NULL

Medial Pterygoid – Pain & Trigger Points

The medial pterygoid is a muscle of your temporomandibular joint and can cause pain in the jaw, throat and ear if it is tense or carries trigger points.

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

On this page you will find instructions how to do this.

You will also learn …

  • where and what pain this muscle can cause.
  • where it is located.
  • which functions it provides.
  • how you feel it.
  • how to massage it.

Got curious? Then read on.

1. Pain Patterns, Symptoms & Differential Diagnoses

1.1 Pain patterns

Trigger points in the medial pterygoid can lead to the following ailments.

  • Tongue pain
  • Pain under and behind the temporomandibular joint
  • Deep earache
  • Sore throat

In general, the pain caused by this muscle is rather diffuse and not clearly distinguishable.

The pain usually increases when you stretch or contract the muscle.

Each time the jaw is opened, the muscle is extended, and each time the jaw is closed, it is contracted.

That means the pain could be increased by …

  • Yawning
  • Chewing food or other objects
  • Teeth grinding

1.2 Symptoms

Besides pain, there may be difficulty swallowing or pressure on the ears.

The pressure on the ears stems from the fact that trigger points in the pterygoid disrupt the function of the tensor veli palatini.

This muscle is responsible for pressure balance in the ear. If the muscle can no longer work “properly”, this may impair this function.

2. Origin & Insertion

In simple terms, the muscle runs from the inside of the lower jaw diagonally upward to the os sphenoidale.

Along with the masseter, which is attached onto the external surface of the lower jaw, it forms a loop on which the jaw is suspended.

3. Function

Concerning the function of the muscle, we must distinguish whether it is active on both sides of the jaw (left and right), or only on one side.

Unilateral contraction: The muscle shifts the lower jaw to the opposite side (excursion of the mandible).

A function that is very important for grinding food during mastication.

Performing bilateral contraction, the muscle closes the jaw. It is supported by the masseter, the upper fibers of the lateral pterygoid and the temporalis.

In addition, contraction on both sides contributes to a forward shift of the mandible (protrusion).

1

Jaw shifted to the side (lateral).

2

Jaw shifted forward (protrusion).

3

Jaw closed.

4. Medial Pterygoid – Trigger Point Activation

Trigger points arise in this muscle primarily due to unfavorable postures, active overload, emotional tension or because of satellite trigger points.

4.1 Unfavourable postures

Any posture or activity in which the head is moved forward, moves the lower jaw into a position that puts this muscle under tension.

In the long run, this can overload the medial pterygoid and activate trigger points.

4.2 Active overloads

The muscle is actively overloaded if you strain it beyond its level of performance.

Especially repetitive movements cause problems.

Examples:

  • Chewing bubble gum
  • Teeth grinding
  • Chewing on hard bread

4.3 Emotional tensions

Emotional tension is generally reflected in an increase of muscle tension. The primarily affected muscles vary from person to person.

However, many people’s jaw muscles are particularly sensitive to stress and deep emotions.

Over time (hours to weeks, depending on the individual) this can lead to tension and trigger points.

4.4 Satellite trigger points

Satellite trigger points are those that arise as a “reaction” to trigger points in other muscles.

In this case, it is the lateral pterygoid that can activate these satellite trigger points in the medial pterygoid. It is therefore worthwhile to have a look at it, too, and to massage it if necessary.

5. Palpation

It is not easy to palpate the muscle or to feel its fibers contracting. Nevertheless, I’ll provide you with an instruction – for all those who would like to try it.

Do not worry if you don’t want to try it or if you are unable to feel the muscle. Even so, you will find the area to be massaged without any problems.

The palpation of this muscle is performed intraorally, i.e. you have to put your fingers into your mouth. That’s why I first of all recommend washing your hands.

Furthermore, you should take it slowly. In order to feel the muscle and to perform the self-massage, you have to reach quite deep into your mouth which could evoke the pharyngal reflex. Slow approach helps to avoid that.

1

Grasp the inside of your lower jaw with the index finger of your opposite hand.

2

Your index finger should now be below your molars.

3

Now push the finger further back in the direction of your jaw angle.

Now you are in the area of the medial pterygoid. You will massage this area in the next chapter. To feel the muscle under tension, proceed as follows:

  • Place a cork between your teeth.
  • Now bite the cork repeatedly.
  • With every bite, the muscle contracts.
  • Experiment a little with the position of your fingers and try to feel this contraction.
  • Take your time. It is not easy to feel this.

If you don’t have a cork at hand, bite your finger. Of course, you cannot bite hard, but it’s still possible to feel the muscle’s contraction.

6. Self-massage of the Medial Pterygoid

Use your fingers for the massage. As massage technique, I recommend the …

  • Ischemic compression
  • Precise massage strokes
  • Pressure-motion technique

You can massage the muscle from the outside (extraoral) or inside the mouth (intraoral). On this page I show you the intraoral massage with precise massage strokes.

Note: For the massage of this muscle, there is no need to exert intense pressure!

6.1 Self-massage with precise massage strokes (intraoral)

  • Place your index finger in the area of the muscle (see chapter Palpation).
  • Perform small strokes from the rear towards the front.
  • Search this way for painful points in the muscle.
  • Massage each of these points with a few short and slow massage strokes.
  • Always stroke from just before to just after a painful point.

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