Some people discover that they are on the hypermobile spectrum disorder (HSD) or have a genetic tissue disorder (hEDS) hypermobile Ehlers Danlos Syndrome after they have a release. If you are hypermobile in the neck and jaw a lot of upper body muscles will compensate to provide stability to those areas. As those muscles compensate and become overactive they can began to need compensation from other muscles down the chain until you get to the very end. When a tongue tie release happens, and you had the proper prehab completed before the release suddenly those muscles that have spent years compensating can now get back to doing the job they were designed to do. Those muscles now have the ability to utilize their full range so you now notice more range of motion in the rest of your body. This can also have the opposite effect if proper assessment for hypermobility is not completed as well as the proper prehab. The hypermobile joints that depended on those compensation patterns from other muscles are no longer providing the additional stability and you end up feeling like a bobble head or one of those air dancers you see at car lots. You don’t have to be hypermobile to experience this. You can be naturally flexible, but when muscles have to pick up the slack for muscles that are dysfunctional they experience the same response.

The trigeminal nerve can cause several of these symptoms when irritated. If you have concerns about a tumor, a Neurologist would be beneficial to see. Anxiety can definitely be a trigger. It's good to be aware if you catch yourself clenching when stressed or notice your teeth resting together. The chronic clenching of the mastication muscles can cause pain, and trigger points can create a headache sensation. If you're taking any medication for anxiety, those can contribute to more clenching. Chronic clenching can lead to inflammation in the TMJ, and that takes up space from the disc, causing it to temporarily become anteriorly displaced, so when you open and close, that click sound happens. The other way around could be mouth breathing during those anxious times, and that will start the fight or flight response. When that happens, we tend to breathe through the mouth and use accessory muscles like the neck and upper back to do the lifting instead of the diaphragm muscle. When those accessory muscles are constantly asked to do a job they are not designed to do, they can form trigger points. The SCM is notorious for referring pain to the neck, jaw, side of the head, and around the eyes. Jaw locking closed tends to be more muscular, getting stuck in a contracted state, whereas locking open tends to be structural. I see the lock open often in my hypermobile patients. Hypermobility can also contribute to instability in the cervical spine and irritation in the vagus and occipital nerves.

I work closely with pelvic floor physical therapists. Constipation can be a symptom of pelvic floor dysfunction. There is a strong connection between the jaw and pelvic floor through the vagus nerve, diaphragm breathing patterns, and body bracing from pain due to gas, bloating, painful periods, hypermobility, stressful events, etc. These are observations I have made over time working with patients that I believe have a correlation. What I have seen over and over again in my office when patients come in with jaw and pelvic floor pain is a dysfunctional breathing pattern. When the diaphragm is not properly able to do its job as a breathing muscle, other muscles will take over. Common areas of the body that kick in to assist with breathing are typically the upper back, neck, and pelvic floor.

The pro of Botox is when you consistently have overactive muscles, typically the masseter and temporalis from clenching it turns that off. Botox is a neurotoxin and the areas your provider injects it into prevent the signals going to those muscles to clench. The con that I see over and over again with my massage patients are now that those strong muscle fibers are off, other muscles have to pick up the slack. People often report feeling tension in the head, neck upper back and face because those are the muscles that are now working a lot harder. They are not designed to do the job of the masseter and temporalis but they will compensate to make it work so you can continue to function. Botox is a band aid until you figure out what was causing the clenching in the first place. At times when the pain is cause havoc for your physical and mental health it can be a starting option for care while you navigate what got you here in the first place.

When you have instability from the upper cervical ligaments it can compress the vagus nerve, veins and arteries causing dysautonomia symptoms and a nerve zinging sensation. This can be common for people with EDS. I myself have hEDS and experienced two high impact accidents that worsened those symptoms. Rear ended while at a complete stop by a car going 45mph in 2015 then a recent bike accident in 2025 being tboned by another cyclist going 15mph. Other muscles now will compensate to try and bring stability to that area. That often times comes from the upper trapezius muscle, anterior neck and jaw muscles like the masseter and temporalis. Clenching will activate those muscles and assist with stability. Upper cervical chiropractors can be apart of your treatment. After I had the severe bike accident I did utilize a chiropractor for my back and hips but it was a physical therapist that helped with my mobility and a personal trainer to help strengthen the surrounding muscles to assist stabilizing my neck.

TMJology: When are you experiencing the acid reflux?
Commenter: Night time
TMJology: I would recommend seeing a provider to have a sleep study completed if you haven’t already.  Sleep apnea and acid reflux are often closely connected. One of the primary reasons is mechanical.  During an obstructive sleep apnea event, the airway collapses while the body continues attempting to breathe. As the diaphragm and chest muscles work harder to pull air into the lungs against a blocked airway, a strong negative pressure is created within the chest and throat. This vacuum-like effect can draw stomach contents upward into the esophagus, increasing the risk of reflux.  If you’re experiencing sleep apnea events that can also cause chronic jaw clenching and grinding a night. It’s a protective mechanism to help open up your airway. When you clench down it can tighten the muscles in your airway and prevent the jaw and tongue from falling back. Grinding can occur if the physical obstruction is coming from the tongue and jaw. When they obstruct the airway your body will respond by sliding the jaw forward to reopen the airway.
Commenter: How about allergies like dust mites? I have a severe dust mites allergy (class level 5 almost)  So im constantly congested  I also have mold in my bathroom I have an allergy to mold  So I think that could be affecting the nervous system/sleep as well.
TMJology: Allergies could be another contributing factor. If you still have your tonsils and adenoids that could be swollen and affecting the space of your airway. Swollen turbinates in the nose will restrict air flow causing you to mouth breathe. If that’s the case working on eliminating the allergens in your home and possibly seeing an allergist or ENT.

Whiplash injury can definitely be the cause to your pain. It’s possible the ligaments from the base of the skull down your cervical spine in the back and/or front experienced severe enough of tension and it tore those ligaments. Just like how you can tear your ACL in your knee. Some of the muscles may have experienced trauma as well and now they have some adhesions. When you lose the stability from those ligaments it can compress the vagus nerve causing the dizzy sensation. Other muscles now will compensate to try and bring stability to that area. That often times comes from the upper trapezius muscle, anterior neck and jaw muscles like the masseter and temporalis. Clenching will activate those muscles and assist with stability. If you were already grinding your teeth those muscles are already overworked and now they are picking up even more work now due to your instability. Upper cervical chiropractors can be apart of your treatment. After I had a severe bike accident on top of dealing with hypermobility in my neck I experienced several of the same symptoms. I did utilize a chiropractor for my back and hips but it was a physical therapist that helped with my mobility and a personal trainer to help strengthen the surrounding muscles to assist stabilizing my neck.

You’re absolutely right! The TMJ is often the victim of a source that could be coming from somewhere else in the body. These are discussions I have with every TMJ jaw pain patient that comes into my office. Be aware of your teeth resting together during the day. They should only touch when you’re chewing and swallowing. The masseter and temporalis strain could be a compensation pattern due to instability. Things like low resting tongue posture, connective tissue disorders, craniocervical instability. When the jaw or cervical spine are not properly supported other muscles will tense up to do the job. Hormones and certain medications could be a contributor (especially SSRIs and SNRIs. Both hormones and antidepressants/anti anxiety medications affect dopamine and serotonin production. Breathing and pelvic floor dysfunction. When we utilize the upper chest to breath instead of the diaphragm accessory muscles from the upper chest and neck will do the lifting instead of the diaphragm. If the pelvic floor has limited movement that can affect how the diaphragm moves as well and repeat the cycle with the upper chest. Nervous system regulation. If you stuck in chronic flight or fight the body responds by “bracing for impact.” It’s going to protect the vital areas and tense up. We often tighten the muscles around the neck and jaw. As well as short and shallow breathing like described above.

I see this over and over again in my TMD patients that come in. Clenching and grinding are being observed so here is a nightguard. A nightguard is great for protecting your teeth from the clenching but it’s not addressing the why to it. For some it helps with their pain and others it worsened their symptoms. The chewing muscles, often the temporalis and masseter become overworked and increase in size so Botox is injected to turn the muscle fibers off. Botox is a neurotoxin so when it’s injected into parts of the muscle the signal is shut off to create a contraction of the muscle. This typically helps short term until the Botox wears off and for some the pain comes back to the levels prior to the injections or ends up being worse. When the muscles that support the jaw are not able to provide stability to the joint other muscles will compensate. That tends to come from muscles of the neck and upper back. When those muscles are performing a job they were not designed to do they being to fatigue and trigger points can form. Those triggers points can refer a pain sensation to areas of the jaw and face making it seem like the jaw muscles are causing the problem when it’s actually coming from another area. Years or grinding and clenching of the jaw causes trauma in the joint and that can create chronic inflammation as well as scar tissue. That’s where the arthroscentesis procedure comes into play. They can go in and flush the joint with saline, remove any adhesions, reposition the disc if necessary and some providers will inject PRP to help with healing. What happens often is you get that procedure done but what got you to the point in the first place to need the procedure was never addressed. With the information you shared I have some ideas of what could be contributing to your TMJ jaw pain. Weight looks different on everyone. But if you do have extra weight around your neck that can contribute to airway obstruction. When the airway is being physically obstructed by extra weight around the neck or the tongue and jaw falling back into the airway that can create that clenching/grinding at night. When your airway is obstructed the body will find a way to open it back up and that’s often from clenching the teeth together to help open up the airway muscles or to prevent the tongue and jaw from sliding back. Or grinding the jaw forward to physically open the airway back up. That’s when you are getting into obstructed sleep apnea (OSA). Solutions for that are weight loss, CPAP, mandibular advancement device (MAD), myofunctional therapy or in severe cases from a recessed maxilla and/or mandible jaw surgery. Poor desk ergonomics can affect your posture and place additional stress on your neck and upper body. When chronic forward head posture occurs the back of the neck and upper back are stuck in a stretched position and end ho being overworked. Then the front of the neck and front of the chest muscles don’t provide as much stability and that can contribute to ongoing jaw and neck tension. I would suggest starting with a sleep study to see if you are experiencing any obstructed sleep apnea or central sleep apnea. From there you can work with a provider to see what would benefit you with treatment moving forward.
Commenter: A lot of interesting info here, thanks for sharing. If a sleep study is done and sleep apnea is ruled out would you think forward head posture/bad posture could be a likely culprit? I just started night clenching a couple years ago and not sure what caused it as I don’t feel stressed.
TMJology:  It can be a contributing to your pain. Forward head posture creates a lot of compensation and strain in the neck and upper back. You also want to be aware of your oral resting posture to support your jaw. Tongue gently suctioned to the palate, teeth 1-3mm apart and lips comfortably resting together. We often only think of experiencing stress during the day when we are dealing with work, family, friends, finances etc. Those stressors can cause clenching of the teeth and upper chest breathing as a normal flight or fight response. Teeth should only touch when chewing or swallowing. If they are in constant contact through the entire day and night your big chewing muscles get overworked and fatigued. Night time stress that creates clenching often comes from obstructed sleep apnea. The brain is trying to get your airway open so clenching tightens the pharynx and it can prevent the jaw and tongue from falling back into the airway. Your body may also grind forward to physically remove the obstruction from the tongue, jaw and soft palate. It can be a protective response to get your brain to wake up just enough to make the movement happen but you don’t necessarily fully wake up to the point that you’re aware of it each time.
Commenter:  Thanks. I don’t clench during the day at all but just need to figure out why I’m doing it at night. Although my at home sleep study was clear I may have to look more into the possibility of apnea. Every splint and night guard I’ve tried has only cause more clenching for me at night.
TMJology: Unfortunately that’s a common response I hear. We naturally want to chew on items when they are placed in our mouth. Each night you wear the nightguard and every morning when you take it out it resets your proprioception and your body spends the day and night looking for the correct position to rest in. Patients who have an upper nightguard notice more clenching as well because it’s taking up space in the palate for their tongue and it ends up falling down and back into their airway.