What is TMJ / TMD?

The Temporomandibular Joint (TMJ) is the joint connecting the lower jawbone (mandible) and the skull. It’s a sliding hinge joint immediately in front of the ear. TMD refers to a Disorder or Dysfunction of the joint. TMD covers jaw pain and associated headache, jaw stiffness, clicking, locking, or difficulty with biting, chewing, talking, yawning, facial expression, etc.

Worldwide about 30% of the population experience TMD according to a recent systematic review (Journal of Oral Facial Pain Headache, 2025 Jun;39(2):48-65)

What caused my jaw pain / TMD?

TMD can occur following trauma (eg. car accident, blow to the head, or prolonged dental work overstretching and inflaming the joint).

It is more commonly a consequence of stress, anxiety, clenching or grinding teeth (known as bruxism), or parafunction (eg. nail-biting, gum-chewing, tongue or cheek biting) which tightens the muscles around the jaw and puts added pressure on the joint. 

Other common causes are prolonged chewing on one side, dental issues causing a bite malalignment, and poor neck and head posture.

Why does my jaw click?

Jaw clicking is common and rarely means the joint is dislocating. It often results from displacement of the disc inside the joint due to muscle spasm or uneven motion of the jaw. Sometimes it is caused by osteoarthritis.

Spinal Plus Physiotherapy can help both.

Is my headache coming from my neck?

Headaches from the neck (Cervicogenic) are typically one-sided, and radiate from the back of the head forwards toward the forehead, temple or behind the eye. They may or may not be associated with neck stiffness or pain, or triggered by prolonged static postures.

Through specific manual pressures and movement tests of the upper spinal segments, we can quickly determine whether your neck is contributing to your headaches.

Are my migraines from my neck?

No, but they're often associated. Whilst migraine is a distinct neurological condition involving the brain, trigeminal and vascular systems, studies have shown that up to 75% of sufferers experience neck pain before or during migraine attacks. And women with migraine also have around half the neck muscle endurance of those without migraine (J Orthop Sports Phys Ther 2019;49(5):330–336).

In practice, skilled physiotherapy to alleviate neck muscle and joint tightness, and strengthen the postural stabilising muscles, has been shown to successfully reduce the frequency and severity of migraine and tension-type headache.

Why do I get neck pain?

Neck pain is very common, affecting up to two thirds of the population at some point. Pain can arise from muscle, ligament or disc sprains, degenerative changes to the bones, joints or discs, from postural or repetitive occupational stress, poor sleeping position, injuries or accidents.  

Physiotherapists identify the contributing factors, and help relieve pain and restore movement through treatment and exercise.

Recovering neck and upper body strength and confidence is often overlooked, but can lead to recurrent pain and headaches. 

Do I need a scan?

Imaging is usually only needed after trauma, or when there are indications of nerve compression (such as arm pain, weakness, numbness or tingling).

Scans often show age-related changes that aren’t actually causing pain. A thorough clinical assessment will determine if imaging is necessary and whether it would change your treatment plan.

What happens during an initial assessment?

You’ll be asked to describe your symptoms, their onset and history, and how they’re impacting your daily life. We then examine how you move, your strength, posture, and flexibility, and palpate relevant muscles, joints, and nerves.

By the end of your first session, you should understand what's causing your problem, how long recovery will take, what treatment you need, whether you need imaging, and what you can do yourself to speed up recovery.

Do I have to keep coming back?

No. The goal is to help you recover so that you can do everything you need with confidence and live your best life without ongoing reliance on therapy. However, some conditions do lead to persistent pain or dysfunction and benefit from longer term care.

Why does my neck crack?

Cracking or popping of the neck or other joints is common and often harmless. Occasional cracking is usually cavitation, (eg. during a joint manipulation/adjustment), whereby rapid formation then collapse of tiny gas bubbles creates the popping noise.

More frequent cracking or crepitus may be from osteoarthritis, or sometimes from aberrant joint motion due to muscle imbalance or weakness

Is it safe to crack my neck?

The occasional crack with movement is fine, but repeated, forceful or end-range cracking carries some risk of creating weakness or instability of the joints, and there is a remote risk of stroke from vascular damage.

Do physiotherapists crack the spine?

Yes physiotherapists are trained to manipulate spinal joints, which may be included with patient’s consent to assist movement restoration as part of a comprehensive treatment program.

What is the best exercise for neck pain?

There’s no single “best” exercise for everyone. Evidence supports regular movement and strengthening for neck pain, but rehab programs are always individualised.

The best exercise is often one that is simple, quick, doesn’t need vast space or equipment, and is preferably enjoyable!

Is my neck causing my shoulder / arm pain?

Yes, arm or shoulder pain can often originate in the neck, even if your neck itself feels ok.

We can assess whether the cause is nerve compression (radiculopathy) or referred pain from tight muscles or irritated joints.

As a guide, any pain on top of the shoulder, or radiating down below the elbow is suspicious for being neck-related.

What's the best pillow for me?

Most people sleep best on their side with a pillow that supports the natural curve of the neck and keeps the airway open. Consider a contoured memory foam pillow, or try a rolled towel inside the pillowcase to create a contour.

If you’ve tried several pillows without relief, the problem may lie in the neck itself — we can help improve mobility, strength, posture, relaxation and sleep hygiene to assist your sleep.

How many sessions will I need?

This varies depending on the condition. Most people improve dramatically within a few sessions, while others with long-standing or more complex issues will need longer treatment. We will outline realistic time frames and goals.

Should I expect pain during / after physio?

Some mild soreness during or after hands-on therapy or dry needling is normal. Tenderness lasting more than a day is uncommon. Application of a heat pack at night often assists.

Treatment is not about inflicting pain, but should be a partnership, working together to get you better. You the patient are always in control and you may withdraw consent at any time.

Will I get exercises or homework?

Yes! Lasting improvement comes from moving well between sessions. We use Physitrack software to send your personalised program by email, complete with videos, progress tracking, and messaging support. Or we can print them out for you.

No more dodgy stick figures!

Should I see a physio or a chiropractor?

Physiotherapists are highly trained to assess and treat the entire neuro-muscular-skeletal system. We use a combination of joint mobilisation, massage, dry needling, taping, posture correction, education about your condition, and exercise-based rehabilitation. Whilst physios do perform spinal manipulation / adjustments where helpful, the focus is on restoring movement, building resilience, and helping you understand and manage your condition confidently — without requiring ongoing maintenance treatments.

Is the pain all in my head?

Pain is an unpleasant sensory and emotional response produced in the brain in response to actual or a perceived threat of tissue damage.

Pain can be ramped up in times of stress, sleep disruption, fear or anxiety. Pain can also be lessened when happy, distracted, feeling valued and productive. So no, pain is in your brain, not in your head or “imaginary”, even when it persists long after injuries have healed.

Physiotherapists are skilled in helping you understand and manage both the physical and psychological contributors to persistent pain.

What can physio do for disc problems?

Disc problems can cause symptoms in the neck, upper back, shoulder blade, or arm. The discs hold the vertebra together and do not slip out, but can bulge or tear become inflamed.

While physiotherapy doesn’t “heal” discs directly, we can reduce inflammation, restore movement, and reduce and centralise referred pain through targeted manual therapy and exercise. Many people experience significant reduction in pain and improvement in function over a few weeks.

What's the difference between dry needling and acupuncture?

Dry needling is an established, mainstream treatment using fine needles (0.3mm) to target specific muscular trigger points to relieve localised tension and pain. Evidence shows rapid reduction in muscle tone, improved blood flow, endorphin release and lowered concentration of pain-causing chemicals and inflammatory mediators. Needling is particularly useful if deep massage is not tolerated or appropriate, and can result in longer benefits than massage alone.

Acupuncture by contrast is a traditional Chinese medicine practice that inserts needles along meridians to restore the body's energy flow and balance overall health. Practitioners must re registered with the Chinese Medicine Board.

Do you treat other areas?

Yes, Peter continues to treat all areas of the body and is very experienced with sports and occupational injuries, vestibular rehabilitation / BPPV, Spinal, Hip and Knee problems.

How long are appointments?

Sessions typically last 30 to 45 minutes, depending on your condition and the number of areas being treated.

 Should I see a doctor about my headache?

You should consult your GP or Urgent Care Clinic before Spinal Plus if any of the following applies;

• First ever headache occurs after the age of 50

• Your usual headaches worsen or become more frequent or severe

• Headache begins abruptly

• Headache is associated with neurological disturbance such as weakness, slurred speech, visual disturbance or altered consciousness

• You are unwell or have a fever

• Your headache is worsening

• It began after neck or head trauma

• You have a history of cancer

• Your headache is precipitated by coughing, sneezing or straining

• Your headache worsens on standing up