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Massage Therapy for Bruxism, Jaw Clenching, and TMJ Syndrome

Perfect Spot No. 7, the masseter muscle of the jaw

Trigger points (TrPs), or muscle knots, are a common cause of stubborn and strange aches and pains, and yet they are under-diagnosed. The 13 Perfect Spots are trigger points that are common and yet fairly easy to massage yourself — the most satisfying and useful places to apply pressure to muscle. For tough cases, see the advanced treatment guide.

Your masseter muscle is your primary chewing muscle — not the only one,1 but the main one — and it covers the sides of the jaw just behind the cheeks. It’s also the main muscle that clenches your jaw and grinds your teeth, unfortunately, and it’s one of the most common locations for trigger points in the entire human body.2 It is probably an accomplice in most cases of bruxism (that’s latin for “grinding your teeth”) and temporomandibular joint syndrome (a painful condition of the jaw joint), plus other unexplained painful problems in the area.3

The masseter muscle is strong (and special)

Not only does the masseter muscle probably harbour the most common trigger points in the human body, the masseter is also the strongest muscle in the human body (pound for pound), although many variables make this is difficult to be sure of.4 Together with the temporalis muscle and a few other smaller muscles, most people can generate at least 150 pounds of force (lbf) between their teeth. For contrast and amusement, the world record for human bite strength is 975 lbf. 975!5 More than six times normal. A human shark!

Muscles might all seem similar, but it’s amazing how specialized they can be. The masseter gets extraordinary strength from a “multipennate” arrangement of fibres that’s like a complex feather — fibres converging diagonally on several internal tendons.6 This feathered arrangement favours torque over speed, making the masseter a very “low gear” muscle, slow but powerful and efficient, lots of chewing bang for your masseter buck. The physics details are a bit mind-bendy.7

Why is the masseter muscle a Perfect Spot for massage?

It’s easy enough to imagine why this muscle might enjoy the occasional massage. Whose jaw isn’t a bit tense? But the masseter’s potential to wreak havoc — and its need for therapy — is often underestimated by the public and health care professionals alike (although I’m pleased to see a surprisingly strong interest in the subject amongst dental specialists). When irritated, masseter muscle knots can cause and/or aggravate several problems:

Headaches, of course — this makes strong intuitive sense to most people. There seems to be a pretty strong connection between tension headaches and jaw clenching. This is partly due to the temporalis muscle, which is reflexively massaged by everyone with a headache. But the masseter is often neglected, even though it is by far the more powerful jaw muscle. They really both need some attention — massaging above and below the cheekbone. I actually considered defining Spot No. 7 as the temple and the masseter.8

Earaches and toothaches — which are much less obvious. A masseter trigger point can radiate pain directly into a tooth. Travell and Simons quip, “This can lead to disastrous results for an innocent tooth.”9 I once suffered a dramatic case of a “toothache” that was completely relieved by a massage therapist the day before an emergency appointment with the dentist: a particularly vivid experience, which originally got me interested in trigger points.

Tinnitus (ringing in the ears) and dizziness. Both can be serious and complex problems, and are definitely not necessarily caused by masseter trigger points. There are many other potential contributing factors and causes of these conditions — but the masseter is one of the possible causes that should be considered.10

Bruxism, or grinding and cracking of molars.

Temporomandibular joint syndrome, which is a slow, painful failure of jaw joint function.

As you can see, masseter problems are not to be taken lightly.

How do you massage the masseter muscle?

Fortunately, it’s easy — really easy — to massage and soothe your own masseter muscle, which is what makes it such a particularly perfect Perfect Spot. It has both great needs and it’s unusually easy and satisfying to self-massage.

The masseter muscle “hangs” from the underside of the cheekbone on the side of the face. The bottom of the muscle attaches to a broad area on the side of the jawbone.

Perfect Spot No. 7 is conveniently located in a notch in the cheekbone, about one inch in front of your ears. The notch is on the underside of the cheekbone, it’s easy to find, and your thumb or fingertip will fit into it nicely, unless you have freakishly large hands. If you press firmly inward and upwards with your thumb in the cheekbone notch, you will usually be rewarded with a sweet ache.

The rest of the masseter muscle, however, tends to feel like not much, or unpleasantly tender. Although the entire muscle can be rubbed gently, most people will find that the Perfect Spot is definitely limited to the upper edge of the muscle.

Spot 7 is a sturdy piece of anatomy, so don’t be afraid to work steadily up to hard pressure — if that’s what you feel like you want. Either constant pressure or small, kneading circles are both appropriate. Since this spot is so tough, another good trick is to use a knuckle for extra pressure. A useful tool in this location is Pressure Positive’s Knobble productshow — it’s easy to lie down on your side and let the weight of your head apply a steady, firm pressure, with the tip fitting nicely into the cheekbone notch.

Two tricks for learning to relax your jaw

Does anyone go to the dentist anymore and not get a prescription for a mouth guard? Judging by the inevitable prescriptions, apparently everyone has some kind of jaw-clenching problem. I do not know if this is actually the case, and sometimes I feel suspicious that the problem is greatly over-diagnosed (because selling mouth appliances is probably profitable). Then again, many people (including my wife) have actual cracks in their molars from clenching so hard — and it’s kind of hard to argue that there isn’t a problem there!

This article is mostly about massaging Perfect Spot 7 in the masseter, but it’s obviously potentially extremely helpful for temporomandibular joint syndrome, bruxism, clenching, and grinding if you can also figure out how to relax your jaw. But this is not easy. A nice massage (or any other relaxing experience) is a helpful start, but it doesn’t do much for long.11 And simply willing yourself to stop clenching seems almost completely ineffective. Simply willing yourself to stop clenching seems to be almost completely ineffective I’ve known many people who have tried to get serious about reminding themselves to stop clenching, using egg timers and so on … with rather underwhelming results.

So what can you do? How can you possibly learn to clench less? Here are two ideas that I think work better than simply “trying hard” not to clench:

Slur your speech as though you are so sleepy that you can hardly form words. You know that lovely feeling when you’re waking up slowly, in no hurry, and you’re conscious yet not even remotely ready to move or speak yet? That floaty, delicious feeling of happy paralysis? Of complete contentment to just lie there? Don’t just visualize that feeling, actually act like you feel that way, in your mouth. Try to say, softly but out loud, “I’m so relaxed I can hardly talk.” But slur your words. Literally slur them. Slur them like your mouth is so relaxed you are having trouble making words! You will find that this is quick and effortless way to relax your jaw. It won’t necessarily last, but it is a most helpful way to quickly get back to the state you want.

I use this technique even when there are people around. I find that I can easily just mouth the words “I can hardly talk,” making no noise, and immediately access the sensory experience of jaw relaxation, with no one around me having a clue about what I’m to.

Spend long periods of time with your jaw wide open. Hold your mouth open at least wide enough to fit a finger between your teeth for one full hour. Not just open, but open wide — the exaggerated reversal from clenched to wide open helps to break the habit of clenching much more quickly. Every time during the hour that you catch yourself with your teeth together, simply calmly stretch your mouth open again. After an hour of this, clenching starts to feel abnormal, and you will find it much easier to keep your jaw relaxed for some time afterwards.

You may also find it helpful to actually prop your mouth open with something durable and spit-proof. Most people will salivate too much to keep this up for an entire long session, but it can be a useful way to help you focus on the challenge for a few minutes at a time. Some people may find it practical for longer.

This intensive approach is generally a much more effective method of breaking the clenching habit than scattered self-reminders to “stop clenching,” which just never really take. If you are really determined, spend an hour a day doing this — if you put in the time, you really can’t fail. I estimate that most people need 5–10 hours of practice in a week to put a good dent in a clenching habit. Of course, life is likely to regenerate the problem back sooner or later … but you will know what to do when that happens.

Good luck!

Notes

1. The other major one is the temporalis muscle, which covers more of the side of the head than most people realize: the entire temple, of course, but quite a bit more above and behind that. BACK TO TEXT
2. Travell et al. Myofascial Pain and Dysfunction. 1999. amazon.com p330. Several studies are discussed that conclude that myofascial trigger points in the superficial masseter muscle are either the most common, or the second most common, of all the trigger points studied. It’s a hard thing to nail down for sure, but it seems pretty clear that it’s an extremely prominent “Perfect Spot!” BACK TO TEXT
3. That’s actually an exaggeration, but it’s a fair one. In fact, there are almost certainly people who have those problems and no masseter trigger points — but the vast majority would still have some kind of dysfunction of the masseter and other jaw muscles. For instance, with or without trigger points on a given day, the masseter would probably still be “tight” (high toned) in these patients. BACK TO TEXT
4. The tongue is also popularly claimed to be the most powerful muscle, but that’s really hard to substantiate. The tongue isn’t one muscle, but a muscle group, and it can’t apply force in a way that can be compared meaningfully to other muscles. How, exactly, do you test tongue strength? Tongue push-ups? BACK TO TEXT
5. According to the 1992 Guinness Book of Records, in 1986 Richard Hofmann of Lake City, Florida achieved a bite strength of 975 lbs. for two seconds. BACK TO TEXT
6. “Pennate” just means “like a feather,” with diagonal fibres converging on a line — a tendon. In a “multi” pennate muscle, there are multiple and dividing central tendons. The result is a very complex, densely packed feathering of fibres. There are only a few multipennate muscles in the body, like the deltoid on the shoulder, and most of the small muscles in the hands and feet. But the masseter is the king of “pennatedness.” BACK TO TEXT
7. Pennate muscle power is a winch: powerful but slow, and you need more cable to pull shorter distances. Pennate muscles exploit the pulley effect by pulling on the sides of tendons that run all the way through the muscle, converging on them at angles. Imagine a tug-of-war team with ropes tied to the main rope — you could have at least twice as many pullers! More fibres pulling on a tendon means that pennate muscles are found in the “tight spaces” in the body where power is needed without a lot of mass. In contrast, muscles with parallel fibres, like the biceps, pull directly on their target bone, and so they can pull faster and farther, but they are also weaker pound-for-pound and take up a lot of room. If you converted pennated muscles to a parallel fibre structure, they would have to be roughly twice as big! Imagine doubling the size of your masseters. Chipmunk! BACK TO TEXT
8. I decided against it because the two halves of the spot are so different in character. The temporalis is much thinner, massage there needs to be generally more delicate and superficial, and it feels more like massage of the surface of the head than the jaw. Only about a centimetre away, just on the other side of the cheekbone, the top of the masseter is sturdy and thick, and tolerates strong pressure which feels more much more penetrating and much more relevant to jaw tension. BACK TO TEXT
9. Travell et al. Myofascial Pain and Dysfunction. 1999. amazon.com p339 BACK TO TEXT
10. Rocha et al. Myofascial trigger points: another way of modulating tinnitus. Prog Brain Res. 2007.

    In 2007, these researchers found that “in 56% of patients with tinnitus and MTPs, the tinnitus could be modulated by applying digital compression of such points, mainly those of the masseter muscle.” And how many people with tinnitus had trigger points? Quite a few. The researchers found “a strong correlation between tinnitus and the presence of MTPs in head, neck and shoulder girdle.”

    BACK TO TEXT
11. This is one of the classic problems with massage. Although massage does appear to be very helpful for some people, some of the time, the results are a bit underwhelming on average — and the benefits are notoriously brief. This is discussed in much more detail in both my advanced trigger points tutorial, and also my general massage review, Does Massage Therapy Work?. BACK TO TEXT

Appendix A: Is trigger point therapy too good to be true?

Trigger point therapy isn’t too good to be true: it’s just ordinary good. It can probably relieve some pain cheaply and safely in many cases. Good bang for buck, and little risk. In the world of pain treatments, that’s a good mix.

But pain is difficult and complex, no treatment is perfect, and there is legitimate controversy about the science of trigger points. The phenomenon of sensitive spots on the body is undeniable … but their nature remains somewhat puzzling, and the classic image of a tightly “contracted patch” of muscle could just be wrong. On the one hand, you can measure their electrical activity, take samples of their highly acidic tissue chemistry, and now a new MRI-like technology can now show them as well. On the other hand, some of that may be wrong, and all of it could essentially just be “side effects” of a more basic problem. No one really knows.

What we do know is that people hurt. Muscle pain is clinically significant, but medically obscure. As Dr. David Simons wrote, “Muscle is an orphan organ. No medical speciality claims it.” Many patients can benefit from educating themselves.

The Perfect Spots are based on a decade of my own clinical experience as a massage therapist, and years of extensive science journalism on the topic. Want to know more? This is the tip of the iceberg. I’ve written a whole book about it …

Appendix B: Quick Reference Guide to the Perfect Spots

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