TMJ Pain & Your Pelvic Floor: It's All Connected

Our jaw joints do a lot. They enable us to tell our best stories, laugh our butts off, chew our favorite foods, and get the most pleasure from sex. So, when our jaw joints stop working properly or become a source of chronic pain, it can be a very big deal.

What many people with jaw issues may not realize is that physical therapy is a top treatment option — and seeing a pelvic floor physical therapist can be especially helpful for people assigned female at birth due to the surprising relationship between your jaw and pelvic floor.

We're here with up-to-date info and expert insight to help you understand this connection.

2 TMJ exercises that help relax your jaw

Before we take a deep dive into the facts, here are a couple of jaw-relaxing exercises you can try right now. (Want to relax your pelvic floor? You'll find 5 simple but effective exercises right here.)

1. The Slow-Mo Chew

This move will help relax the muscles of the TMJ joint on each side:

• Sit with your shoulders relaxed and your ears in line with your shoulders and hips. Keep your head still and gaze straight ahead.
• Place your tongue against the roof of your mouth and behind your front teeth.
• With your tongue still positioned on the roof of your mouth, open your mouth halfway.
• Stabilize your TMJ on one or both sides by placing one finger at the joint with sustained pressure throughout this exercise.
• Slowly and with control, close your mouth fully before repeating this motion.

As this becomes easier, try opening your mouth fully during this exercise, rather than halfway.

2. The Slack Jaw

Here's another way to relax those TMJ muscles:

• Sit with your shoulders relaxed and your ears in line with your shoulders and hips. Keep your head still and gaze straight ahead.
• Place your tongue against the roof of your mouth and behind your front teeth.
• With your tongue still positioned on the roof of your mouth, allow your jaw muscles to relax, letting your teeth separate and your mouth open slightly.
• Try to keep your muscles relaxed as you hold this pose.

The link between TMJ & pelvic floor pain

Pelvic floor physical therapists see regular evidence of this connection when treating patients with tight pelvic floors who also complain of jaw tension. “A history of injury, inflammation, or pain, can lead to what's called 'guarding' — where our muscles brace and hold to protect us from a threat, which can be physical or emotional and either real or imagined,” explains Dr. Celestine Compton, PT, DPT, WCS, a pelvic floor physical therapist at Origin. “That's what's happening when you clench your jaw or grind your teeth, and that's what's happening when your pelvic floor muscles are unable to fully relax."

While more research is needed, studies have found links between chronic pelvic pain, which is often caused by pelvic floor dysfunction, and chronic jaw pain which is often caused by TMJ dysfunction. For example, a 2023 study involving 128 people with endometriosis found a correlation between endometriosis-related chronic pelvic pain and TMJ joint pain.

There may also be differences in posture among people with TMJ dysfunction, which could impact the pelvic floor. One 2017 study found that among 243 participants ages 10-15 seeking dental care services, muscular TMJ dysfunction was significantly associated with differences in spinal curves, head posture, and lower limbs. Similar results were found in a 2009 study among participants ages 20-30.

Along the same lines, there’s a possible association between TMJ dysfunction and restrictions in hip motion. The results of a very small study of 20 women with complex regional pain syndrome (CRPS) suggest that TMJ dysfunction contributes to the restriction of hip motion, which can, in turn, contribute to pelvic floor dysfunction.

All about TMJ dysfunction

Temporomandibular joint dysfunction (the official abbreviation is TMJD but it's more commonly known as TMJ pain, TMJ dysfunction, or just TMJ for short) is a chronic pain condition where dysfunction in the joints connecting the lower jaw to the skull leads to pain and tenderness. TMJ dysfunction may result in pain that's located only in these joints or it can cause more widespread pain.

As many as 12% of all people may experience TMJ dysfunction. TMJ issues are also about twice as common among people assigned female at birth, which speaks to how common it can be for us to hold tension in our bodies.

What are the symptoms of TMJ dysfunction?

As is the case with so many chronic pain conditions, the symptoms of temporomandibular joint dysfunction can vary from person to person.

Common symptoms of TMJ dysfunction may include:

• Jaw pain
• Facial pain
• Shoulder or neck pain
• Jaw stiffness
• Difficulty opening or closing the mouth
• Jaw popping or clicking
• Headaches and migraines
• Earaches
• Toothaches
• Ringing in the ears
• Change in how the teeth fit together

What causes TMJ pain and dysfunction?

Most chronic pain conditions can’t be traced to one particular cause or factor. Studies show several possible factors in the development and maintenance of temporomandibular joint dysfunction, including:

• Genetic factors: Chronic TMJ dysfunction has been associated with at least six genetic markers, including ones related to the glucocorticoid (involved in metabolism) and serotonin (involved in mood and cognition) receptors.
• Teeth alignment: Differences in how the upper and lower teeth align can lead to TMJ dysfunction.
• Posture: It’s possible, though not proven, that head and cervical (neck vertebrae) posture may contribute to TMJ dysfunction.
• Physical trauma: Injuries to the jaw may cause TMJ dysfunction.
• Pain threshold and processing: Like with other chronic pain conditions, how people experience and process pain may play a role in TMJ dysfunction. Genetics may contribute to differences in pain threshold and processing.
• Psychological factors: Some research has shown associations between chronic TMJ dysfunction and mental health conditions like anxiety, depression, post-traumatic stress disorder, and history of abuse.

How is TMJ dysfunction treated?

A paper published by the journal of the American Association of Oral and Maxillofacial Surgeons recommends that people with TMJ dysfunction try all of the following to reduce pain:

• Eating soft foods to let the jaw joints rest.
• Using over-the-counter pain medication like ibuprofen to decrease inflammation.
• Using heat or ice 15 minutes a day on painful areas.
• Doing activities that help with stress levels, like getting in regular exercise.
• Using splints or bite plates to limit grinding and clenching.
• Getting physical therapy.
• In some cases, getting surgery.

TMJ Headaches: A symptom of whole-body stress

If you have TMJ pain and experience chronic headaches, the common culprit is likely to be stress. “Stress doesn't just live in your brain, it manifests in your body physically,” explains Dr. Compton. It's well-established that people who have chronic stress can develop migraines, among other issues.

When we’re scared or very stressed out, there’s a physiological reaction that affects other systems in the body that's commonly known as the fight-or-flight response. “Your body thinks you need to be able to run, so your muscles engage and contract to stabilize you for a sprint," says Dr. Compton. "Your neck muscles might become overactive because you start to take fast, shallow breaths.” These types of stress-induced changes can set you up for a major headache.

Why pelvic floor PT can be the best treatment for TMJ dysfunction

A 2016 systematic review and meta-analysis found that physical therapy may decrease pain and improve active range of movement among people with disorders of the temporomandibular area. Pelvic floor physical therapists, in particular, take a holistic approach that considers and explores how TMJ dysfunction may impact the rest of the body, including the pelvic floor.

“Physical therapists who treat the pelvic floor are in a unique position that we've had to kind of explore beyond that, and incorporate more into our care,” says Dr. Compton. “If you saw somebody who specializes in the jaw, they're not going to ask you if you're peeing your pants or about pain during sex. They're just not going to cross that bridge.”

People who go to a pelvic floor physical therapist may learn and use a variety of techniques to relieve their TMJ dysfunction, including:

• TMJ muscle relaxation: “Horse-lip” breathing can help someone relax their jaw as well as the pelvic floor. Taking deep, diaphragmatic breaths to relax the jaw also supports expanding the abdomen and lengthening the pelvic floor. (Horse-lip breathing is commonly used to help with relaxation while peeing.)
• TMJ massage: The masseter muscles are involved in clenching and grinding the teeth. Massaging these and other related muscles (e.g., the pterygoid and scalene muscles) can lead to relaxation and release. A pelvic floor physical therapist can do these massages in person or teach you to do them at home.
• Postural awareness: Pelvic floor physical therapists can provide education on finding and using their most “neutral” posture. “How your pelvis is positioned can impact how your lower back is positioned, which impacts how your upper back is positioned, and affects how your jaw is positioned,” says Dr. Compton.

Get long-term relief from TMJ dysfunction

Many of Origin’s pelvic floor physical therapists are trained to provide treatment for TMJ dysfunction — in addition to pelvic floor dysfunction.

As compassionate, trauma-informed practitioners, Origin’s physical therapists support people’s minds and bodies. So, if stress is contributing to jaw pain, or if several areas of the body are experiencing tension, our physical therapists are well-positioned to help.

We want to make pelvic floor physical therapy accessible to everyone who wants it. Origin accepts many commercial insurance plans and Medicare at some Texas locations. If we don’t accept your insurance, we’ll work with you to find a pelvic floor physical therapist who does.

Book a free 10-minute intro call to see if Origin is right for your care needs.

Your pain is never “normal.” We’re here to help you feel better in your body, whatever that takes.