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Lateral Pterygoid – Pain & Trigger Points

The lateral pterygoid is a muscle of your temporomandibular joint and can cause pain in the area of the jaw and face if it carries trigger points.

Trigger points are small tensions or muscle nodules that can cause diverse pain and discomfort.

However, it’s possible to “eliminate” these tensions and trigger points with a self-massage.

On this page you will find instructions how to do this. You will also learn …

  • where exactly this muscle can cause pain.
  • where it is located.
  • which functions it performs.
  • how you might have overloaded it.
  • how to feel it.
  • how to massage it.

So stay a little longer here.

1. Pain Patterns, Symptoms & Differential Diagnoses

1.1 Pain patterns

If the lateral pterygoid is tense, it may be sensitive to local pressure and lead to a feeling of tension in the jaw.

Trigger points in this muscle lead to the same problems, but can cause different kind of pains:

  • Deep pain in the temporomandibular joint
  • Pain in the maxillary sinus

1.2 Symptoms and ailments

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

The tensions can lead to a slight protrusion of the lower jaw, which may become apparent in an unclear dental impression and a creaking noise in the jaw.

2. Origin & Insertion

The lateral pterygoid has two muscle heads, a lower/inferior and an upper/superior one. Put simply, it runs from the temporomandibular joint to the temple.

Origin superior fibers

  • Crista infratemporalis of the os sphenoidale

Insertion superior fibers

  • Radiation into the joint capsule of the temporomandibular joint

Origin inferior fibres

  • Lamina lateralis of the processus pterygoideus

Insertion inferior fibres

  • Processus condylaris of the mandible

3. Function

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

3.1 Function of the superior fibers

The upper fibers of the muscle are involved in jaw closure.

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 produces lateral shift of the lower jaw to the opposite/contralateral side.

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

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Jaw in neutral position.

2

Lateral shift of the jaw.

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).

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Jaw in neutral position.

2

Jaw in protrusion.

4. Lateral Pterygoid – Trigger Point Activation

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

4.1 Active overload

If you constantly strain the muscle, trigger points can develop.

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

  • Breathing through open mouth (stuffy nose)
  •  Chewing 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 tension and trigger points.

These can be short high strain or long low strain.

Two 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 is located in its pain zone. This is referred to as satellite trigger points.

Therefore I recommend to also take a look at this muscle if you have problems with the lateral pterygoid or if you suffer from jaw pain.

5. Palpation

The lateral pterygoid is sometimes difficult to feel, which is due to its “hidden” position behind the zygomatic arch.

Still, you should try to feel it. You may not be able to do 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 subdivide 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 sides 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.
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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.

5.2.1 Palpation of the inferior fibers below the zygomatic arch

  • Your jaw is slightly open.
  • Place your index finger on your temporomandibular joint.
  • It’s the spot where you feel your zygomatic arch above your finger, your temporomandibular joint diagonally above it and your mandible joint at its back.
  • Move your index finger slowly forward, but always stay below your zygomatic arch. While you are doing this, perform one of the two following movements.Open your jaw repeatedly or move it to both sides.
  • With these movements, the inferior fibers of the lateral pterygoid contract. Try to feel that.

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.

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Place your index finger at the back of the zygomatic arch, just before your temporomandibular joint.

2

Slide your finger a quarter of an inch upwards.

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Now you are in the area of the superior fibers of the lateral pterygoid.

Try to feel the muscle under contraction by repeatedly biting your teeth against each other.

However, you can only feel the muscle with a very firm bite.

6. Self-massage

Use your fingers for the self-massage of this muscle. If you have long fingernails, I recommend to shorten them. Otherwise the massage will be very 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).
  • Look 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