updated 5/26/10
Massage Therapy for Bruxism, Jaw Clenching, and TMJ Syndrome
Perfect Spot No. 7, the masseter muscle of the jaw
by Paul Ingraham, Vancouver, Canada MOREclose
Credentials and qualifications
I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.
For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.
Credentials and qualifications
I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.
For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.
Trigger points (TrPs), or muscle knots, are the world’s most common cause of aches and pains, and yet they are rarely diagnosed correctly. Having too many stubborn trigger points is called “myofascial pain syndrome” (MPS). The Perfect Spots series of articles highlights trigger points that are unusually common and yet relatively easy to treat yourself — the most satisfying and therapeutically significant places to apply pressure on the human body. For a complete, advanced tutorial that walks you through every possible self-treatment option for muscle pain, see Save Yourself from Trigger Points & Myofascial Pain Syndrome!
Your masseter muscle is your primary chewing muscle, and it covers the sides of the jaw just behind the cheeks. It’s also the muscle that makes you clench your jaw and grind your teeth, unfortunately, and it may be the single most common location for trigger points (muscle knots) in the entire human body.1 It is an accomplice in pretty much every case of chronic jaw clenching, bruxism (that’s latin for “grinding your teeth”), and temporomandibular joint syndrome (a painful condition of the jaw joint).2
The masseter muscle is strong
Not only does the masseter muscle probably harbour the most common trigger points in the human body, the masseter may be the strongest muscle in the human body, although many variables make this is difficult to measure.3 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 965lbf!4 For two seconds, anyway. Ouch.
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 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 intuitive sense to most people.
Earaches and toothaches — which are much less obvious. A masseter trigger point can refer pain directly into a tooth. Travell and Simons quip, “This can lead to disastrous results for an innocent tooth.”5
Tinnitus (ringing in the ears) and dizziness. Both can be serious and complex problems, and are not necessarily caused by masseter trigger points. There are many other potential contributing factors — but the masseter is one of the possible causes that should be considered.6
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 this particular notch you will be rewarded with a sweet ache.7 The rest of the muscle, however, tends to feel like not much, or unpleasantly tender. Although the entire muscle can and should be rubbed gently, the Perfect Spot is definitely limited to that upper edge of the muscle.
Perfect Spot No. 7 is a sturdy piece of anatomy, so don’t be afraid to work steadily up to hard pressure — if that’s what it seems to 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.
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 relieve some pain cheaply and safely in many cases. The existence of trigger points is not controversial. 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.
The Perfect Spots are based on a decade of my own clinical experience, and on the research and writing of Drs. Janet Travell and David Simons, pioneers of myofascial pain syndrome research. They produced “the Big Red Books” (a massive pair of texts).
Trigger points are clinically significant, but unfortunately obscure. As Dr. Simons wrote, “Muscle is an orphan organ. No medical speciality claims it.”
Want to know more? This is the tip of the iceberg. There’s a whole book …
Not too good to be true.
Just ordinary good. Trigger point therapy isn’t a miracle cure, but it is a valuable life skill. Practically anyone can benefit at least a little, and many will experience significant relief from stubborn aches and pains. The first several sections are free.
Appendix C: Quick Reference Guide to the Perfect Spots
1Perfect Spot No. 1 — Massage Therapy for Tension Headaches
Under the back of the skull must be the single most popular massage target in the human body. No other patch of muscle gets such rave reviews. It has everything: deeply relaxing and satisfying sensations, and a dramatic therapeutic relevance to one of the most common of all human pains, the common tension headache. And no wonder: without these muscles, your head would fall off. They feel just as important as they are. Read more.
| for pain: almost anywhere in the head, face and neck, but especially the side of the head, behind the ear, the temples and forehead | related to: headache, neck pain, migraine | muscle(s): suboccipital muscles (recti capitis posteriores major and minor, obliqui inferior and superior) |
2Perfect Spot No. 2 — Massage Therapy for Low Back Pain
This perfect spot lives in the “thoracolumbar corner,” a nook between your lowest rib and your spine — right where the stability of the rib cage gives way to the relative instability of the lumbar spine. Muscle tends to bunch up around this joint between the last of the thoracic vertebrae and the first of the lumbar. The sweet spot consists of trigger points in the upper-central corner of the quadratus (square) lumborum muscle and in the thick column of muscle that braces the spine. Read more.
| for pain: anywhere in the low back, tailbone, lower buttock, abdomen, groin, side of the hip | related to: low back pain, herniated disc | muscle(s): quadratus lumborum, erector spinae |
3Perfect Spot No. 3 — Massage Therapy for Shin Splints
Perfect Spot No. 3 is in the your shins — seemingly an unlikely place for muscle knots! But there is meat there, and if you’ve ever had shin splints then you know just how vulnerable that meat can be. Even if you’ve never suffered so painfully, your shins probably still suffer in silence — latent trigger points in the upper third of the shin that don’t cause symptoms, but are plenty sensitive if you press on them. Read more.
| for pain: in the shin, top of the foot, and the big toe | related to: shin splints, drop foot, anterior compartment syndrome, medial tibial stress syndrome | muscle(s): tibialis anterior |
4Perfect Spot No. 4 — Massage Therapy for Neck Pain, Chest Pain, Arm Pain and Upper Back Pain
Deep within the Anatomical Bermuda Triangle, a triangular region on the side of the neck, is the cantankerous scalene muscle group. Massage therapists have vanished while working in this mysterious area, never to be seen again. The region and its muscles are complex and peculiar, and many lesser-trained massage therapists have low confidence working with them. Read more.
| for pain: in the upper back (especially inner edge of the shoulder blade), neck, side of the face, upper chest, shoulder, arm, hand | related to: thoracic outlet syndrome, lump in the throat, hoarseness, TMJ syndrome | muscle(s): the scalenes (anterior, middle, posterior) |
5Perfect Spot No. 5 — Massage Therapy for Tennis Elbow and Wrist Pain
Just beyond your elbow, all the muscles on the back of your forearm converge into a single thick tendon, the common extensor tendon. At the point where the muscles converge, in the muscles that extend the wrist and fingers, lies one of the most inevitable myofascial TrPs modern civilization: Perfect Spot No. 5. It is constantly and greatly aggravated both by computer usage today and by the use of a pen in simpler times — and by the occasional tennis match, then and now. Read more.
| for pain: in the elbow, arm, wrist, and hand | related to: carpal tunnel syndrome, tennis elbow (lateral epicondylitis), golfer’s elbow (medial epicondylitis), thoracic outlet syndrome, and several more | muscle(s): extensor muscles of the forearm, mobile wad (brachioradialis, extensor carpi radialis longus and brevis), extensor digitorum, extensor carpi ulnaris |
6Perfect Spot No. 6 — Massage Therapy for Back Pain, Hip Pain and Sciatica
When you have back pain, buttock pain, hip pain, leg pain, much or even all of your trouble may well be caused by trigger points in the obscure gluteus medius and minimus muscles, a pair of pizza-slice shaped muscles a little forward of your hip pocket. Other muscles in the region are usually involved as well, such as the gluteus maximus, piriformis, and the lumbar paraspinal muscles. However, the gluteus medius and minimus are a bit special: their contribution to pain in this area is particularly significant, and yet people who have buttock and leg pain rarely suspect that much of it is coming from muscle knots so high and far out on the side of the hip. Read more.
| for pain: in the low back, hip, buttocks (especially immediately under the buttocks), side of the thigh, hamstrings | related to: sciatica, trochanteric bursitis, low back pain | muscle(s): gluteus medius and minimus |
7THIS PAGE (Perfect Spot No. 7 — Massage Therapy for Bruxism, Jaw Clenching, and TMJ Syndrome)
8Perfect Spot No. 8 — Massage Therapy for Your Quads
A lot of quadriceps aching, stiffness and fatigue emanates from an epicentre of knotted muscle in the lower third of the thigh, in the vastus lateralis, a huge muscle — one of your biggest — that dominates the lateral part of the leg. Stretching it is impossible, but massage is an option: although often shockingly sensitive, Perfect Spot No. 8 is often a contributing factor or complication of other problems in the area, especially runner’s knee (iliotibial band syndrome). Read more.
| for pain: in the lower half of the thigh, knee | related to: iliotibial band syndrome, patellofemoral pain syndrome | muscle(s): quadriceps (vastus lateralis, vastus lateralis, vastus medialis, rectus femoris) |
9Perfect Spot No. 9 — Massage Therapy for Your Pectorals
The “pecs” are popular muscles. Of the 700+ muscles in the human body, the pectoralis major is one of the dozen or so that most people can name and point to. It also harbours one of the most commonly-encountered and significant — yet little known — trigger points in the human body, and can produce pain much like a heart attack in both quality and intensity. Read more.
| for pain: anywhere in the chest, upper arm | related to: “heart attack,” respiratory dysfunction | muscle(s): pectoralis major |
10Perfect Spot No. 10 — Massage Therapy for Tired Feet (and Plantar Fasciitis!)
The tenth of the Perfect Spots is one of the most popular of the lot, and right under your feet — literally. It lies in the center of the arch muscles of the foot. This is one of the Perfect Spots that everyone knows about. No massage is complete without a foot massage! Read more.
| for pain: in the bottom of the foot | related to: plantar fasciitis | muscle(s): arch muscles |
11Perfect Spot No. 11 — Massage Therapy for Upper Back Pain
This “spot” is too large to really be called a “spot” — it’s more of an area. The thick columns of muscle beside the spine are routinely littered with muscle knots from top to bottom. Nevertheless, there is one section of the group where massage is particularly appreciated: from the thick muscle at the base of the neck, down through the region between the shoulder blades, tapering off around their lower tips. There is no doubt that this part of a back massage feels even better than the rest — even the low back, despite its own quite perfect spots, cannot compete. Read more.
| for pain: anywhere in the upper back, mainly between the shoulder blades | related to: scoliosis | muscle(s): erector spinae muscle group |
12Perfect Spot No. 12 — Massage Therapy for Low Back Pain (So Low That It’s Not In the Back)
At the top of the gluteal muscles lies a Perfect Spot among Perfect Spots: a sneaky but trouble-making brute of a TrP that commonly forms in the roots of the gluteus maximus muscle, just below the pit of the low back — close enough that most patients describe it as back pain, even though it’s actually in the upper buttocks. It produces a deep ache that spreads throughout the region. This is the kind of spot that the Perfect Spots concept is really all about — not only does it tend to produce a profound and sweet ache when massaged, but the extent of the pain that spreads out around it is almost always a surprise. Read more.
| for pain: in the lower back, buttocks, hip, hamstrings | related to: low back pain, sciatica, sacroiliac joint dysfunction | muscle(s): gluteus maximus |
13Perfect Spot No. 13 — Massage Therapy for Low Back Pain (Again)
Some of the Perfect Spots are perfect because they are “surprising” — they aren’t where you thought they’d be, and it’s delightful to discover the real source of pain. Others are perfect because they are exactly where you expect them to be — and what a relief it is to be able to treat them. Perfect Spot No. 13 is perhaps the ultimate, the quintessential “right where I thought it was” trigger point: right at the very bottom of the thick columns of muscle, in the “pit” of the low back. Read more.
| for pain: in the low back, buttocks, hamstrings | related to: low back pain, sciatica, sacroiliac joint dysfunction | muscle(s): erector spinae muscle group at L5 |
Notes
- Travell et al. Myofascial Pain and Dysfunction. 1999. 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!” Return to text.
- 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 master and other jaw muscles. For instance, with or without trigger points on a given day, the masseter would probably still be “tight” (high toned). Return to text.
- The tongue is popularly claimed to be the most powerful muscle, but just try to substantiate that. 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? Return to text.
- 1992 Guinness Book of Records. Return to text.
- Travell et al. Myofascial Pain and Dysfunction. 1999. p339 Return to text.
- Rocha et al. 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.” Return to text.
- Anatomy students may notice that the masseter muscle is not really in “the notch.” In the drawing at the top of the article, for instance, you can clearly see that only the edge of the masseter muscle is in the notch, and even that might be a stretch. I have three replies to this: first, it depends on what anatomy text you look at. Second, put your finger there and clench and tell me there’s no masseter muscle there: the muscle right under the skin bulges dramatically. Third, there’s a fudge factor here: that spot feels good, whether it is actually masseter tissue or masseter trigger points! Return to text.