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Massage Therapy for Bruxism, Jaw Clenching, and TMJ Syndrome

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

2,300 words, updated Jul 11th, 2013
by Paul Ingraham, Vancouver, Canada bio
I am a science writer, the Assistant Editor of ScienceBasedMedicine.org, and a former Registered Massage Therapist with a decade of experience treating tough pain cases. I’ve written hundreds of articles and several books, and I’m known for sassy, skeptical, referenced analysis and a huge bibliography. I am a runner and ultimate player, and live in beautiful downtown Vancouver, Canada. • full bioabout SaveYourself.ca

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.


Pain Location Problems Related Muscles
in the side of the face, jaw, teeth (rarely) bruxism, headache, jaw clenching, TMJ syndrome, toothache, tinnitus masseter
“Big Red Books” Reference: Volume 2, Chapter 8
see chart of all spots below

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 an accomplice in many cases of bruxism (that’s Latin for “grinding your teeth”) and temporomandibular joint syndrome (a painful condition of the jaw joint), and probably other unexplained painful problems in the area — it will be either a contributing factor or a complication.


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 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, 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 everyone, both patients and professionals. (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.

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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:

The Fake DrunkSlur 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. To get into the spirit of the thing, speak the words, “I’m so relaxed I can hardly talk,” and 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 up to.

Excellent.

Now, don’t move.

The Long Surprise: 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 — as though you are really just shocked by something, continuously, for an hour. 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, such as a Lego block, or a small rubber ball. 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 holding your face like someone just stuck a needle in your keister. 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, and have fun with it.

About Paul Ingraham

I am a science writer, former massage therapist, and assistant editor of Science-Based Medicine. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook and Google, but mostly Twitter.

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. 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
  4. 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
  5. “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
  6. 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
  7. 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
  8. Travell et al. Myofascial Pain and Dysfunction. 1999. amazon.com p339 BACK TO TEXT
  9. 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
  10. 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 …

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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.

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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 B: 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 pleasing and popular target for massage 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 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 in 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, or 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   

7Perfect Spot No. 7 — Massage Therapy for Bruxism, Jaw Clenching, and TMJ Syndrome

Your masseter muscle is your primary chewing muscle — not the only one, 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. 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. Read more (this page!)

for pain: in the side of the face, jaw, teeth (rarely)    related to: bruxism, headache, jaw clenching, TMJ syndrome, toothache, tinnitus    muscle(s): masseter   

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 effectively impossible, but massage is an option: although often shockingly sensitive, Perfect Spot No. 8 can also be quite satisfying. It also often complicates or contributes to 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, but experienced as low back pain. 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   

14Perfect Spot No. 14 — Massage Therapy for Shoulder Pain

I avoided adding Spot 14 to this series for many years, because it’s a little tricky to find. But precision is not required: although there is one specific spot that’s especially good, nearly anywhere just under the ridge of bone on the shoulder blade is worthwhile, and often a surprising key to pain and stiffness everywhere else in the shoulder… but especially all the way around on the other side, facing forward. Read more 

for pain: any part of the shoulder, and upper arm    related to: frozen shoulder, supraspinatus tendinitis    muscle(s): infraspinatus, teres minor