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Learn about the benefits of chiropractic rehabilitation for treating jaw pain and improving overall oral health from TMJ.
Abstract
This educational post explores the intricate world of Temporomandibular Joint (TMJ) Dysfunction. This condition affects millions and often extends beyond the jaw to affect the neck, shoulders, and overall well-being. From my perspective as Dr. Alex Jimenez, and in collaboration with my esteemed colleague and Medical Director, Dr. Maria Guadalupe Cardenas, MD, I will guide you through the complexities of TMJ anatomy, the physiological underpinnings of dysfunction, and the latest evidence-based treatment approaches. We will delve into the critical role of the trigeminal nerve, the biomechanics of jaw movement, and how chronic stress and inflammation contribute to pain and dysfunction. This post highlights our integrative approach at Injury Medical Clinic, where we combine chiropractic care, functional medicine, advanced injection techniques, and medical oversight to provide comprehensive, patient-centered solutions. You will learn how chiropractic adjustments can restore alignment in the cervical spine and upper extremities, relieve referred pain, and improve TMJ function. We will also detail specific diagnostic methods, explain the rationale behind treatments like intra-articular injections, and show how our multidisciplinary team works together to create personalized care plans that address the root causes of TMJ disorders, not just the symptoms. Join me on this journey to understand how a holistic, evidence-based strategy can unlock lasting relief and restore optimal health.
Introducing Our Collaborative Care Model at Injury Medical Clinic
Hello, and welcome. I am Dr. Alex Jimenez. My journey in healthcare has been driven by a passion for understanding the intricate connections within the human body and finding the most effective ways to restore health. With a background that spans chiropractic (DC), advanced practice nursing as a Family Nurse Practitioner (APRN, FNP-BC), and dual certifications in functional medicine (CFMP, IFMCP), I have dedicated my career to an integrative, evidence-based approach to patient care.
At my practice, Injury Medical Clinic PA in El Paso, Texas, we have cultivated a unique environment where different medical disciplines converge to provide comprehensive care. A cornerstone of our practice is my collaboration with Dr. Maria Guadalupe Cardenas, MD. Dr. Cardenas is a highly respected internist, board-certified in Internal Medicine, with over four decades of invaluable experience. She serves as our Medical Director and Collaborative Physician, providing essential medical oversight and enriching our clinical capabilities. Her NPI is #1164426749, and her Texas MD License is #J2933.
This multidisciplinary setup is not just a matter of convenience; it is a philosophical commitment to treating the whole person. Our team integrates:
- Medical Oversight (Dr. Cardenas): Ensuring all treatments meet the highest standards of medical safety and efficacy. Dr. Cardenas reviews complex cases, provides medical diagnoses, and oversees procedures that fall within the scope of medicine, such as prescription management and specific injection therapies.
- Chiropractic Care (Dr. Jimenez): Focusing on the biomechanical integrity of the musculoskeletal system, particularly the spine. We utilize precise adjustments to correct misalignments (subluxations) that can cause nerve interference and contribute to a wide range of health issues, including TMJ dysfunction.
- Functional Medicine: Investigating the root causes of chronic illness. We look beyond symptoms to understand the interplay of genetics, lifestyle, and environment, using advanced diagnostics to address issues like inflammation, hormonal imbalances, and nutritional deficiencies.
- Personal Injury and Rehabilitation: Specializing in the recovery from accidents and injuries, we design comprehensive rehabilitation programs that restore function, reduce pain, and prevent long-term complications.
Today, I want to take you on a detailed journey into a condition that beautifully illustrates the power of this integrative model: Temporomandibular Joint (TMJ) Dysfunction. While often perceived as a localized jaw problem, TMJ issues are frequently intertwined with the neck, shoulders, and even systemic health. By combining our expertise, Dr. Cardenas and I can offer patients care that addresses these complex connections, leading to more profound and lasting outcomes.
A Clinical Glimpse: Performing a TMJ Injection
To ground our discussion in a real-world clinical context, let’s walk through a common procedure we perform for acute TMJ pain: an intra-articular injection. Just recently, on September 2, 2026, a patient presented with significant aching in their jaw joint, a classic symptom of TMJ inflammation. My immediate goal was to provide rapid pain relief and reduce inflammation within the joint capsule.
Here is a narrative of the procedure, explaining the “why” behind each step:
“Okay, we’re going to do the injection now on the TMJ, the temporomandibular joint,” I explained to the patient, ensuring they were comfortable and informed. “Go ahead and open your mouth, please, and close. Open one more time. Good. And close.”
This simple act of opening and closing the jaw is a critical diagnostic step. I visually and palpably assess the joint’s range of motion, listen for any clicking or popping (crepitus), and watch the movement of the mandibular condyle. The patient’s ability to perform this movement also helps me pinpoint the precise injection site.
“All right. So, we’re going to take the posterior approach to the joint. With your mouth open, do this. Open your mouth again.” As the patient opens their jaw, a remarkable biomechanical event occurs. The head of the mandible, or the condyle, slides forward and downward along a structure called the articular eminence. This movement is essential for wide mouth opening.
“If you can see that sulcus there, close it and open again. Right there is the approach entry point that we need to take.” That “sulcus,” or small depression that appears just in front of the ear’s tragus when the mouth is open, is our target. It’s a temporary anatomical window.
“So close your mouth for a moment. When you open your mouth, the head of the mandible slides forward. And opens up the rear of the joint, the posterior aspect of the joint. Otherwise, there’s no joint space. The joint space is there, but you cannot access it. This is a crucial point. In a closed-mouth position, the condyle sits snugly within the glenoid fossa of the temporal bone. The joint space is minimal and protected by bone, making a posterior entry impossible and unsafe. Forward translation of the condyle during jaw opening creates the necessary space in the posterior part of the joint for a needle to be inserted safely without hitting bone or critical structures. This space is known as the bilaminar zone or retrodiscal tissue area.
Next came preparation for the injection, where sterility is paramount. “So, just cleaned you with alcohol, cleaned you with Betadine, a little bit more Betadine to help prevent any infections.” We use a two-step cleansing process. We use alcohol (isopropyl alcohol) first to degrease the skin and remove surface contaminants. We then follow with Betadine (povidone-iodine). This powerful antiseptic provides a broader, more sustained antimicrobial effect. It significantly reduces the risk of introducing bacteria into the joint, which could lead to a serious condition called septic arthritis.
“And now we’re going to do the injection. We are not going to use the ethyl chloride spray, or else it will run down.” Ethyl chloride is a vapo-coolant spray often used as a topical anesthetic to numb the skin before an injection. However, because the injection site on the face is vertical and close to the ear canal and hair, the spray can be difficult to control. It might run into the ear or freeze unintended areas, causing discomfort. In this case, the precision of a swift needle insertion is preferred over the potential complications of a topical spray.
“Okay, get things here. Okay, go ahead and open your mouth. One, two, three. Ouch.” I guide the patient through needle entry with a clear countdown. The “Ouch” is the patient’s brief, expected reaction to the needle piercing the skin and, more significantly, the highly innervated joint capsule.
“Okay, right at the joint capsule. Does that hurt?” I ask, holding the needle in place. This question serves two purposes. First, it confirms I am in the correct location. Pain at this stage often indicates the needle is stimulating the sensitive capsular tissue. Second, it gauges the patient’s real-time comfort level.
“Is that hurting at all right now?”
“Not now,” the patient replied. The initial sharp pain subsides as the needle passes through the capsule into the joint space.
“Let’s do it again a little bit more. I actually felt it just go into the joint capsule.” The sensation of a needle “popping” through a fibrous layer like the joint capsule is a distinct tactile feedback for an experienced clinician. It confirms entry into the intra-articular space, ensuring the medication will be delivered exactly where it’s needed—into the synovial fluid to bathe the inflamed joint surfaces.
“Can you feel any fullness in the joint?” I asked as I began to inject the medication (typically a combination of a local anesthetic like lidocaine and a corticosteroid like Kenalog). The feeling of fullness or pressure is a positive sign. It indicates the fluid is filling the small, enclosed space of the joint, displacing the synovial fluid and slightly expanding the capsule. This confirms the medication is being deposited intra-articularly and not into the surrounding muscle or soft tissue.
“A little,” the patient confirmed.
“Put a little pressure on this spot. You can close your mouth,” I instructed as I withdrew the needle. Applying gentle pressure helps to prevent bleeding or bruising at the injection site and can help disperse the medication within the joint.
“Here we go. Okay. Done. I believe so. Let me get a Band-Aid on it now. Yeah. Pretty much done. Probably could just put a spot Band-Aid on there, but I got the big Band-Aid right there. And that is good.” A simple bandage protects the puncture site from contamination as it heals.
The final and most important step is the immediate post-procedure assessment.
“Okay. Now, does that hurt right now?”
“No pain,” the patient reported. This immediate relief is due to the local anesthetic that was part of the injection cocktail. It provides a diagnostic and therapeutic benefit. If the pain disappears, it strongly confirms that the joint itself was the primary pain generator.
“Right now, press over the area with your finger, and open your jaw a few times. Does that hurt?” I have the patient actively use the joint to see if the pain with movement is gone.
“Was it hurting when you came in here?”
“It was aching. Yeah.”
“And it’s not aching now?”
“No, not really.”
“Excellent. Okay, we are done.”
This rapid cessation of an aching pain that was present just minutes before is a powerful indicator of a successful procedure. The anesthetic provides immediate comfort, while the corticosteroid begins working over the next 24-48 hours to provide longer-lasting anti-inflammatory effects. This injection is a bridge—it calms the acute fire, allowing us to implement our broader, long-term strategies involving chiropractic, physical rehabilitation, and functional medicine.
The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, and physical medicine, as well as wellness, sensitive health issues, and functional medicine articles, topics, and discussions. We provide and facilitate clinical collaboration with specialists across disciplines. Each specialist follows their professional scope of practice and the jurisdiction in which they are licensed. We utilize functional health and wellness protocols to treat and support care for musculoskeletal injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters and issues that directly or indirectly support our clinical scope of practice. Our office has made a reasonable effort to provide supportive citations and identify relevant research studies for our posts. We provide copies of supporting research studies upon request to regulatory boards and the public.
We are here to help you and your family.
Blessings
Dr. Alex Jimenez, DC, MSACP, APRN, FNP-BC*, CCST, IFMCP, CFMP, ATN
Email: coach@elpasofunctionalmedicine.com
Multidisciplinary Licensing & Board Certifications:
Licensed as a Doctor of Chiropractic (DC) in Texas & New Mexico*
Texas DC License #: TX5807, Verified: TX5807
New Mexico DC License #: NM-DC2182, Verified: NM-DC2182
Multi-State Advanced Practice Registered Nurse (APRN*) in Texas & Multi-States
Multi-State Compact APRN License by Endorsement (42 States)
Texas APRN License #: 1191402, Verified: 1191402 *
Florida APRN License #: 11043890, Verified: APRN11043890 *
New York APRN License #: N25929, Verified: APRN-N25929*
License Verification Link: Nursys License Verifier
* Prescriptive Authority Authorized
ANCC FNP-BC: Board Certified Nurse Practitioner*
Compact Status: Multi-State License: Authorized to Practice in 40 States*
Graduate with Honors: ICHS: MSN-FNP (Family Nurse Practitioner Program)
Degree Granted. Master's in Family Practice MSN Diploma (Cum Laude)
Dr. Alex Jimenez, DC, APRN, FNP-BC*, CFMP, IFMCP, ATN, CCST
My Digital Business Card
Dr. Maria Cardenas, MD
(Board Certified in Internal Medicine)
Medical Director & Collaborative Physician
NPI # 1164426749
MD License #: J2933
Learn about the benefits of chiropractic rehabilitation for treating jaw pain and improving overall oral health from TMJ. If you have any questions or concerns, please call Dr. Jimenez at 915-850-0900.