By Dr. Alex Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST
Learn about the benefits of chiropractic rehabilitation for treating jaw pain and improving overall oral health from TMJ.
Table of Contents
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.
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:
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.
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.
To understand TMJ dysfunction (TMD), we must first appreciate the joint’s remarkable complexity. The TMJ is one of the most unique and constantly used joints in the human body. It is a ginglymoarthrodial joint, a term that reflects its dual functions: ginglymoid (hinge-like rotation) and arthrodial (sliding or gliding).
Let’s break down what happens during a simple action like opening your mouth:
This coordinated two-phase movement allows the wide range of motion needed for speaking, yawning, and chewing.
TMJ Dysfunction is not a single diagnosis but an umbrella term for a group of disorders affecting the joint and the muscles of mastication. We can broadly categorize them into three types:
You can’t discuss TMD without highlighting the trigeminal nerve (Cranial Nerve V). This massive sensory nerve supplies the face, teeth, gums, and, crucially, the TMJ capsule and the muscles of mastication. The trigeminal nerve has a large nucleus in the brainstem with extensive connections to other cranial nerves and, most importantly, to the sensory nerves of the upper cervical spine (C1, C2, C3).
This convergence of nerve signals in the brainstem is known as the trigeminocervical complex. It is the physiological basis for the strong clinical connection between jaw problems and neck problems. TMJ irritation can send pain signals through the trigeminal nerve, which the trigeminocervical complex then processes. The brain can misinterpret these signals as originating from the neck, head, or face, leading to:
Conversely, dysfunction in the upper cervical spine—a common issue addressed by chiropractic care—can irritate the cervical nerves. These signals travel up to the trigeminocervical complex, and the brain may perceive them as jaw or facial pain, even if the TMJ is structurally healthy. This is why a patient might have jaw pain that actually originates in their neck. This intricate neural wiring underscores why a holistic approach that assesses both the jaw and the neck is essential for accurate diagnosis and effective treatment.
As a chiropractor, my primary focus is on the relationship between structure (primarily the spine) and function (as coordinated by the nervous system). When it comes to TMD, the connection to the cervical spine isn’t just theoretical; it is a clinical reality I see daily.
Your head position directly influences your jaw. Consider the common issue of Forward Head Posture, where the head juts forward in front of the shoulders. This posture, often caused by prolonged computer use, “text neck,” or past injuries like whiplash, creates a cascade of biomechanical compensations:
This chronic strain can be a primary driver or a significant contributing factor to both myofascial pain and internal derangement of the TMJ.
Our chiropractic approach to a patient with TMD is multifaceted, extending beyond the jaw itself to address the entire kinetic chain.
By addressing the structural and neurological dysfunctions in the neck, upper back, and shoulders, chiropractic care plays a critical role in alleviating the biomechanical stresses that perpetuate TMD. This creates a healthier environment for the jaw to function, often reducing pain and improving mobility even before direct TMJ treatment.
While chiropractic care addresses the crucial structural component, and injections can manage acute inflammation, a truly comprehensive approach must also consider the systemic factors that contribute to pain and dysfunction. This is where our functional medicine expertise becomes invaluable.
Chronic pain is rarely just a local issue. It often reflects systemic imbalance, particularly chronic inflammation. At Injury Medical Clinic, we investigate the root causes of this inflammation.
Our approach includes stress management techniques such as mindfulness, breathing exercises, and biofeedback. We also assess adrenal function through saliva or urine testing (e.g., the DUTCH test) to understand an individual’s stress response pattern and provide targeted support with adaptogenic herbs and nutrients.
By identifying and addressing these underlying systemic issues, we can reduce the body’s overall inflammatory burden, manage the physiological effects of stress, and provide the raw materials needed for tissue repair. This functional medicine approach complements and enhances the effects of our structural and procedural interventions.
Let’s return to our patient who received the TMJ injection. The injection was Step One: crisis management. It broke the acute pain-and-inflammation cycle. What happens next is a perfect example of our integrative model in action.
The results would inform a personalized plan involving dietary changes, targeted nutritional supplements (like magnesium, omega-3s, or curcumin), and stress-reduction strategies.
This comprehensive, three-pronged approach ensures that we are not just chasing symptoms. We are addressing the patient’s condition from every relevant angle: medically, structurally, and biochemically. This is the essence of true integrative healthcare and the key to achieving not just temporary relief, but lasting health and resilience. My collaboration with Dr. Cardenas ensures the patient receives the best of both worlds—the structural and holistic focus of chiropractic and functional medicine, combined with the diagnostic rigor and oversight of internal medicine.
Temporomandibular Joint Dysfunction is a complex and often debilitating condition that sits at the crossroads of dentistry, medicine, and chiropractic. Too often, patients are bounced between specialists, and receive fragmented care that addresses only one piece of the puzzle. The jaw is not an island; it is intimately connected to the neck, the nervous system, and the body’s overall health
At Injury Medical Clinic, we have built our practice on this principle of interconnectedness. By uniting Dr. Cardenas’s expertise in internal medicine with my background in chiropractic and functional medicine, we offer a truly holistic, integrated model of care. We combine advanced diagnostic and therapeutic procedures, like targeted injections, with foundational treatments such as chiropractic adjustments and personalized lifestyle interventions. We look at the latest evidence-based research to guide our hands-on clinical work.
Our goal is to take our patients on an easy-to-understand journey from pain and dysfunction to relief and recovery. We empower them with knowledge about their own bodies, address the root causes of their suffering, and provide them with the tools to build a foundation for long-term health. If you are struggling with jaw pain, headaches, or neck and shoulder tension, I encourage you to consider an approach that looks at the bigger picture. Your path to healing may lie in the powerful synergy of integrative care.
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General Disclaimer, Licenses and Board Certifications *
Professional Scope of Practice *
The information herein on "Chiropractic Rehabilitation for Pain Relief From TMJ" is not intended to replace a one-on-one relationship with a qualified health care 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.
Blog Information & Scope Discussions
Welcome to El Paso's Premier Wellness and Injury Care Clinic & Wellness Blog, where Dr. Alex Jimenez, DC, FNP-C, a Multi-State board-certified Family Practice Nurse Practitioner (FNP-BC) and Chiropractor (DC), presents insights on how our multidisciplinary team is dedicated to holistic healing and personalized care. Our practice aligns with evidence-based treatment protocols inspired by integrative medicine principles, similar to those on this site and on our family practice-based chiromed.com site, focusing on naturally restoring health for patients of all ages.
Our areas of multidisciplinary practice include Wellness & Nutrition, Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Headaches, Sports Injuries, Severe Sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Complex Injuries, Stress Management, Functional Medicine Treatments, and in-scope care protocols.
Our information scope is multidisciplinary, focusing on musculoskeletal and physical medicine; wellness; contributing etiological viscerosomatic disturbances within clinical presentations; associated somato-visceral reflex clinical dynamics; subluxation complexes; sensitive health issues; and functional medicine articles, topics, and discussions.
We provide and present clinical collaboration with specialists from various disciplines. Each specialist follows their professional scope of practice and licensure jurisdiction. We use functional health & wellness protocols to treat and support care for musculoskeletal injuries or disorders.
Our videos, posts, topics, and insights address clinical matters and issues that directly or indirectly relate to our clinical scope of practice.
Our office has made a reasonable effort to provide supportive citations and has identified relevant research studies that support our posts. We provide copies of supporting research studies upon request to regulatory boards and the public.
For further discussion on how this information relates to specific care plans or treatment protocols, please ask Dr. Alex Jimenez, DC, APRN, FNP-BC, or contact us at 915-850-0900.
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*
Chiropractic Licenses:
Texas DC License #: TX5807, Verified: TX5807
New Mexico DC License #: NM-DC2182, Verified: NM-DC2182
Nurse Practitioner Licenses:
Texas APRN License #: 1191402, Verified: 1191402 *
New Mexico CNP License #: 90560, Verified 90560
Florida APRN License #: 11043890, Verified: APRN11043890 *
Colorado License #: C-APN.0105610-C-NP, Verified: C-APN.0105610-C-NP
New York License #: N25929, Verified N25929
Georgia APRN License #: GAA-NP005701
Multi-State Advanced Practice Registered Nurse (APRN*) Texas & Multi-States
Multi-state Compact APRN License by Endorsement (43 States)
Compact Status: Multi-State License: Authorized to Practice in 43 States*
Nursing Licensure Compact: Updated Here
DEA Registration: (Drug Enforcement Agency Registered)
All medical (MDs) and family practice providers (FNP-APRN) are registered and licensed to offer various levels of medication.
Verify Providers' DEA Registration Here
License Verification Link: Nursys License Verifier
* Prescriptive Authority Authorized (DEA Registered Providers). Call if Required
Board Certification:
ANCC FNP-BC: Board Certified Nurse Practitioner*
Education:
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
(Board Certified: Family Practice Nurse Practitioner—Multistate)*
(Licensed Nurse Practitioner & Chiropractor - Multistate)*
Clinical Director
DC & FNP License (Review Above)
Digital Business Card
NPI: 1205907805
Dr. Maria Cardenas, MD
(Board Certified: Internal Medicine)
(Licensed Medical Doctor)
Medical Director, Clinical Director & Collaborative Physician
NPI # 1164426748
MD License #: J2933
Licenses and Board Certifications:
MD: Medical Doctor
DC: Doctor of Chiropractic
APRNP: Advanced Practice Registered Nurse
FNP-BC: Family Practice Specialization (Multi-State Board Certified)
FNP-BC: Family Practice Across Life Span (Neonatal to Geriatrics)
RN: Registered Nurse (Multi-State Compact License)
CFMP: Certified Functional Medicine Provider
MSN-FNP: Master of Science in Family Practice Medicine
MSACP: Master of Science in Advanced Clinical Practice
IFMCP: Institute of Functional Medicine
CCST: Certified Chiropractic Spinal Trauma
ATN: Advanced Translational Neutrogenomics
Family with Primary Care Focus (Family Nurse Practitioner or FNP)
Memberships & Associations:
TCA: Texas Chiropractic Association: Member ID: 104311
TNA: Texas Nurse Association: Member ID: 06458222
TNP: Texas Nurse Practitioner Association ID: 2025091511
AANP: American Association of Nurse Practitioners: Member ID: 2198960
ANA: American Nurses Association: Member ID: 06458222 (District TX01)
| Primary Taxonomy | Selected Taxonomy | State | License Number |
|---|---|---|---|
| No | 111N00000X - Chiropractor | NM | DC2182 |
| Yes | 111N00000X - Chiropractor | TX | DC5807 |
| Yes | 363LF0000X - Nurse Practitioner - Family | TX | 1191402 |
| Yes | 363LF0000X - Nurse Practitioner - Family | FL | 11043890 |
| Yes | 363LF0000X - Nurse Practitioner - Family | CO | C-APN.0105610-C-NP |
| Yes | 363LF0000X - Nurse Practitioner - Family | NY | N25929 |
| Yes | 363LF0000X - Nurse Practitioner - Family | NM | 90560 |
| Yes | 363LF0000X - Nurse Practitioner - Family | GA | GAA-NP005701 |
Dr. Alex Jimenez, DC, APRN, FNP-BC*, CFMP, IFMCP, ATN, CCST
(Board Certified: Family Practice Nurse Practitioner—Multistate)*
(Primary Care Across Lifespan—Neonatal / Pediatric / Adult / Geriatrics)
(Licensed Nurse Practitioner & Chiropractor - Multistate)*
Clinical Director
Digital Business Card
NPI: 1205907805
Dr. Maria Cardenas, MD
(Board Certified: Internal Medicine)*
(Licensed Medical Doctor)*
Medical Director, Clinical Director & Collaborative Physician
NPI # 1164426748
MD License #: J2933
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