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updated 7/26/08

Massage Therapy for Bruxism, Jaw Clenching, and TMJ Syndrome

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

by Paul Ingraham, Vancouver, Canada (qualifications)

Trigger points (muscle knots) are the world’s most common cause of aches and pains. The Perfect Spots series of articles teaches you how to self massage the most satisfying and therapeutically significant places on the human body to apply pressure. Each Perfect Spot article focuses on a specific location. 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


“TMJ syndrome” is often mistakenly referred to as just “TMJ”. This isn’t a casual shortening of the term: people really think “TMJ” refers to the syndrome. But the acronym TMJ refers just to the joint. This makes it slightly amusing for me when people earnestly tell me, with grave concern, “I have chronic TMJ.”

“I know the feeling!” I tell them. “I also have a temporomandibular joint I can’t get rid of — been there since I was born!” Yuk yuk.

Sometimes I’m surprised that I get any repeat business.

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’s 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 always a likely suspect 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.

So, 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.


All The Perfect Spots for Trigger Point Massage

Choose your perfect spot!

Or, for general information and advanced tips about trigger point therapy, see Save Yourself from Trigger Points!

and …


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Are trigger points too good to be true?

Trigger point therapy often fails, but it often succeeds. Trigger points are not a “flaky” diagnosis. They are based on a lot of hard science. You can take photomicrographs of them, measure their electrical activity, take samples of their acidic and toxic tissue chemistry.

In addition to a decade of my own clinical experience, the Perfect Spots are based primarily on the research and writing of Drs. Janet Travell and David Simons, the pioneers of myofascial pain syndrome research. Dr. Travell died in 1997 after decades of tireless efforts to educate her medical colleagues about trigger points. Dr. Simons continues to publish. They produced “the Big Red Books,” a massive 2-volume text about trigger points, and recently Dr. Simons published Muscle Pain with Dr. Siegfried Mense.

The existence and importance of trigger points is not scientifically controversial, but it is obscure. The challenge is to get the word out. Doctors are generally uninformed about musculoskeletal health care — it simply isn’t on their radar. As Dr. Simons wrote, “Muscle is an orphan organ. No medical speciality claims it.

Notes

  1. 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.
  2. 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.
  3. 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? Maybe I’m missing something … Return to text.
  4. 1992 Guinness Book of Records. Return to text.
  5. Travell et al. Myofascial Pain and Dysfunction. 1999. p339 Return to text.
  6. Rocha et al. Prog Brain Res. 2007. In 2007, these researched 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.
  7. 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.