Why looking beyond the painful area can make such a difference in physiotherapy, TMJD, and whole-body movement.
Sometimes the most important thing we can do as physiotherapists is step back and look at the bigger picture.
Last weekend, I had the opportunity to take Doreen Killens' Mobilization of the Myofascial System course. It was a wonderful reminder of just how interconnected the human body is, and how much we can learn when we approach our work with curiosity, precision, and an open mind.
We were a small group, which made the experience particularly valuable. I loved being surrounded by other strong, experienced practitioners who were equally interested in exploring the relationships between different systems of the body and refining the way we work with them.
One of the things I appreciated most was the emphasis on gentle, precise techniques. It reinforced something I have seen throughout my years in practice: sometimes, less really is more.
And this is something I want more people to understand about their own bodies.
What is fascia, and why does it matter?
Fascia is a connective tissue system that surrounds, supports, and connects structures throughout the body, including muscles, organs, nerves, blood vessels and much more.
Rather than existing as isolated layers, fascia forms a continuous network that helps the body move, adapt, and respond to the demands placed on it.
This means that the tissues around your jaw are not entirely separate from the tissues around your neck, ribcage, abdomen, or hips. They are part of a larger system that works together to support movement and function.
Fascia also interacts with the nervous system, which plays an important role in how we experience pain, tension, and changes in movement.
When we look at the body through this lens, we begin to appreciate why symptoms can sometimes persist even when we are addressing the area where they are felt.
The jaw, for example, doesn't function independently of the rest of the body. Its relationship with the neck, breathing mechanics, ribcage, and surrounding connective tissues can all be relevant when assessing someone with TMJ dysfunction (TMJD).
The same principle applies to other areas of the body. Persistent neck tension, headaches, restricted breathing, or discomfort around the ribs may involve more than the local tissues alone.
This doesn't mean every symptom originates somewhere else. It means we need to be willing to look beyond the obvious when the clinical picture calls for it.
Why gentle manual therapy can be so effective
One of the things that stood out to me during this course was how much could be accomplished with very little force.
Some of the techniques involved incredibly gentle pressure and subtle contact. And yet, the responses we observed were meaningful.
This is an important distinction because there is often an assumption that effective manual therapy needs to be deep, strong, or uncomfortable. It doesn't. And I think a lot more people need to understand this!
When working with sensitive tissues, applying too much force can sometimes overwhelm the response we're trying to observe. We can move past the tissue's natural response rather than allowing it to emerge.
With gentle, precise contact, we can give the tissues time to respond and pay closer attention to what is happening beneath our trained hands. The goal isn't to force a change. It's to work with the body in a way that respects its sensitivity and capacity to adapt.
This is particularly relevant for people who have been living with chronic pain, persistent tension, chronic pain/tension or symptoms that seem to flare easily. More pressure isn't necessarily better, and discomfort isn't a requirement for effective treatment.
Looking beyond the jaw: a clinical example
This week, I had the opportunity to apply some of what I learned with a client who has been struggling with ear pain and pressure.
We had already been working on several areas that seemed clinically relevant, including the head, neck, jaw, thoracic region, and ribs. I had also incorporated intra-oral and cranial techniques.
These are all areas I would naturally consider when assessing someone with this presentation.
But I wanted to explore another possibility. Given the interconnected nature of the fascial system, I decided to introduce a very gentle, precise release along the lateral line of the body, working around the quadratus lumborum (QL), hip, and lower lateral ribs.
As I worked, the client reported feeling a release in his ear. I wouldn't suggest that treating the hip or lower ribs is a solution for ear pain. What I can say is that it was a reminder of how valuable it can be to consider the relationships between different regions of the body, particularly when symptoms have been persistent.
Sometimes, the area that feels uncomfortable is only one part of a much larger picture.
What does this mean for you?
If you've been struggling with TMJD, chronic pain, persistent tension, an old injury or movement restrictions, it can be frustrating when treatment focused on the painful area doesn't seem to create lasting change.
You might have spent months working on your jaw, neck, or shoulders, only to find that the discomfort keeps returning.
That doesn't necessarily mean you've been doing the wrong things. It may simply mean there are other contributing factors worth exploring.
A comprehensive physiotherapy assessment considers more than the location of your symptoms. It looks at how you move, how you breathe, how your body responds to different demands, and how the various systems work together.
Depending on your presentation, this may involve manual therapy, functional movement, breathing strategies, and techniques that address the fascial, visceral, or cranial systems.
The goal isn't to treat everything at once or to assume that every symptom has a hidden connection. It's to understand your body well enough to make informed decisions about what may be contributing to your symptoms and what approaches are most appropriate for you. And sometimes, that means being willing to explore an area that initially seems unrelated.
A reminder to stay curious
One of the things I love most about physiotherapy is that there is always more to learn. Courses like this remind me that even after years of clinical experience, there is still so much to explore about the human body and the relationships between its systems.
If you've been dealing with persistent jaw pain, TMJD, chronic tension, or other symptoms that haven't responded to the approaches you've tried, it may be worth exploring a more comprehensive assessment to look at the bigger picture.
And that's where we can begin.
If you're looking for a physiotherapist in the Squamish and Britannia Beach area who takes a whole-body approach to TMJD, chronic pain, and movement dysfunction, I'd love to help you explore what may be contributing to your symptoms.