If your patient is limited in their opening to less than 40 millimeters or less than about three stacked up fingers, your first task is to determine how acute that restriction is. Do they have pain? When you palpate them, do they jump out of the chair or do they say it's just sort of a dull, achy muscle type of sensation? Is the pain coming from the joint or from the muscle? If they are in pain and tight, they need to start with heat or something to decrease their muscle tension. And if they have a higher level of activation, stretching can actually make them worse. So you want to make sure that you are lining up the exercises with their level of irritability so that you can set them up for success. Generally, releasing muscle tension before progressing with stretching will help that patient be successful. If your patient has opening limited to less than 40 millimeters or those three fingertips or two knuckles, the first task is to determine how acute is that pain. Are they jumping out of the chair when you touch them or can they handle a fair amount of palpation? If they have acute pain, you do not want to push stretching. If the pain is not too bad and they are restricted underneath those points, then we want to decide is the pain coming from the joint or from the muscle? If it's from the joint, again, you're not going to push too much stretching. But if it's from the muscle, then we can start as long as they're not terribly acute. I always have my patients start with heat and self-massage before they do much intense stretching to make sure that they're not going to strain their muscles. So the exercises that we're going to use if you have restricted range of motion, if the patient is opening with their jaw coming off to the side, I always have them start out by training straight opening with the controlled rotation exercise. So for this exercise, you'll use your tongue to guide your movement. Place one finger up in front of the ear. Usually you want to monitor the side that it's moving away from so that they can't feel that movement. So keep your finger there. Then put your other hand in front of your chin to guide. Let that tongue go up to the roof of the mouth and just drop only as far as your tongue allows and close. Good. So this exercise straightens out the jaw range of motion if it's pulling off to the side. Yep. Beautiful. So you do this about five, six times and put your hands down. And then I want you to do it six times per day. In the morning, in the afternoon, in the evening. That controlled opening is important because if I'm having her stretch, I do not want her stretching off to the side. It's going to cheat and overstretch the opposite side and not stretch the tight side. For jaw stretching, I start with that same tongue up protected opening. And then they can start sliding knuckles or fingers in to stretch at their restriction. If they're really tight, you're going to start with just one knuckle. So go ahead. Yep. Take your one knuckle. Slide it in. Good. Add a little pressure upward so you're resting on your finger and then let your jaw hang. Good. Good. Nice big breath. Exhale. Let your jaw hang from your finger. Good. Breathe in again. Nice big exhale. Good. And then last one. Big exhale. And take your finger out. I have people stretch for three breaths because once we start counting, we start clenching. You want tooth prints on the top of your finger. Yep. Good. But not on the bottom. If it's on the bottom, they're clenching and that doesn't help. So if they can open wider than that, then we can go up to two fingertips. So go ahead. Take your two fingertips. Point them toward yourself. Good. Again, add a little pressure upward. Good. That looks nice. Exhale. And you would hold that for three breaths for stretching. If this is uncomfortable, have them back down to one knuckle. She looks pretty good. So I'm going to have her do this as her stretch. Okay. Go ahead and take your fingers out. As your range stretches open, our goal is to be able to get two knuckles in between the teeth, which I think you can do. So go ahead and slide them in. Good. Add that pressure upward so you're just resting rather than holding open. Big breath. Exhale. Imagine your jaw hanging. Good. And you want them to stretch for three breaths. Nice. One more. And exhale. And go ahead and take your fingers out. Does that feel okay? Yep. A little bit of a pull in those muscles? Mm-hmm. If it causes any pain or discomfort, I have them back down to the level previous to where they had the pain, depending on how many fingers or knuckles that is. And then we need people to do this up to six times per day in order to stretch gradually to get the range of motion back to where we want it to be, 35 to 40 millimeters, or three stacked up fingertips, or two knuckles. There's a more passive stretch we can do that we call the scissor stretch. In this, you're not having any muscle activity whatsoever. Your fingers get to do all the work. So for you, take your index fingers and place them on your bottom teeth. Yep. Perfect. Your thumbs slide up and sneak in between. Yep. And now, your fingers get to work like you're opening a pair of scissors. Good. Find where that restriction point is and then hold it for a breath. Breathe in. Exhale. Good. Breathe in again. And on your exhale, try to open it a little more if you can. You feel that pulling and stretching? Mm-hmm. Let's do one more breath. And exhale. Beautiful. And you've got some good range of motion now. So that looks great. It's easy to overdo it. So once again, we don't want any strain, discomfort, or clicking. And I would have this person, I would have my patient intersperse that with the finger or the knuckle stretches. And then finally, my exercise for restricted range is training lateral deviation. And we do this with the pinky stabilizing between the teeth. Go ahead and place it between your teeth. Yep. Good. Place the teeth on your finger and roll your jaw from side to side. The finger provides some feedback. Yep. And it's not, it doesn't have to be perfect. We're just giving it some stability so that it knows where to move. We need to have normal side to side movement around, you know, two tooth widths or eight to 10 millimeters in order to expect our jaw to open all the way. So we can't forget about the side to side movements either.

assessing patients

treating limited jaw opening

joint or muscle pain

heat and self-massage

jaw exercises