A Quick Tip for TMD and Headache Patients | Modern Manual Therapy Blog

A Quick Tip for TMD and Headache Patients

There is a common motion dysfunction that many TMD and cervicogenic headache patients have. I am dating myself as a gamer, but if your patient looks like this guy....

They are using their capital extensors, instead of gravity and diagastrics to help open their mouth. We should not have to use capital extensors to promote end range mandible depression. This also leads to overuse of cervical protracted posture, which may place stress on the mandible elevators and TM joint.

As a review, the mandible should depress (open) with a rolling phase first, and then an anterior translation phase. The cranium should not go into extension (at least during the rolling phase, or roughly the first half of depression).
So a quick thing I look for is what i call "pac-manning." When asking the patient to open their mouth as wide as possible, do they
  • have an initial rolling phase (or do the mandible condyles translate anteriorly immediately)
  • are they simultaneously extending the cranium and cervical spine during mandible depression
If so, you need to educate them on mandible rolling and some subcranial shear distraction, one of my favorite cervical/headache techniques is probably indicated to help reduce tone in the capital extensors.

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Keeping it Eclectic...


  1. Long time reader, thanks for the great content!

    How does one educate on mandibular rolling?

    -Simon Koytiger, DPT

  2. Hi Simon, I have the patient palpate their mandible condyle, and learn to feel the different between anterior translation which feels like sliding and rolling. I use my fingertip on theirs to show them the difference. I also perform active assistive motion with one finger on the front of their chin, guiding it posteriorly and inferiorly, which feels very foreign to them. After a few minutes of this, I have them practice in front of a mirror and do that at home at least 2-3 times/day in addition to the regular practice without the mirror.