Therapy for the TMJ and Nuchal Ligament.

BrownEyed Cowgirl requested some more information on what I work on to help Willy's TMJ and pole ligament issues. It sounded like a great idea for a post that might do some good, so here it is. I fully intended to take some pictures while I was at the barn yesterday but it was SO stinking hot that after attempting to ride (25 min, mostly walk) I gave up, hosed off the horse, grazed, and rushed to the a/c in the car. I did manage to pull some "stock" photos from my computer and some off the net, so hopefully that will help the explanations.

I want to start with a little disclaimer. I am not a vet, or a chiropractor, or an expert in any other area that pertains to horses. What I am describing in this post is what I'm doing for my horse, based on a thorough assessment, recommendations, and instruction from my chiropractor. Your horse might have very different underlying issues. That said, I think it's very unlikely that any of this could harm any horse but again, I'm not an expert. I know you're all smart and I don't need to say this but I wouldn't feel right if I didn't.

The Temporomandibular Joint (TMJ)

The TMJ is the joint of the jaw between the temporal bone and the mandible, hence it's name. There is actually a fair bit of information on this joint, and various disorders of it, online. Therefore, I am not going to go into the biomechanics of it and all the possible issues. Suffice it to say that many things can lead to problems in the TMJ such as how they are ridden, dental work (or lack thereof), and even the simple fact that they eat all day can lead to tightness. This can lead to a whole host of behaviours (like Willy’s headshaking) and soreness in seemingly unrelated parts of the body, such as the sore back (closer to pelvis) Willy has on-and-off. The good news is Dr. J assures me that these secondary areas of soreness begin to resolve as the TMJ begins to function better. She also works on the area to provide some immediate therapeutic benefit and relief.

Interestingly, TMJ tightness is known for causing issues at the pelvis. Although Willy’s pelvis showed plenty of “spring” and was very supple, he was a bit body sore. Furthermore, the TMJ and atlantoaxial joint have very intimate relations. The atlantoaxial joint is where the atlas (aka the first cervical vertebra, C1), articulates with the second cervical vertebra (C2). So, TMJ issues will often present with atlas/pole issues as well. Wish I knew all this 3 months ago! It still amazes me how all the pieces fit together so completely.

In my search for pictures, I found this site and found the article very good article that is (mostly) in line with what my chiropractor has told me. For more information, check out Equine CranioSacral Workshops.

This shows the articulation and some structures of the TMJ.

Ok, so what do we do about it? Body work! It’s so simple and produces such amazing results that I intend to always do some TMJ massage from now on, just with lessened intensity for preventative maintenance.

First, we need to locate the TMJ. Look for the big bone that sticks out at the top of your horse’s cheek. It’s shaped somewhat like a flat-ish chevron ^ or boomerang.

Here you can see the area quite clearly as Mr. Will has a drink.

In normal head position, you would see vertical striations from his

TMJ down through his cheek. Here, he is drinking so they are parellel to the bone.

Run your fingers side-to-side under that bone. You will probably feel some ligaments that run vertically into the cheek. You might be able to see them, especially if it’s very tight. Yes? These are what you want to be working on. Apply pressure/massage across the ligaments, so your movements are perpendicular to the way the ligament runs (you can work in the same direction too, but it should mostly be across the grain).

How much pressure? Back in March I had encountered some information on the TMJ and discovered some Cranio-Sacral people (like the link above but not that exact one) that emphasized using only the lightest touch. I tried it and it did nothing as far as I could tell. I remember not being able to keep my hand in the right spot with such a light touch because he was headshaking so badly. Because of what I had read online I was afraid to use more pressure and abandoned the idea. I was told by Dr. J to use as much pressure as I can muster for this and I have strong hands from years and years of rock climbing. I use a lot of pressure when I'm working deep and have nothing but good results. In fact, I think the more muscle I put in, the more he gets out of it. You’ll have to test this out for yourself, I guess.

I generally start with a med-light general massage of the TMJ and full cheek. Then I work up to medium with more focus on the specific ligaments, and finally full pressure on the ligaments. Once I think he’s had enough, I basically do the same thing in reverse and end with firm but gentle total cheek massage. I do most of the work one side at a time but end facing him and massage both cheeks at once. This is the droopy eye and lip stage!
You are looking for him to yawn or open his mouth, move his jaw side to side, lick and chew, and drop his head, as low as he wants, no cross-ties! Now that I’ve been doing it awhile, I don’t always get strong reactions, sometimes just a head-tilt and a slight opening of mouth.

Some other points:
- I work the atlas area first because it’s actually more aggravating to Willy. I like to finish on the relaxed note that the TMJ massage provides.
- You can use a curry to do this if you want. I personally prefer to use my hands so I can feel everything but I imagine this might be hard for someone with arthritis, for example. I blew a tendon in my hand two winters ago and I have to be really careful how I use my fingers when I’m massaging, so I can relate.
- Listen to your horse. You’ll start to figure out how much is best to do before/after the ride. I generally take a more “relaxation massage” approach before a ride and really work deep after the ride. However, lately I’m finding it better to do a bit deeper pole work before the ride as it’s helping him relax more under saddle. It changes day by day and I just try my best to interpret the cues he’s giving me.

The Nuchal Ligament

This is the ligament that attaches at the atlas and runs down the entire length of the neck.

In yellow.

Tightness here can cause many of the same issues as disorders of the TMJ and problems in one are associated with problems in the other. In my case, I have the added bonus of some scar tissue in the atlas area. Willy has never been worked over-bent or forced into a frame, so our best guess is that he suffered some trauma to the area. It isn’t much and Dr. J thinks it will completely break up as I continue to work the area.

It’s a little harder to describe how to locate this ligament. Start at your horse’s head, right where the skull attaches to the neck, right about where the crown piece on your bridle rests. Just behind the bony protrusion that is the skull, run your fingers up and down the top couple inches of the crest. Again, you are working each side separately, so you’re probing to each side of the vertebrae, not on them.

You should feel something similar to a fat guitar string somewhere in there. Similar in feel to the ligaments in the TMJ. Some days I have a harder time finding it, which is a good sign.  It can also depend on their head position, so see if you can get your horse to raise or lower its head. I find it best if it’s level or a bit above level, but that’s not easy!  It can be easier to work from the off-side, so standing on the right when working the left side, and vice versa. I do a combination and still try out new ways of positioning myself.For the first 4 to 6 inches, you will be able to follow it along on either side of the cranial vertebrae. Right about where the muscle groups really differentiate, you probably won’t be able to find it any more.

Work it the same way as I described for the TMJ, mostly massaging crosswise to the ligament, going back and forth over it. Pay special attention anywhere where you feel “crunchies” as it’s a trouble spot. It can be scar tissue, previous sites of sprain, inflammation, muscle knots, etc. Either way, it needs to be worked. You won’t get rid of it all at once, just give any spot like that some extra time.

You can expect the same type of reactions from the horse; yawning, dropping the head, etc. During this work it’s especially important to let him stretch down.

I finish up with some carrot stretches to stretch out that ligament.

Any questions?