Injuries

Facial pain is a debilitating condition that is often chronic and patients have commonly spent a large amount of time and money attempting to find the answers to its cause and often to no avail.

Do you suffer from face, tooth, jaw or head pain? If you do - read on....

Symptoms:

Facial pain encompasses a variety of symptoms and locations but most commonly it presents as single or double-sided pain in the jaw, check, ear, tooth, neck and/or headaches. These symptoms may be worst first thing in the morning (if you are a night grinder or clencher) but otherwise can be aggravated throughout the day. It is very common for sufferers to limit the foods they eat ie hard foods, nuts, chewing gum along with limiting the amount they open their mouth when talking, laughing, smiling etc in order to limit the amount of pain they suffer.

Facial pain is most commonly suffered by females - 4:1 x that of males. Very frequently sufferers have a history of neck issues or injury in the past and they need not be suffering from any neck pain at all at the time of their facial pain.

There are a large number of causative factors which commonly interact to cause tightness in the facial muscles and hence cause facial pain. Some of these causes are listed below:

• History of head or neck trauma
• Sedentary job
• Poor posture particularly sitting posture
• Telephone use at work (without headset)
• Teeth grinder or clencher (day and/or night)
• Malaligned teeth
• Sleeping positions/pillow use/sleeping habits
• Poor breathing techniques
• Stress, anxiety, depression
• Poor relaxation ability
• Diet

Treatment of this condition depends on the combination of causes specific to the individual but largely comprises of:

• Neck mobilisations and/or manipulations
• Upper back (thoracic spine) treatment
• Dry needling and trigger point release of the facial musculature
• Treatment of the jaw joint (TMJ) as required
• Education and rehabilitation

Common questions we are asked by people suffering from facial pain:

I have tooth pain without any other symptoms and it is worse when I eat hard foods and when cold air/drink gets on it. Could this really not be coming from my teeth? It is very common for these issues to aggravate your symptoms if facial pain is the cause just as if a tooth is causing your pain. If your dentist is happy with your teeth/tooth concerned it is highly likely that you may have a myofascial facial pain issue.

I have been advised to get a night splint - do these work? Yes these can be beneficial for many patients and will help protect your teeth if you clench or grind at night. They may also help aid your symptoms but will not correct the cause of the clench or grind which needs to be addressed as otherwise you will continue to have issues.

How many times will I need to see you for treatment? This will vary case to case but on average most patients will see us 2 -3 x to resolve their acute pain. After this those who have been suffering for years with pain will often come back for maintenance treatment once every 1 -2 months as required until they feel they are able to manage any flareups they have.

I have had acupuncture before, what is dry needling? Dry needling is a form of acupuncture that is effective via a different mechanism and therefore utilized for different conditions. It utilizes one needle which is not left in place for any period of time but simply placed into the "knot" of a muscle and moved around slightly to achieve a "muscle twitch/es" before it is removed. This usually takes around 30 secs. The needle itself is painfree when inserted, there can be a deep ache when the needle is in the "knot" and it can be achy for a period of time. Heat and stretching will help settle this.

I don't like needles, are there alternative treatments available for my facial pain? Yes you don't need to have dry needling for your facial pain but often it is the most successful and quickest way to get great results. Trigger point release can be used on the majority of your facial muscles (those that are superficial) and this will help resolve these overactive muscles. It is also important to note that the use of motor control training, stretching, heat and self massage are essential in the complete resolution of these areas of overactivity.

Sometimes my jaw clicks and locks, can you still help my facial pain? Yes we can still help resolve your facial pain. If you continue to have mechanical symptoms such as locking we will refer you to a maxillaryfacial surgeon to have your TMJ joint further assessed but rarely is surgical intervention required.

In order to prevent this facial pain returning once treatment has resolved it, it is essential that all underlying causes are identified and then addressed. This comes largely in the way of exercises - stretches, self trigger point release, postural improvements, breathing retraining, motor control training ensuring symmetrical jaw opening, deep neck muscle training and education around active strategies that people can use in order to ensure they are able to cope with the daily life stressors in a way that doesn't result in "winding up" their system again and causing the pain and dysfunction to return.

Considering that patients who suffer from facial pain have often had the pain for years before they get to us it is amazing how quickly their symptoms resolve with on average 3 treatments. After this it is learning how best to manage their individual stressors so that this pain doesn't reoccur and if it does they have the tools to self manage along with an early check up as required if they aren't able to manage it themselves.

Facial pain is a condition that very few people think about a physiotherapist for. You need to specialize in this area and it is an area that a number of our physiotherapists work regularly with. For this reason we get great results for our patients who have suffered a lot and it is therefore really satisfying work for us as therapists. We are continuing to work to increase the awareness of this condition particularly with dentists who are usually the first point of call for any tooth, jaw or facial pain.