1. Pain Patterns, Symptoms & Differential Diagnoses

1.2 Symptoms and ailments

Besides pain, trigger points and tensions often lead to a a dysfunction of the temporomandibular joint.

The tensions can protrude the lower jaw, which then manifests in an uneven dental impression and/or a creaking in the jaw.

3. Function

Concerning the function of this muscle, we must distinguish between the two muscle heads.

3.2 Function of the inferior fibers

Here we distinguish between an unilateral and bilateral contraction, depending on whether the muscle contracts on one or both sides of the jaw.

3.2.1 Unilateral contraction of the muscle

A one-sided contraction laterally shifts the lower jaw to the opposite/contralateral side.

This means, when it contracts on the left side, the jaw shifts to the right.

3.2.2 Bilateral contraction of the muscle

When the muscle contracts on both sides, it opens the jaw and moves it slightly forward (protrusion).

4. Lateral Pterygoid : Trigger Point Activation

In this muscle, mainly satellite trigger points arise, activated by trigger points in other muscles, as well as due to active overload and external forces.

4.1 Active overload

If you constantly stress the muscle, trigger points can be activated.

All activities that require a constantly opened or pushed forward/protruded jaw or chewing for long periods, can overload the muscle.

• Breathing through an open mouth (stuffy nose)
•  Chewing bubble gum
• Teeth grinding
• Playing a wind instrument with the jaw pushed forward
• Visit to the dentist (keeping the mouth open for a long time)

4.2 External forces/impacts

External forces or objects pressing sideways on your jaw can cause tensions and trigger points.

The stress can be short and high, or low but long.

Examples

• High and short strain: Punch on the jaw, for example when boxing.
• Low, but long strain: A violin is tucked with the jaw while playing the instrument.

4.3 Satellite trigger points

Trigger points in the sternocleidomastoid might activate trigger points in the pterygoid, because it lies in its pain zone. This is referred to as satellite trigger points.

Therefore, I recommend also looking at this muscle if you have problems with the lateral pterygoid or if you suffer from jaw pain.

5. Palpation

The lateral pterygoid can be difficult to feel, due to its “hidden” position behind the zygomatic arch.

Still, you should try to feel it. You may not be able find it right away, but that´s not a big deal.

Just take your time, and don’t mind if it doesn’t work out. Because for the massage it is not absolutely necessary that you can feel the muscle.

We divide the palpation into an intraoral (“through the mouth”) and an extraoral one.

5.1 Internal/Intraoral palpation

The internal palpation allows to feel the anterior lower fibers of the muscle. Before you begin, wash your hands.

• Open your mouth and place your index finger all the way back to the side of your molars.
• With the other hand, shift your lower jaw towards the side you want to feel.
• Now push your index finger diagonally backwards as far up as possible.
• Press from the side into the hard tissue there. This is where the fibers of the inferior part of the muscle are located.

To feel the muscle, proceed as follows:

• Open an close your jaw repeatedly – perform only small movements.
• With your index finger, try to find the spot where you feel a slight contraction under your finger.
• If you can do this, you’ve found the muscle. Congratulations.
• If you don’t make it, try again later or the next day.

5.2 External/extraoral palpation

The extraoral palpation allows you to feel both the inferior and the superior fibers of the lateral pterygoid.

5.2.2 Palpation of the superior fibers (above the zygomatic arch)

Place your index finger on the zygomatic arch. This is the horizontal bone that you can feel right next to your ear.

6. Self-massage

Use your fingers to massage this muscle. If you have long fingernails, I recommend cutting them. Otherwise the massage will be unpleasant, and you run the risk of breaking your nails.

As a massage technique, you can use “my” common techniques, namely the ischemic compression, precise massage strokes or the pressure-motion technique.

For the massage, proceed as follows:

• Place your finger on the desired area of the muscle (See chapter Palpation).
• Search for painful points by putting slight pressure on the muscle.
• Once you encounter a painful tension, perform one of the following three techniques.

Ischemic compression:

• Hold the pressure for 30 – 60 seconds and try to relax.

Precise massage strokes:

• Carry out a short massage stroke from just before to just after the tense point.
• Make sure to only move the skin over the muscle, but not to move your finger over the skin.

Pressure-motion technique:

• Press into the muscle.
• Close and open your jaw repeatedly, or
• move it a few times to the side.

References

• Calais-German, Blandine. Anatomy of Movement. Seattle: Eastland Press, 1993. Print
• Davies, Clair, and Davies, Amber. The Trigger Point Workbook: Your Self-Treatment Guide For Pain Relief. Oakland: New Harbinger Publications, Inc., Print
• Simons, David G., Lois S. Simons, and Janet G. Travell. Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore, MD: Williams & Wilkins, 1999. Print.
• Schünke, Michael., Schulte, Erik, and Schumacher, Udo. Prometheus: Lernatlas der Anatomie. Stuttgart/New York: Georg Thieme Verlag, 2007. Print