Temporomandibular dysfunction (TMD) and tinnitus (ringing in the ears) are two of the most rapidly responding impairments to dry needling. The addition of upper cervical joint manipulation amplifies this effect. The results are nothing less than magical sorcery, and let me tell you, I like me some magic and sorcery. Both of these impairments are challenging to treat without needling. With needles, complete, quick resolution of both problems is often achieved. As with so many neuromusculoskeletal dysfunctions, the addition of dry needling and spinal manipulation makes everything so much easier.

Although TMD and/or tinnitus are day-to-day issues for millions of people, treatment for both of these impairments, which frequently occur together, usually consists of a pill or lots of pills. Masking symptoms with pills and masking the side effects of those pills with more pills, and so forth, sadly, is how almost all medical maladies are treated. For many medical providers, it is easier and quicker to cover the symptoms with a band-aid versus locating the source. They are overworked/overbooked (pushed to see more patients than they can handle in order to make more money) and therefore are required to make a diagnosis in less than 5 minutes while subsequently choosing a treatment method that checks the boxes.

Because of this, critical thinking in medicine is almost non-existent, across all fields. Non-pill treatments, like DN, and old, off-patent pill-treatments are viewed like the black death or are considered to be quackery by many in the medical establishment. This is because there is little money to be made if a treatment fully resolves the impairment. The only thing that is pushed as treatment for most conditions is new, super expensive pharmaceutical treatment that may or may not work, that may or may not cause more harm than good. But who cares, they make money! Now, if you want to address the cause of the problem, to, you know, actually fix it, the combination of dry needling and joint manipulation should be at the top of the list.

Tinnitus

Tinnitus can happen for a lot of reasons. Medication, stress, pathologic muscles or joints, and the list goes on. Regardless of the original cause, ANS dysregulation is a common factor. Dry needling combined with joint manipulation is the most powerful regulator of the ANS we have at our disposal. Remember, ANS homeostasis helps with all medical impairments, including tinnitus. I have seen needling and manipulation eliminate tinnitus secondary to a multitude of causes, medication included. For the purpose of this article, however, let’s stick to tight muscles and joints as the cause. Pathologic muscles and joints are not considered capable of causing tinnitus by many medical professionals, which is unfortunate, because these are common causes and are two of the easiest to treat.

The muscles most capable of directly causing tinnitus are the levator veli palatini and the tensor veli palatini, which attach to the palate and the cartilage of the Eustachian tube. The tensor veli palatini is the safest and easiest to treat of the pair. The other muscles I find most commonly causing tinnitus are the two heads of the lateral pterygoid. Unfortunately, if you do not have needles, proper treatment of these muscles is impossible. With needles, treating these muscles is super easy and consistently produces rapid and full resolution of both TMD and tinnitus.

Between these 4 muscles, you have attachments on the palate, the TMJ and the auditory tube. This makes it relatively obvious that pathology of any of the 4 could cause either of the problems we are discussing. I have had a few ear nose and throat physicians specifically ask about needling the tensor/levator veli palatini for tinnitus. To access these muscles with needles, it is necessary to pass through both masseter muscles. This works out nicely for us as the two masseters, along with the three pterygoids on each side, are common causes of TMD.

Temporomandibular Dysfunction

TMD, like tinnitus, can be a challenging impairment to treat, if you don’t have needles. With needles, rapid, full resolution is consistently achieved. Although the masseters are on the outside of the mandible, the 3 pterygoids are on the inside, making them difficult to treat, unless you use needles. Then it is easy. The 3 pterygoids and 2 masseters surrounding each TMJ are the ten primary muscles that when pathologic, most directly lead to TMD. All of them are innervated by cranial nerve V, the trigeminal nerve. Lots of other muscles can play a role in TMD, however, the pterygoids and the masseters are the muscles that cross or attach to the TMJ.

As with all muscles, the ten muscles mentioned above respond more strongly to electrical needling than any other treatment. Strength of these muscles is not a problem. The problem is tightness and inflammation. Stretching these muscles is next to impossible, so they must be treated manually. Again, there is no better treatment on planet earth than needling to normalize muscle, both neurologically and mechanically. From popping or clicking of the jaw, to deviations with jaw opening or closing, to pain, dry needling combined with joint manipulation is, by far, the best treatment to quickly resolve all forms of TMD.

Note: Don’t forget to treat the Suboccipitals, upper cervical and other pathologic muscles crossing the neck. All of these may play a role in TMD.

Upper Cervical & TMJ Manipulation

Upper cervical, C0-C1-C2, and temporomandibular joint manipulation is key if full resolution of TMD is desired. The transverse process of C1 is situated behind the TMJ. If C0/C1/C2 is deviated from neutral, it places unusual stresses and strains through the TMJ, leading to TMD. Whether the joint or muscle pathology happens first, the other will quickly follow and become pathologic as well. For this reason, it is essential to treat both the joints and soft tissues when treating TMD and any other neuromusculoskeletal impairment.

Tribonucleation is the physiologic process through which we experience the joint “popping” sound, or cavitation. This occurs by stretching the joint capsule quickly enough to increase its internal volume. When you increase the volume of a container enclosing a liquid, like a joint capsule, the pressure inside the capsule drops. Decreased pressure on enclosed fluids (synovial fluid) allows molecules dissolved in the fluid to move around more, making them less soluble in that fluid. So, by eliciting tribonucleation of the joint capsule we hear a “pop,” which is gas, most likely carbon dioxide and nitrogen, going from dissolved in fluid to actual gas floating around above the fluid, inside the joint capsule. This is like sticking a ball pump needle into the capsule and pumping it up a few times, creating intracapsular joint distraction. It is so cool that we can now see this with real-time imaging!

This tension on the joint capsule from an air bubble forming inside the capsule stimulates a mechanotransducive neurophysiologic response, inhibiting soft tissue tonicity and tightness, while inducing endogenous opioid release, like beta-endorphin from the hypothalamic-pituitary-adrenal (HPA) axis, and reduces pro-inflammatory markers such as interlukin-6 and tumor necrosis factor alpha (TNF-a), along with regulation of the pro-inflammatory Nrf2 pathway. Many of these mechanisms of action mimic and amplify those of dry needling, creating a synergistic effect.

Summary

If you are treating patients with TMD and or tinnitus, or you suffer from one or both of these issues, dry needling combined with upper cervical and TMJ manipulation is the best way that exists to quickly and effectively eliminate TMD and or tinnitus. Tinnitus and TMD can happen for a variety of reasons, making them difficult to treat. With the implementation of dry needling and joint manipulation, these two impairments often quickly resolve, when no prior treatment has made a difference.

Give this a try and let me know if anyone has any questions about anything. If you are a patient or practitioner, I can help you locate someone to treat you or sign up for a course. Talk to you soon.

Jason

DISCLAIMER: The content on the blog for Intricate Art Spine & Body Solutions, LLC is for educational and informational purposes only, and is not intended as medical advice. The information contained in this blog should not be used to diagnose, treat or prevent any disease or health illness. Any reliance you place on such information is therefore strictly at your own risk. Please consult with your physician or other qualified healthcare professional before acting on any information presented here.
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Neural Plasticity

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B-endorphin

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Enteric Nervous System, Gut-Brain Axis

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  Vagus Nerve Stimulation
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Orthopedic Conditions

• Clark, N.G., Hill, C.J., Koppenhaver, S.L., Massie, T. and Cleland, J.A., 2021. The effects of dry needling to the thoracolumbar junction multifidi on measures of regional and remote flexibility and pain sensitivity: A randomized controlled trial. Musculoskeletal Science and Practice, 53, p.102366.
• Navarro-Santana, M.J., Gómez-Chiguano, G.F., Cleland, J.A., Arias-Buría, J.L., Fernández-de-Las-Peñas, C. and Plaza-Manzano, G., 2021. Effects of Trigger Point Dry Needling for Nontraumatic Shoulder Pain of Musculoskeletal Origin: A Systematic Review and Meta-Analysis. Physical Therapy, 101(2), p.pzaa216.
• Ma, Y.T., Li, L.H., Han, Q., Wang, X.L., Jia, P.Y., Huang, Q.M. and Zheng, Y.J., 2020. Effects of trigger point dry needling on neuromuscular performance and pain of individuals affected by patellofemoral pain: a randomized controlled trial. Journal of Pain Research, 13, p.1677.
• Carusotto, A.F., Hakim, R.M., Oliveira, R.G., Piranio, A., Coughlan, C.P. and MacDonald, T.J., 2021. Effects of dry needling on muscle spasticity in adults with neurological disorders: a systematic review. Physical Therapy Reviews, pp.1-6.
• Haser, C.H.R.I.S.T.I.A.N., Stöggl, T.H.O.M.A.S., Kriner, M.O.N.I.K.A., Mikoleit, J., Wolfahrt, B., Scherr, J., Halle, M. and Pfab, F., 2017. Effect of dry needling on thigh muscle strength and hip flexion in elite soccer players. Med Sci Sports Exerc, 49(2), pp.378-383.
• Ceballos-Laita, L., Jiménez-del-Barrio, S., Marín-Zurdo, J., Moreno-Calvo, A., Marín-Boné, J., Albarova-Corral, M.I. and Estébanez-de-Miguel, E., 2019. Effects of dry needling in HIP muscles in patients with HIP osteoarthritis: a randomized controlled trial. Musculoskeletal Science and Practice, 43, pp.76-82.
• Geist, K., Bradley, C., Hofman, A., Koester, R., Roche, F., Shields, A., Frierson, E., Rossi, A. and Johanson, M., 2017. Clinical effects of dry needling among asymptomatic individuals with hamstring tightness: a randomized controlled trial. Journal of sport rehabilitation, 26(6), pp.507-517.
• Osborne, N.J. and Gatt, I.T., 2010. Management of shoulder injuries using dry needling in elite volleyball players. Acupuncture in medicine, 28(1), pp.42-45.
• Albin, S.R., Koppenhaver, S.L., MacDonald, C.W., Capoccia, S., Ngo, D., Phippen, S., Pineda, R., Wendlandt, A. and Hoffman, L.R., 2020. The effect of dry needling on gastrocnemius muscle stiffness and strength in participants with latent trigger points. Journal of Electromyography and Kinesiology, 55, p.102479.
• Navarro-Santana, M.J., Sanchez-Infante, J., Gómez-Chiguano, G.F., Cleland, J.A., López-de-Uralde-Villanueva, I., Fernández-de-Las-Peñas, C. and Plaza-Manzano, G., 2020. Effects of trigger point dry needling on lateral epicondylalgia of musculoskeletal origin: a systematic review and meta-analysis. Clinical Rehabilitation, 34(11), pp.1327-1340.
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