| Age / Sex | 32-year-old female |
| Primary Diagnosis | Temporomandibular joint (TMJ) dysfunction with myofascial pain |
| Contributing Factor | Forward head posture and upper cervical dysfunction |
| Symptom Duration | ~18 months of progressive jaw pain, clicking, and limited opening |
| Functional Limitation | Pain while eating and talking, restricted jaw opening, reliance on a night guard/splint |
| Previous Treatment | Dental night guard/splint, NSAIDs — symptoms managed but not resolving |
| Treatment Provided | Jaw neuromuscular retraining, postural correction (DNS, AiM), chiropractic cervical care |
Background
A 32-year-old woman presented with chronic jaw pain that had progressively worsened over 18 months. She experienced pain while eating and during prolonged conversation, audible clicking on one side, and had been wearing a dental night guard for over a year. While the splint prevented nighttime clenching damage, it did nothing to address the underlying dysfunction — her symptoms continued to worsen during the day. She had been told that TMJ issues are simply something to manage, and was seeking an alternative perspective.
Clinical Assessment
Our evaluation revealed that the jaw dysfunction was inseparable from her posture. Significant forward head posture had shifted the mechanical relationship between her cervical spine and mandible, altering the resting position of the jaw and the way the muscles of mastication functioned. We identified specific dysfunctions in both jaw opening and closing — the mandible was deviating laterally during opening, and the closing pattern recruited compensatory muscles rather than the primary movers. These abnormal neuromuscular patterns were the driving force behind her pain, clicking, and functional limitation. Without correcting the posture, any jaw-specific treatment would have been temporary at best.
Treatment Protocol
Phase 1 Weeks 1–3 | Postural Foundation & Pain Reduction Chiropractic adjustments addressed upper cervical and thoracic restrictions that were driving the forward head posture. DNS-based exercises began retraining deep neck flexor activation and thoracic extension to restore a neutral head-over-shoulders position. Initial jaw work focused on reducing muscle guarding and pain through gentle manual techniques targeting the pterygoids and masseters. |
Phase 2 Weeks 3–7 | Jaw Neuromuscular Retraining With postural improvements providing a stable foundation, treatment shifted to retraining the neuromuscular patterns of jaw movement. Specific exercises corrected the lateral deviation during opening and restored balanced bilateral muscle activation during closing. AiM principles were applied to integrate jaw movement with cervical and thoracic positioning, ensuring the corrections carried over into eating, talking, and resting posture. The patient practiced coordinated jaw opening and closing patterns daily. |
Phase 3 Weeks 7–10 | Functional Integration & Appliance Weaning As neuromuscular control improved and postural corrections became habitual, the patient gradually reduced night guard use under guidance. Functional exercises progressed to include chewing harder foods and sustained conversation without symptom provocation. A home maintenance program was established to preserve the corrected movement patterns and postural gains long-term. |
Progress Timeline
| Months 1–6 (Pre-Treatment) | Consulted dentist for jaw clicking and pain — fitted with a night guard/splint. Managed symptoms with NSAIDs. Jaw pain and headaches decreased but never fully resolved. Sought a more comprehensive approach after symptoms plateaued. |
| ▸ Treatment at City Integrative Rehabilitation | |
| Week 1 | Reduction in jaw muscle tension following initial cervical adjustments and manual therapy. Patient noticed less clenching awareness during the day. |
| Week 3 | Jaw clicking frequency reduced significantly. Able to eat softer meals without pain for the first time in months. Posture visibly improved. |
| Week 5 | Opening and closing patterns normalized — lateral deviation corrected. Eating comfortably with a wider range of foods. Conversational pain resolved. |
| Week 7 | Began reducing night guard use. No return of symptoms during trial nights without the appliance. |
| Week 10 | Fully pain-free eating and talking. Night guard no longer needed. Discharged with a home program for postural and jaw maintenance. |
Results vary by individual. This case study represents one patient’s experience and is not a guarantee of outcomes.