face and ear. It is called a trigeminal-cervical complex. So the pathology in one area will misrepresent in the other area. For example, the TMJ disc problem can refer to pain in the ear and in the same way, the cervical Spine problem refers to pain in the jaw area. So neck issues can lead to jaw issues. The TMJ disc one displaced, and it is hard to recapture it because of a lack of muscular control to pull it back to its normal position. Parafunctional habits like bruxism(clenching teeth), nail-biting, and abnormal oral sexual activities cause or contribute to TMD. Even at the school level, TMD management is poorly taught in the regular physiotherapy or dental curriculum. So most doctors have less knowledge or experience in treating TMD. These are the reasons why TMD is hard to treat, and the most TMD patients suffer.

Whom to meet if you have TMD?

TMD patients must meet a doctor who has knowledge of TMJ Anatomy,  Biomechanics, Pathomechanics, Neurophysiology, Oral Medicine, Cervical Spine Pathology, Orthotics/Splinting, Orthodontics, Exercise therapy and joint mobilization. Finding someone who integrates all the above methods while treating TMD is hard. Dentists are usually the first contact practitioners, but not all dentists are well-informed about TMD management. So as with Physiotherapists. But both Professionals can treat TMD but must have some basic understanding and training in TMD.  

What is the treatment for TMD?

In earlier days, splinting was the only line of treatment for TMD. But the evidence for Splinting is very contentious. Since TMD affects TMJ, a joint like any other joint in the body, it needs joint-based and muscle-based intervention as a first line of treatment. This includes joint mobilization, joint positioning exercises, joint decompression exercises, myofascial trigger point release, dry needling, and stabilization exercises. But every patient is unique, and treatment must be tailor-made based on the patient’s presentation. For example, a hypermobile joint that is dislocating needs stabilization exercises. A closed lock (disc displacement without reduction) needs joint mobilization exercises with or without splinting. A myofascial pain needs manual trigger point release or dry needling. A cervical spine-related TMD needs posture correction and neck curve correction exercises. So a detailed assessment must be done before deciding the treatment strategies.

Do braces or appliances help in TMD?

Braces and Splints have a role to play in TMD. Before prescribing a splint, the patient must be treated with mobilization and exercises. Splinting must be added only if the initial treatment fails to improve the condition. Splints are to be given in case of bruxism or other parafunctional habits. It can also be given when there is a gross bite issue, like a crossbite or an underbite. But the splinting must be regularly adjusted as the condition progresses. There is a small risk of worsening the condition if the splints are given inappropriately.

How do we treat TMD at APTER Clinic?

We are the only clinic in the country that offers a multidisciplinary and prudent approach to TMD. We evaluate and treat the jaw joint, craniomandibular muscles, neurophysiology and cervical spine, making our approach superior to others. We don’t use fancy machines nor offer high-priced splints. Instead, we give manual therapy, mobilization, myofascial therapy, dry needling, cervical spine correction and postural correction program. Splints are prescribed only as deemed necessary. We also specialize in TMD associated with fibromyalgia, Headache, Cervical spondylitis, osteoarthritis, rheumatoid arthritis and other inflammatory/non-inflammatory diseases that affect TMJ.

We also offer workshops and certification training programs to Dentists and Physiotherapists to improve the overall skillsets of Professionals to treat TMD.

Clients Feedback

Our Client Reviews

Have a look at all the wonderful reviews our esteemed clients have given to us.

Dry Needling is my strongest unique sword in my career. Many times it leaves my patients amazed post needling. "DRY NEEDLING" is so special that it helped me to obtain professional heights. Thank you Dr. Raj Sir.

Dr.Avanthi, PT,

Independent Private Practitioner, Bangalore, INDIA

Dry Needling is very fast in relieving chronic pain such as Shoulder, Low back ache, groin pain. Many problems are being solved in short time. I am really happy to say that in a single session of dry needling I have seen good results.
Completing Module 2 was an eye opening about further knowledgein the areas of trigger points in muscles .Thank you sir so much.

Dr. Satya Nagaraju, PT,

Independent Private Practitioner, Kurnool, INDIA

Managing patients with pain had been one of the most challenging tasks being a physio..... Majority of the pain encountered (acute or chronic) was musculo-fascial in origin and no approach was giving a long term solution even though promising some short term relief....Dry needling came as a boon to me and it started to work wonders in eliminating pain very effectively with immediate return in function. I would rather call is as "magical therapy"...

Learning the dry needling course from the man himself Dr. Rajkannan was the best thing to happen. I believe that nobody can teach dry needling as effectively as him and I want to thank sir wholeheartedly...Now I am pretty much confident in my practice and dry needling makes it to the top of my list as an intervention when properly indicated.


Assistant professor, Dr DY Patil college, Pune.

Dry Needling was a totally new concept for me when I heard about it. Even though it was tough to learn, because we should have proper knowledge about Muscle anatomy, it’s relations, Biomechanics, palpations, needle positioning etc.. Dr. Rajkannan Sir delivered it in its simplest form.His approach to Education is Quality based, emphasis more on recent advancement in this particular field. I would like to take his own words to describe him, “He is an Evidence Informed Practitioner.

Dr. Mohammed Salah, PT,

Sports Physio, Bangalore

Dr. Rajkannan did a great a job. He was very methodological and well organized in his teaching method. His Dry Needling course has changed the entire paradigm of my treatment methodology and has opened the door for much better clinical efficacy as goals for pain reduction can be achieved in significantly fewer sessions.

Dr. C.H. Nazeer Ahmed, PT,


Dry Needling, a form of treatment, though painful is loved by many patient. It's an extra tool for all physio which have positive results on varied conditions. Besides basic course which gave good base about needling, the advance course was too more informative which covered most of the difficult part of human body (which most of physio doesn't cover or miss as a part of treatment). Overall it was a great experience to learn DRY NEEDLING COURSE.

Suraj Prasad Tamrakar PT,


Dry needling has a great impact in my clinical practice. I took the course two years ago with Dr. Raj Kannan and he is an excellent, dedicated, and effective instructor. He was able to provide us with a comprehensive background on trigger point dry needling coupled with hands on training. His detailed teaching style was able to make me quickly learn the technique and apply the information to my clinical practice.

I have embraced dry needling as an incredibly effective and contemporary physiotherapy treatment. It allows me to provide immediate, effective, and lasting results to my patients and to variety of musculoskeletal problems. I am grateful to be a part of Dr. Raj’s class and I am thankful for the information and technique that he as shared as it has improved the outcome I have achieved with my patients.

Dara Raj,PT,

Director and HOD Wellcare group of physiotherapy clinic, Trivandrum, Kerala.

I have been practicing Dry Needling since 2016, it has done wonders for my practice. Since I am an independent practitioner its easy for me to convince my clients for Dry Needling. I honestly say that I have got almost 90% of the success rate through Dry Needling. I would say its another tool under my sleeves to treat my clients. I sincerely request all the physios to continue to practice Dry Needling or Manual Therapy after doing certification/ Workshop to become a good practitioner.


Dr. Chandru Jayaraman

Director, Sportsrehab & Physiotherapy