A special thanks to Jennifer for writing this for us!

 Driving is something that’s hard to avoid. Whether it’s a daily
work commute, a summer vacation, or traveling to visit family at
the holidays, you probably drive at some point. However, driving
can mean lots of jaw, muscle, and back pain for many people.

Why does driving hurt the jaw and muscles so much?
As with most TMJ-related problems, I think this is a
mutli-layered issue. First, posture while driving isn’t ideal. The car seat
may not lock in to your ideal sitting position, and your spine,back muscles,
and leg muscles may not be sitting comfortably. While driving, you have to
hold your head forward, move your neck to look around, use your right leg way
more than the left, and perform other motions that may put extra strain on
already stressed muscles of your body.

It’s also very easy to end up clenching your jaw, which hurts the joint and
other muscles. Driving can be stressful, or boring, and either one of these
situations can let you easily slide into clenching. Rough roads can also
cause a lot of movement that can cause your jaw to move
around, and you may clench to help stabilize it.

Dehydration can also be an issue, especially if it’s a longer drive.
It’s easy to avoid beverages all together to avoid making lots of stops,
and it’s easy to choose coffee or pop over water or other more hydrating
choices which can affect your muscles. And if you’re anything like me,
you may also talk and sing (a lot!) in the car.
When we drive to visit family, we’re in the car for 5 hours, and
we don’t really want to sit there silently. We usually have the radio
on loud, and talk over it, and occasionally sing along. 5 hours
(or any amount of time) is a lot of time to use my jaw for this!

For all drives, make sure your seat and mirrors are comfortable before
departing. Position your steering wheel at a height that allows your
arms and shoulders to be as comfortable as possible.

Position your seat and situate yourself comfortably. I have a little round pillow
like this one:
http://www.amazon.com/gp/product/B000QZ1WL0/ref=as_li_ss_tl?ie=UTF8&tag=th0b3-20&linkCode=as2&camp=1789&creative=390957&creativeASIN=B000QZ1WL0

I bring with me. Putting this against the lower back can help cushion
or make up for the sometimes less than ideal position I’m in while driving.
I can also use it for my neck
You can also purchase in-car lumbar support like this one:

http://www.amazon.com/gp/product/B000O5EZQQ/ref=as_li_ss_tl?ie=UTF8&tag=th0b3-20&linkCode=as2&camp=1789&creative=390957&creativeASIN=B000O5EZQQ
for a sturdier way to position your back.

If I am going to be driving far, I usually take a preventative ibuprofen
or two. I’m not a fan of over-medicating, but trying to fix this problem
before it starts is worth it to me in this situation.
If I get a bad headache or pain while driving, and then take an ibuprofen,
I’d have to wait for it to kick in… while still driving or while sitting
at a rest area. I’d rather try to stop it before it starts.I am fortunate
enough that ibuprofen works for my pain, but if you need stronger medication
for your pain, be cautious taking it before or while driving!

Stopping at least once on a longer drive can be great as well. I usually
like to drive as far as possible without stopping, but getting out of the
car around half way and stretching can help a lot. I usually do this at a
fast food restaurant where I can get something to eat and drink as well
(fruit and yogurt parfaits and milkshakes are very jaw friendly!).
I also make sure I have plenty of water and jaw-friendly snacks with me
for when I can’t stop or just want to go to a rest area.
Yogurt travels pretty well, or really soft Nutrigrain bars work, too.
Eating or drinking has a huge placebo effect for me. Whatever works!

If you have a car with electric outlets in it, bring your favorite heating
pad with you! One with an auto-off feature might be best for driving so it
doesn’t get too hot, but if you feel you can manage
to reach the switch and safely manage it, any one should do.

Do you have any other tips for jaw-friendly driving?

We received this letter from one of our members and wanted to share it with you.  Please note that not everyone is going to have the same results, but we felt that in light of the fact that we are getting so many questions about joint replacement that it was very important for you to hear her story. 

Hi, I’m 43, a wife and mother of 4 beautiful daughters aged between 16 and 26, I work full time as a tax agent for a small accounting firm. I would love to share my TMJ story with you. It all started when I was about 18, when my jaw locked for the first time. So I’ve been dealing with it for quite a long time, however it’s only been in the last couple of years that I finally did something about it. Basically I put my family first, as one of my daughters has a major disability together with mild mental retardation, so I’ve had my hands full.

Over the years I learned to manage my jaw problems. I learned not to bite into anything or chew chewy foods. My jaw would lock and crunch if I did and as you know this hurt like hell and my jaw would ache as a result. I’ve been on a soft diet for years now. It wasn’t so bad in the early years and I managed it quite easily, however it got much worse in the last 2-3 years. My jaw would lock constantly, even when I was just talking and the pain became constant. I’m not the type of person who says anything to anyone when I’m not feeling ok and didn’t even take any pain killers, or seek medical help. If anyone ever asked I would just say I was ok. I didn’t even tell my husband what I was dealing with until a couple of years ago. However it got to a point where I just couldn’t deal with it any longer and finally went to the doctors. Just my GP to begin with, who then referred me to a TMJ specialist?

The first form of treatment was night splinting together with physio. This lasted about 6 – 8 months with no results. In fact the physio was very painful and just made things worse. So it was back to the TMJ specialist and an MRI was arranged. The MRI showed severe osteoarthritis in the right joint and milder in the left. The osteo had also spread to my skull.  The discs on both sides had completely gone.
My TMJ specialist said I needed a total joint replacement on the right and the plan is to do the left in about 5 years time or earlier if necessary. At this point I just cried and cried, feeling very angry with myself for not doing something earlier.
I asked the usual questions. Such as, what the surgery involve and would it fix the problem. The surgeon did a very good job of explaining what the surgery would be like and said “yes” it would solve my problems. However I feel he let me down in not explaining how long I would take to recover. He seemed more interested in explaining the fact that I would have very little scaring. I’m not the kind of lady who cares about scaring. It’s the other things that matter to me.  He explained I might have facial palsy and I do. I still can’t raise my eyebrow on the right side. He also said I would need 4 weeks off work.
Just as the surgeon had explained, the first couple of weeks were the worst. Swollen, bruised and very sore, the pain killers and sleeping tablets did the trick during this period. I also had great support during this time from family & friends, helping with the household chores & cooking. They were wonderful, cooking soups and other liquid/soft foods to eat.

It’s now been 8 weeks since I had the right TMJ total joint replacement surgery and I’ve been back at work for (full time) 3 weeks now. I would love to have more time off work but unfortunately I’ve run out of holiday & sick pay and just can’t afford too. I’m finding it very difficult at work. Talking to clients, which is unavoidable is very hard. Some days are very difficult, the more I talk the more it aches. I have trouble saying some words, especial words with sounds like “sh” in them.
I can only open my mouth wide enough to get a small spoonful of food in. I can’t even fit 1 little finger between my teeth. My jaw just aches all the time. I can’t even laugh or smile without making my face ache.
I visited my surgeon this week and asked two basic questions.

1. Is this pain normal?
2. Can I ever expect to be pain free?

His answer’s were as follows:

1. Yes the pain is normal, he said it’s was because the muscles are trying to re-attach themselves to the prosthesis and the more I talk and use the jaw the longer this will take to heel. It’s also muscle spasms.
2. In regards to the prospect of a pain free future. His answer was less definitive. He just said “That was the goal”.

He also went onto say it could take 6 – 12 months for a completely recovery. I just wasn’t prepared for that!!!!!!!!!!!!!!!!!!!!!!!!!
My close family are very sympathetic; however they just don’t understand how hard this all is. I’m very tired both physically and mentally.
I admit I should have done more research before the surgery. I only just found your website this week. I just trusted by Doctor’s/Specialists. It wouldn’t have changed the fact that I needed to have surgery, but maybe I could have been more prepared.
I start physio next week and I’m very anxious about it, I’m concerned that while it will help with the opening of my mouth, it will cause more pain. Basically I’m just not looking forward to dealing with more pain.
Thanks for listening
Thanks for your wonderfully informative website

How many times have you cancelled plans with a close friend because of your pain?  Did you make up an excuse or tell the truth?  Why do we often feel the need to lie?

I’ve recently found it necessary to let go of a few relationships where I could not be myself, and instead am learning to embrace the ones that seem to embrace me – chronic pain and all. I hope you will too!

Like many women these days, I’m generally preoccupied with my family’s needs, their schedules, the endless to-do lists, doctor’s appointments, and obviously my pain high levels.  Anyone who has TMJ pain knows that the best medicine often can be simply resting the jaw, ice and heat, avoiding triggers, eating a special diet, paying attention to relaxation, getting some sleep, etc.

However, I believe it is in our best GIRLFRIENDS that we truly find nurturing and healing. It really is a big part of taking care of ourselves, and each other!

Whether it’s a girlfriend you’ve known since childhood, or one you connected with on TMJ Hope, our girlfriends seem to give us something we can’t get anywhere else. I often say my girlfriends have magical powers, powers that far outweigh anything from a doctor’s office!  I say this because after a really good talk, encouraging email exchange, or a weekend away with my dearest of friends, I feel I’ve found sanity again! I feel suddenly like I’ve received a boost of energy and confidence and can relax. I do actually lose track of time and forget to take my medication. I forget because my pain is not nagging me! Girlfriends give us a kind of medicine and positive energy I wish I could bottle up!

When you live in pain long enough your closest friends can easily be broken into two groups – your girlfriends, and your girlfriends with chronic pain. In this article, we’ll talk about the first group.

We all likely have one or two friends we’d call “lifelong” friends, our oldest and dearest, and what a treasure!  If you’re lucky enough to have one of those friends, hang onto them as they are like no other friends in your life.  These are the women who know the most sacred of secrets and all about your biggest dreams.  Lifelong friends are precious – they are family we choose, your sisters, and what a gift they are!  These are also women that perhaps knew what you were like “pre-tmj” and often need some help learning about how your life has changed now because of it.

Clearly they can’t fix you, but you can do something – HELP THEM to HELP YOU.

Here are some tips to help you nurture these friendships:

• Be honest.  When you don’t feel well, what is it you need? Do you like to be alone? Do you prefer company?  What is most helpful to you on your worst of days? Perhaps there is a special soft dish your friend makes that you can request? Is there an errand she can run for you? Friends want to help you feel better, and as patients we have to learn to let others help us. Open a dialogue so it’s not uncomfortable to talk with your best friend about your pain.
• Be a patient teacher  –   It is difficult to have patience when you’re not feeling well, but we must remember that these friends are trying to help. TMJ Hope is one place that has suggestions on how to talk to your loved ones about your pain. Whether they truly “get it” or not, give them credit for trying.  Say thank you for putting up with you in the worst of moods, or coming over to help out, or just calling to say hello and check in!  Pain patients often hide just how bad we are feeling, but if these are your closest friends they may appreciate you telling the truth.
• Make “Girlfriend Time” a priority.   It’s hard for others to understand that those last minute cancellations are not to be taken personal, but our pain often dictates our schedule doesn’t it?  Add in children, spouses, work and life’s unexpected events, and well there isn’t much “girlfriend time” leftover. Realize that certain people may pull away because they are tired of declined invitations over and over again.  So, when you find yourself having a good day make time for those friends. Show your friends that you appreciate and recognize their efforts. Ask about their lives and see how you can be there for them too. Reconnect with them and do what you can, when you can. Make time for your girlfriends because in turn you are truly nurturing yourself also. Personally I find that when I’m relaxed and able to just be myself, and take care of myself, I may forget all about my pain! Yes, you heard me! Even if just for a few hours, it’s worth it!

Bottom line… It doesn’t matter if I’m feeling frustrated, happy, sad, or purple… From the dearest of friends who have been there since childhood, to the friends who checked on me and sent care packages after my surgeries, these are the girlfriends that take the time to love and appreciate ME – the good, the bad, and the TMJ!

Stay tuned for part two of this article – we’ll discuss why it’s incredibly important to develop and nurture friendships with those who have chronic pain, too.

Do you have any tips to share with us about friendships and pain? How do you balance friendships, pain, family, work, etc?  

You may have heard of the term “sleep bruxism”, which includes both clenching and grinding. Everyone who grinds his or her teeth clenches as part of the grinding, but not everyone who clenches grinds. The grinding part causes tooth wear, but most of the problems of TMJ Disorder come directly from the clenching.

In this article we’ll take a look at three main things:
1. Why clenching causes so much more damage than chewing.
2. How diverse symptoms such as migraines, jaw pain, neck pain, TMJ joint problems, loose teeth, receding gums, and root canals can all come from clenching.
3. How nighttime clenching becomes a habit (and why the clenching habit remains even when you remove the original cause).

1. Why does clenching cause more damage than chewing?

All the joints of our bodies are designed to withstand much larger forces briefly than they can sustain over a longer period of time. When a runner runs on pavement, it is not unusual for his or her ankles and knee joints to sustain brief shock forces of 400 pounds for a few hundredths of a second each time a foot hits the pavement. When you chew a piece of meat, it is not unusual for your teeth to sustain a brief pulse of force of over 100 pounds for a tenth of a second on each chew. But…the protective tissue in our joints that cushions these blows can only do so briefly.

The protective tissue in our joints has many of the same qualities as Silly Putty. If you ever played with Silly Putty as a kid, you know that if you make it into a ball, you can bounce it. During the brief shock force of the bounce, it behaves like rubber, but if you squeeze it for even half a second, it mashes like dough. When something is resilient when you squeeze it briefly but mashes when you squeeze it longer, that property is called “thixotropic”. The thixotropic protective tissue in our temporomandibular joint and around the roots of our teeth gets mashed and accumulates damage when we clench for more than a couple of seconds at a time. That’s why clenching can cause so much more damage than grinding.

2. The many and varied consequences of clenching

Now lets look at the different consequences of that protective tissue being damaged.

Consequences of clenching:
Bacteria gets between teeth and the jaw (which leads to loose teeth, receding gums, an abcess, or some combination of these problems)
Jaw pain, clicking and popping
Nerve damage
Headaches, migraines, tinnitus

When the protective tissue that bonds teeth into the jaw is damaged, one bad consequence is that bacteria can get between the teeth and the jaw, and this can lead to loose teeth, receding gums, an abscess that requires a root canal procedure, or some combination of these problems.

When the protective tissue in the temporomandibular joint is damaged, many things can go wrong. The joint can become painful. The geometry of the joint can change so that clicking and popping can occur. But because the trigeminal nerve runs through that joint, as protective tissue in the nerve becomes damaged, many more things can go wrong.

When the trigeminal nerve gets mashed from clenching, direct pain may result, and in addition sympathetic and parasympathetic nerve fibers can carry signals to the brain that can bring on headaches or migraines. Facial pain, muscle pain, and ringing in the ear are also common effects.

3. How nighttime clenching becomes a habit

The way we build a habit is that over time we build a neural association (connection) in our brain between something we see or hear or feel and an action we take in response. We build good habits this way (like stepping on the brake when tail lights light up in front of us), and we sometimes build bad habits this way (like fingernail biting in response to stress).

Building a nighttime clenching habit looks like this:

Once the habit is in place, the original disturbance or intention that put the habit there can go away, and the habit remains.

An established habit looks like this:

Each time we use a neural pathway, it gets strengthened. This happens physically at the synapses between neurons. So as the habit gets more entrenched, this neural “path through the forest” may begin to look more like a road or a highway.

Do you grind or clench? Have you had any success trying to stop it? Share your experiences with us in the comments below.

Editor’s note: I’m excited to bring you our first guest post on TMJ Hope. We’re always looking for interested patients, professionals, and others to tell their stories. If you would like to guest post on TMJ Hope, please contact me! Without further ado…. our first guest! Cynthia is an experienced physical therapist, and author of the book, “The TMJ Healing Plan: Ten Steps to Relieving Headaches, Neck Pain, and Jaw Disorders.”

1. Less is Best

I agree with the National Institute of Health (and TMJ Hope!) who say, “Less is often best in treating TMJ Disorders”. You would be wise to explore your safe, conservative, reversible and cost-effective options before making any permanent changes to your bite, undergoing surgery, or spending exorbitant sums of money.

2. Posture

I feel that trying to treat your head, neck and jaw without addressing your posture would be like giving you a car without any tires. If your posture is out of balance or alignment, it can adversely impact your jaw, neck and head. You need to address your posture in sitting, standing and sleeping. My patients with the worst jaw joints are often those who sleep on their stomach or on their side with their hand or arm pressing on their face. Try sleeping on your back. You could benefit from seeing a specialized orthopedic physical therapist to help you evaluate your posture and alignment. Many patients with TMJ Disorders don’t realize they have loose joints and hyperextend their knees. If your joints are loose you need to learn to unlock your knees and protect and stabilize your joints including your jaw.

Read more TMJ tips from Cynthia…

3. Tongue

If your tongue works and rests correctly, it can help you separate your teeth and relax your jaw. Your tongue should gently rest along the roof of your mouth like when you make a “cluck” sound. If your tongue wants to push against your front teeth at rest, in speech or swallowing, you likely need to tone and retrain it, on your own, with your PT, or with a speech language pathologist specially trained in tongue thrust and swallowing disorders.

4. Swallowing

You swallow between 500 and 2,000 times a day. If you are swallowing incorrectly you may be contracting muscles that shouldn’t have to be on the job and thrusting your tongue every time you swallow. Learn to be a swallowing superstar.

5. Breathing

Breathing should be through your nose and diaphragm and is normally 12-16 breaths per minute. Most of the patients I see are rapid chest breathers. Learning to breathe can also calm muscles and help you switch gears from a stressful “fight flight” to a restful relaxed state.

6. Teeth Apart

Your teeth should only touch momentarily when you swallow in the back. Otherwise they should never touch. Common postures and even medications can cause clenching.

7. Lips Together

“Our Lips are Sealed” is not only a song, but a healthy way to help your jaw relax and keep your tongue gently suctioned on the roof of your mouth. Some people have short upper lips and have difficulty closing their lips. These people can benefit from some stretches and exercises to make it easier.

8. Calm Your Muscles and Your Mind

Tight and tender muscles are one of the biggest contributors to headaches, neck pain and jaw disorders. Muscles can even cause headaches, ear pain, dizziness, ringing in the ear, and even tooth pain (along with jaw pain!). It is critical you gain a better understanding of what irritates and relaxes your muscles. Our minds and physical bodies are intricately connected. Mental stress and a nervous system that is stuck in high gear must also be managed.

9. Avoid Over-Opening

Yawning is only one of the activities that can cause you to over open your jaw. Try keeping your tongue on the roof of your mouth as you yawn to stop you from opening too far. Understanding the basic anatomy of your jaw joints, how they work and how to care for them is vital for success.

10. Avoid Extra Pressure on Your Jaws

Just like your shoes wear out the more you run around in them, your jaw joints are subject to similar wear and tear. Overuse and abuse of your joints, including your jaws, can wear them down. Hurtful habits like sleeping on your stomach, resting your chin on your hand, holding the phone to your shoulder, singing, eating, excessive talking are only a few of the ways we unwittingly wear down our joints. As you learn to replace hurtful habits with healthy ones, you can set the stage for health and wellness (and hopefully, less jaw pain!).

Cynthia Peterson is physical therapist in Utah, who has been treating TMJ disorder for over 20 years. She is the author of The TMJ Healing Plan: Ten Steps to Relieving Headaches, Neck Pain, & Jaw Disorders.

Important Note: This information does not replace a thorough evaluation by a medical professional. It is always advisable to check with your physician or licensed health care professional before starting any exercise, stretching or self-management program.
Content is excerpted (or adapted) from The TMJ Healing Plan © 2010 by Cynthia Peterson and published by Hunter House Publishers.