How Trigger Point Injections Relieve Pain from the TMJ Syndrome

We have treated TMJ and TMD (temporomandibular joint dysfunction) patients for decades, and one lesson towers over the rest: the pain usually is not coming from where it hurts. Localized or referred pain in the head and neck can grind on for years, with the sufferer bouncing between providers, because the true source, trigger points in the jaw muscles, was never on anyone’s list. Our TMJ treatment page covers the condition broadly; this article explains the mechanism, and why a precisely placed injection can relieve pain that nothing else touched.

What Trigger Points Are

A trigger point is a small knot of contracted muscle fibers that has become hyperirritable. In the classic reference on the subject, Myofascial Pain and Dysfunction: The Trigger Point Manual, Dr. Janet Travell and Dr. David Simons mapped how each muscle’s trigger points refer pain in predictable patterns, frequently to locations far from the knot itself.

The jaw system is fertile ground for them. There are at least five muscles of mastication on each side, and any of them can develop trigger points when chronically overworked, most commonly because an uneven bite forces the muscles to brace and compensate through thousands of closures a day.

Why the Pain Shows Up in Strange Places

Referred pain is what makes this condition so deceptive. Trigger points in the jaw muscles can produce:

• A severe, gnawing jaw ache, chronic or acute
• Diffuse pain over the eye or in the temples near the hairline
• Symptoms that mimic a tooth needing root canal treatment
• Ear pain with stuffiness or a sense of diminished hearing
• Discomfort around the eyes, sometimes with visual disturbance

Some of this pain can mimic migraine headache, which is why patients with stubborn “migraines” and coexisting jaw symptoms deserve a muscle evaluation, a connection we examine in can TMJ be the cause of migraine or severe headaches. The broader lesson, that most “TMJ pain” is muscular rather than joint pain, is illustrated with real cases in TMJ and neuromuscular pain.

How the Injections Interrupt the Cycle

Trigger point injection therapy places a fine needle directly into the knot, releasing the contracted band and breaking the self-sustaining cycle of contraction and pain. When the muscle lets go, its referred symptoms can subside as well, which is why relief is sometimes felt in the temple or ear rather than at the injection site.

The sophistication is in the diagnosis as much as the needle. The clinician must identify which muscle, and which point within it, is generating a given referral pattern, and that requires detailed training in the referral maps. Dr. Marlin wrote his prosthodontic master’s thesis on TMJ therapy and was personally trained in trigger point injection of the jaw muscles by Dr. Janet Travell herself.

Injections Within a Complete Plan

An injection relieves the knot; it does not fix what tied it. Durable treatment pairs muscle therapy with correction of the underlying cause. In Dr. Marlin’s sequence, a detailed diagnostic workup comes first, followed by precision bite adjustment and replacement of any defective restorations that keep the muscles overworking, with injections deployed where muscular pain persists. When and for whom injections make sense is covered in the companion article, trigger point injections to treat TMJ/TMD.

You do not have to keep living with TMJ or migraine-like pain that no one can locate. Call 202-244-2101 or request an appointment with Dr. Marlin at Elite Prosthetic Dentistry in Friendship Heights, Washington, DC, and start with a diagnosis that looks in the right place.