TMJ condylar tracking as well as crepitus can often be improved using a combination of active and passive exercises to normalize joint translation and disc tracking.

1.Minor joint dysfunction - first stage of home treatment of joint clicking, popping, or crepitus::
The patient presses the tongue against the center of the roof of the mouth directly behind the front teeth (where the tongue would go to say "la"), then opens and closes the jaw. If this alone reduces crepitus and/or normalizes joint motion, the patient should perform three sets of ten repetitions, 4-5 times a day, for 4-8 weeks. If it doesn’t improve function, increase tongue pressure, if it still does not stop the "clicking" sound then proceed to the next group of exercises.

2. Lateralization of the TMJ:
The patient places the tongue behind the front teeth at the roof of the mouth on the side away usually from the “popping” or pain. The tongue needs to be placed as far left or right suficiently to create the greatest ease in opening and closing while decreasing or eliminating any joint "clicking". The patient needs to repeat this exercise daily. As improvement is noted, they will gradually be able to centralize tongue position. The exercise repeated until the tongue can be placed centrally at which time the patient should proceed with exercise #1.

3. Protrusion and Retrusion:
The patient places the tongue on the roof of the mouth usually anteriorly (to aid in TMJ dysfunction caused by mandibular retrusion) or posteriorly (if caused by mandibular protrusion). The tongue is placed as far forward or backward as necessary to create the greatest ease in opening and closing while decreasing or eliminating any joint "clicking".. The exercise is repeated until the tongue can be placed centrally and the patient should proceed with exercise #1.

With complex mandibular dysfunction, oblique positions and various pressures might be required. The ultimate goal is to bring the tongue into a central position at roof of the mouth and reduce or eliminate any joint popping or clicking

4. Disc Centralization:
Once the patient can perform exercise #1 with without crepitus, the patient can then proceed to the following mirror-assisted exercise. With the tongue in central position, the patient attempts to maintain the jaw in the midline while opening and closing, evaluating the center of the bottom and top teeth during motion. The patient should perform this exercise, three sets of ten repetitions, 4-5 times a day.  Once they can learn how to open and close in a balanced manner the mirror would only need to be used to assure proper motion one time per day, however the exercise is still performed 4-5 times a day, until they can begin to reduce tongue tension, there is no joint clicking, and their jaw opens evenly.

Relief of muscular tension:
Difficulty will be observed when the patient attempts to swallow while maintaining a level chin and forehead when supine or while tilting the head back when sitting. Often the patient may complain of respiratory difficulties particularly at night, sometimes leading to a TMJ form of sleep apnea. This is often accompanied by persistent suboccipital and/or submandibular muscle tension.

Instruct the patient to perform the following muscle relaxation exercises.

1.    The patient places the tip of the tongue in a relaxed manner near the roof of the mouth behind the front teeth, in a position if they would make the sound "la."   The patient then focuses their attention to the back part of their tongue that is the farthest back in the throat and relaxes that part of the tongue as much as possible.

2     The patient next puts their attention to their jaw and relaxes the jaw muscles, allowing the mandible to drop downward and forward.

3.    The patient then consciously atempts to relax their suboccipital muscles as if their nose would nod downward a half inch. 

4.     This exercise can become a mediation as the patient attempts to repeatedly go from: "tip of the tongue near the roof of the mouth," "back part of tongue relaxes," "jaw drops downward and forward," and "back part of head relaxes."

With repetition, the patient will gain greater awareness and control of the muscular tension.  I have often recommended to patients that they perform this relaxation exercise every 20 seconds for the rest of their life.

These home exercises, when used in conjunction with Sacro Occipital Technique cranial treatment for TMJ dysfunction, can be of tremendous help to the patient’s progress. If they fail to normalize joint crepitus, translation or disc tracking, dental co-treatment is usually required.