Pain guide · Neck pain
Temporomandibular disorder (TMD, often called TMJ after the temporomandibular joint) causes pain around the jaw, ear and temple, clicking and stiffness, often worse when you chew or feel stressed. It is common and usually gets better with self-care. Jaw pain is usually the jaw, but not always: jaw pain with chest pain, breathlessness or sweating needs 999, and a headache with jaw pain when eating, a tender scalp or vision problems needs an urgent GP appointment or NHS 111 the same day.
For pain that lasts, the best evidence supports exercise, posture work, hands-on treatment and cognitive behavioural therapy (CBT), not splints. Jaw exercises can't be shown on the 3D figure, so they are written out as numbered steps; the staged plan, with 3D demos, covers the neck, posture and breathing. Start with the warning signs.
Exercise is for pain that has been checked or is clearly mild and settling.
TMD is a problem with the movement of the jaw: the joint just in front of the ear, and the chewing muscles that run up into the temple. The NHS lists pain around the jaw, ear and temple; clicking, popping or grinding noises; a headache around the temples; difficulty opening the mouth fully; and the jaw locking. It may be worse when you chew or feel stressed, and can disturb sleep. NHS physiotherapy leaflets add earache, a blocked or buzzing ear, neck stiffness and dizziness.
In pooled studies using standard criteria (27 studies, 20,971 people), about 3 in 10 people (29.5%) met the criteria for TMD, women more often than men, and muscle pain and clicking were the most frequently reported signs. Long-lasting TMD pain affects 6% to 9% of adults. Estimates vary widely between studies.
The NHS lists teeth grinding, wear and tear, a blow to the head or face, stress and an uneven bite as causes. In a US study that followed 1,729 adults aged 18 to 44 for a median of 2.8 years, a jaw injury went with about 4 times the risk of developing TMD, and 80% of those injuries came from yawning or keeping the mouth open a long time.
Clicking is common and often painless. In 25 people whose clicking jaw had never locked, the click behaved the same over 2 years; in 30 who had occasional locking it sometimes changed, but permanent locking was rare.
Scans can mislead: on MRI (magnetic resonance imaging), 22 of 62 people with no jaw symptoms (35%) had a displaced disc in the jaw joint, against 45 of 58 patients (78%). The NHS describes self-care and GP treatment first, and a specialist only if those don't help.
The NHS says TMD isn't usually serious and generally gets better on its own. Long-standing muscle pain can be more stubborn: of 165 people with jaw muscle pain followed for 5 years, a third recovered, a third had it come and go, and a third kept it. More frequent pain, more tender spots and pain elsewhere in the body made it more likely to last.
Heart pain can spread to the jaw, and angina can cause jaw pain on exertion that eases with rest. Giant cell arteritis causes jaw pain while eating or talking, with headaches, a tender scalp or temples, or vision problems, mostly in older adults. A dental abscess causes toothache, swelling and sometimes a fever. Trigeminal neuralgia causes sudden electric-shock pains lasting seconds, set off by light touch, eating or brushing the teeth. Mouth cancer can show as an ulcer lasting more than 3 weeks, a red or white patch or a lump. The warning signs above say what to do.
The NHS says TMD usually gets better without treatment. It suggests soft food, paracetamol or ibuprofen, an ice pack (frozen peas in a tea towel, for no more than 5 minutes at a time) or a heat pack (a hot water bottle in a tea towel, for 15 to 20 minutes twice a day), whichever feels better, massaging the sore jaw muscles and finding ways to relax. Don't chew gum or pen tops, bite food with your front teeth, yawn too wide, bite your nails or clench your teeth: apart from when eating, your teeth should be apart. A physiotherapy leaflet adds cutting chewy food small and avoiding hard food.
This is health-service advice built on experience rather than trials, and it is where everyone starts.
A 2023 guideline in the BMJ, built on a network meta-analysis of 153 trials (8,713 people), looked at TMD pain lasting 3 months or more. With moderate- to high-certainty evidence, the treatments that helped most were CBT combined with biofeedback or relaxation (36 more people in every 100 got an important pain reduction than with a placebo or sham), hands-on jaw mobilisation by a therapist (36 more in every 100) and trigger point massage (32 more). CBT alone, supervised posture exercise, supervised jaw exercise and stretching, and usual care with home exercises, stretching and reassurance followed (23 to 30 more in every 100).
All eight got strong recommendations. The authors' summary: treatments that help people cope and encourage movement and activity work best. These recommendations are for long-lasting pain, not a new flare, where the NHS self-care advice applies.
A meta-analysis of 6 trials (419 people) found jaw mobility or mixed exercise programmes gave a moderate short-term reduction in pain and better mouth opening, but not clearly better function. An earlier review of 48 trials rated the evidence for exercise and hands-on treatment as low overall. In a 70-person trial, adding a home exercise programme to education raised the 3-month success rate from 57% to 77%, a difference that could have been chance.
In a 60-person trial of people with jaw muscle pain, posture training plus self-care cut TMD symptoms by 41.9% and neck symptoms by 38.2% at 4 weeks, against 8.1% and 9.3% with self-care alone. Supervised posture exercise is one of the 2023 guideline's strong recommendations. In a 30-person trial, adding neck stabilisation training to education and home exercises eased jaw pain at rest a little more. That's why the 3D-demo plan on this page is built from neck, posture and breathing moves.
In a systematic review for the NIHR (the National Institute for Health and Care Research), splints did not reduce pain compared with no or minimal treatment when all types of TMD were pooled (13 trials, 1,076 people), on very low-certainty evidence, and no other outcome improved; there wasn't enough evidence to say whether they protect the teeth from grinding. The 2023 guideline advises against reversible splints for long-lasting TMD pain (a conditional recommendation) and strongly against treatment that permanently changes the bite. A separate review found no evidence that adjusting the bite treats or prevents TMD.
The Rocabado 6x6 programme, a set of jaw, neck and posture exercises, is widely taught and often described as well researched. We found no trial of it in ordinary TMD: one small trial was in rheumatoid arthritis affecting the jaw, and another, in headaches from the neck, found it less effective than a neck self-mobilisation.
For long-lasting TMD pain, the 2023 guideline makes conditional recommendations against botulinum toxin (Botox), low-level laser therapy, TENS (electrical nerve stimulation), gabapentin, relaxation therapy or biofeedback on their own (CBT that includes them is strongly recommended), and several kinds of injection. It strongly advises against irreversible splints, surgery to remove the disc and anti-inflammatories combined with opioids.
Source 3
Jaw exercises should be pain-free: an NHS dental leaflet says open only as wide as you can without causing pain. Stop any jaw exercise that hurts, makes the jaw lock or makes clicking painful, and don't push opening past comfortable; the NHS says don't yawn too wide.
For the neck, shoulder and posture moves, use NHS inform's scale for neck exercise: 4 to 5 out of 10 during exercise is acceptable, 6 or more is too much, and your neck should be no worse the next morning.
Your jaw should be no worse the next day. If it is, go back a step (our suggestion).
Start at the first stage. Each move opens a full guide with a 3D demo.
Weeks 0 to 2. NHS self-care: soft food, small bites, no gum, no wide yawns, teeth apart, heat or ice, massage for the sore muscles and time to relax. Do jaw steps 1 and 2, written out below, daily. The doses here are an NHS physiotherapy leaflet's, NHS inform's or the moves' own.
3D demoSlow breathing (6 breaths a minute)Beginner · No equipment5 min, once or twice a day · Tongue resting on the roof of your mouth, teeth apart
Easier: Breath reach · Harder: Crocodile Breathing (prone diaphragmatic breathing)
3D demoChin tuckBeginner · No equipment8 to 10 reps, holding 3 to 5 s · The dose in an NHS physiotherapy leaflet for jaw pain
Easier: Lying chin tuck · Harder: Isometric neck holds (four-way)
3D demoNeck CARsBeginner · No equipment2 to 3 slow turns, tilts and nods each way, every hour or two at a desk · Separate movements before full circles
3D demoShoulder rollsBeginner · No equipment10 each way, once or twice a day
3D demoUpper trap releaseBeginner · No equipment2 holds of 30 s each side · Let the head's weight do the work
Move on when: Talking and eating soft food are comfortable, and your jaw opens more easily.
About weeks 2 to 6, most days. Posture training plus self-care beat self-care alone in a 60-person trial, and supervised posture exercise is strongly recommended for jaw pain that lasts. Add jaw steps 3 to 5. Doses are the moves' own or editorial.
3D demoLying chin tuckBeginner · No equipmentUp to 10 holds of 10 s, very light effort
Harder: Chin tuck
3D demoChin tuck with head liftIntermediate · No equipment3 to 5 holds of 5 s
Easier: Chin tuck · Harder: Chin-up with a knee raise (gorilla chin)
3D demoBand rowBeginner · A band + An anchor point2 to 3 sets of 10 to 15
3D demoDoorway chest openerBeginner · A wall2 to 3 holds of 30 s
Easier: Elbows back · Harder: Fish Pose (Matsyasana)
3D demoSeated upper-back lift (sit tall, shoulders back)Beginner · A bench or box5 holds of 3 to 5 s
Easier: Elbows back · Harder: Prone Y-T-W raises
Move on when: Jaw pain is mild or gone on most days, and the exercises don't set it off.
From about week 6, 2 or 3 days a week. Add jaw step 6 if it's comfortable. If the pain lasts beyond about 3 months, the treatments with the best evidence are guided by a professional: CBT, hands-on jaw treatment from a therapist and supervised jaw exercise. Doses are the moves' own or editorial.
3D demoIsometric neck holds (four-way)Beginner · No equipment5 holds of 10 s each direction, about half effort
Easier: Chin tuck · Harder: Chin tuck with head lift
3D demoProne Y-T-W raisesBeginner · No equipment8 of each shape, 2 rounds
Easier: Wall angel · Harder: Bent-over reverse fly
3D demoSupported single-arm dumbbell rowIntermediate · A dumbbell + A bench or box3 sets of 8 to 12 each side
Easier: Incline ring row · Harder: Bent-over barbell row
3D demoBand pull-apartIntermediate · A band2 to 3 sets of 15
Easier: Prone Y-T-W raises · Harder: Barbell rear-delt row
3D demoTreadmill walkingBeginner · Cardio machine20 to 30 min most days · Or cycling
Harder: Treadmill jogging
Move on when: Ongoing. Go back to stage 1 for a flare.
Jaw movements can't be shown on the 3D figure, so these are written out from two NHS trust leaflets, one from a hospital physiotherapy team and one from a community dental service. Every jaw exercise should be pain-free. Steps 1 and 2 start in stage 1, steps 3 to 5 in stage 2 and step 6 in stage 3. The site's jaw release drill is a version of steps 1 and 2.
Soft food, cut small and chewed on the back teeth; no gum, pen tops or nail biting; and your teeth apart except when eating. Support your chin with a hand when you yawn: yawning and keeping the mouth open a long time were the commonest jaw injuries linked to new TMD. A physiotherapy leaflet also advises against cradling a phone between your ear and shoulder, and against sleeping face down.
If teeth grinding might be part of it, the NHS suggests seeing a dentist, who may offer a splint. Splints haven't been shown to ease TMD pain, and whether they protect the teeth from grinding is also unproven, so don't expect one to fix jaw pain on its own.
| Habit or position | Why it matters | Instead |
|---|---|---|
| Chewing gum, pen tops or nails | The NHS says avoid them, and a physiotherapy leaflet says extra chewing stops the jaw resting. | Rest the jaw, with your tongue on the roof of your mouth. |
| Clenching, or resting your teeth together | Apart from when eating, your teeth should be apart, the NHS says. | The rest position (jaw step 1) and slow breathing; the jaw release drill practises both.Try: Jaw release drill |
| Hard, chewy food and big bites with the front teeth | The NHS and a physiotherapy leaflet advise against both. | Soft food, cut small, chewed on the back teeth. |
| Wide yawns and long spells with your mouth open | Yawning and keeping the mouth open a long time were the commonest jaw injuries linked to new TMD, and the NHS says don't yawn too wide. | Support your chin when you yawn, and ask the dentist for breaks during long appointments (our suggestion). |
| Cradling a phone between your ear and shoulder | A physiotherapy leaflet advises against it. | A headset or speaker, and chin tucks from the plan.Try: Chin tuck |
| Sleeping face down | A physiotherapy leaflet advises against it. | Sleep on your back or side. |
| Forcing your jaw open to stretch it out | Jaw exercises should be pain-free. | Controlled, straight opening (jaw steps 2 to 5), as in the jaw release drill.Try: Jaw release drill |
| Having your bite ground down, or other permanent bite changes | A review found no evidence that adjusting the bite treats or prevents TMD, and the 2023 guideline strongly advises against permanent bite-changing treatment. | Reversible care first: self-care and exercise, then CBT or a physiotherapist if it lasts. |
Eight gentle neck and shoulder stretches for desk stiffness, done standing or seated in ten minutes.
10 minBeginner8 movesA wallA quick stretch break you can do beside your desk: neck, back, chest, wrists, hips and quads.
5 minBeginner7 movesA wallA 6-minute breathing routine: slow breathing, crocodile breathing, alternate nostril breathing, box breathing and 4-7-8 breathing.
6 minBeginner5 movesNo equipmentA 12-minute routine for a stiff upper back and rounded shoulders: chin tucks, wall angels, Y-T-W raises and open books.
12 minBeginner8 movesA foam roller, A wallA slow, 10-minute floor routine to unwind before sleep: child's pose, twists, happy baby and slow breathing.
10 minBeginner7 movesA wallTemporomandibular disorder (TMD) affects the jaw joint and the chewing muscles, causing pain around the jaw, ear and temple, clicking, difficulty opening fully and sometimes locking. About 3 in 10 people met the criteria for it in pooled population studies, and 6% to 9% of adults have long-lasting TMD pain.
The NHS says it usually gets better without treatment. Muscle-type jaw pain can be stubborn, though: over 5 years, a third of people recovered, a third had it come and go and a third kept it.
For pain that lasts, a 2023 guideline in the BMJ strongly recommends home exercises and stretching, supervised jaw exercise and stretching, and supervised posture exercise, alongside hands-on treatment and CBT. Our written jaw exercises come from NHS trust leaflets, and the 3D-demo plan adds neck and posture work, which beat self-care alone in a small trial.
Not in the trials so far: pooled across 13 trials (1,076 people), splints didn't reduce pain, on very low-certainty evidence, and the 2023 guideline advises against them for long-lasting TMD pain. A dentist may still suggest one for teeth grinding.
Clicking is common, often painless and usually harmless: it was the second most frequently reported sign of TMD in pooled studies, and without locking it stayed the same over 2 years in a small study. See a GP or dentist if your jaw locks, you can't open it fully, or it isn't settling.
Yes. Chest pain spreading to the jaw, especially with breathlessness, sweating or feeling sick, needs 999, and jaw, neck or arm pain that comes on with exertion and stops with rest can be angina. TMD pain is usually worse with chewing and doesn't come on with walking.
TMD commonly causes pain around the ear and temple, and some people feel their ear is blocked or buzzing. Ear and tooth problems can do the same, so see a dentist or GP if you also have a fever, a swollen face or toothache.
Usually not. On MRI, a third of people with no jaw symptoms have a displaced disc, so scans can mislead. The NHS describes self-care and GP treatment first, and a specialist only if those don't help.
The 2023 guideline advises against botulinum toxin (Botox) for long-lasting TMD pain, a conditional recommendation, as it does for laser therapy, TENS (electrical nerve stimulation) and several kinds of injection. The evidence for those treatments was low or very low certainty, while exercise, hands-on treatment and CBT had better support.
The NHS lists stress as a cause and says the pain can be worse when you're stressed. CBT, especially combined with relaxation or biofeedback, was among the most effective treatments for long-lasting TMD pain in a large analysis of trials.
No: a review found no evidence that adjusting the bite treats or prevents TMD, and the 2023 guideline strongly advises against permanent bite-changing treatment. Start with care that can be undone: self-care and exercise, then CBT or a physiotherapist if the pain lasts.
Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.
