[TMJ]
Why does the jaw make the whole body ache? — the chain that starts with the small force of a swallow
Every time you swallow, the muscles at the back of your neck contract. Repeated hundreds of times a day, that small force travels straight to the neck while the jaw is in place — but once the jaw leaves its ideal position it becomes a distorted force. As dripping water wears away stone, that small force accumulates: it can break posture down, and it can also set it right. Here is the path from the jaw to the rest of the body, with the research behind it.
Before you read on, try one thing. Open your mouth wide and try to swallow. It will not go down easily.
Now close your mouth, place your fingers in the hollow just below the back of your head where it meets the neck, and swallow again. With each swallow you will feel, right at your fingertips, the muscles of the back of the neck tighten and release.
That small force, produced every time you swallow, can break your whole body down — or keep it well.
It is also what we explain most often to patients at the TMJ Balance Medicine clinic of Sandol Korean Medicine Clinic in Sejong. Let us follow the path by which the jaw does not stop at the jaw.
The jaw is the only joint that never stops, all day long
The temporomandibular joint is the only joint in the body that never rests. It works while you eat and speak, and it keeps working through the night to swallow saliva. It is also the only joint whose left and right sides must always move together.
If one knee or one shoulder is uncomfortable, the other side can take over. The jaw cannot do that. When one side leaves its place, the other side moves out of line with it — all day, for a lifetime.
The small force of a swallow can twist the neck, or set it straight
When the jaw sits in its ideal position, the force produced by swallowing reaches the neck along its normal path. Once the jaw leaves that position, a distorted force is delivered to the neck instead, and it gradually twists the cervical vertebrae.
There is an anatomical route for this. The small muscles below the back of the head — rectus capitis posterior minor and major, and obliquus capitis inferior — attach directly to the dura mater that sheathes the spinal cord. This connection is called the myodural bridge complex. When the tissue there stiffens, each contraction pulls abnormally on the dura, and that signal converges with the trigeminal nerve at the level of the upper cervical nerves, where the brain reads it as pain in the head. Animal experiments have demonstrated this.19
As dripping water wears away stone, this is why something as slight as a swallow can twist the neck vertebrae — and equally, can help straighten them. A single swallow is negligible; hundreds of them a day, for a lifetime, are not.19
The body's three postural sensors — the eyes, the feet and the masticatory system
The vestibular system regulates balance by combining information from three main postural sensors: the eyes, the feet and the masticatory system, the last of which covers the teeth and the jaw together. If any one of them goes wrong, the information is disturbed and posture becomes unsteady.1
In other words, the proprioceptive signal arriving from the occlusion matters for postural control. If you give someone without a temporomandibular disorder a cotton swab to bite on one side, creating an artificial occlusal imbalance, the load distribution and contact area of the foot on that side change immediately.
Correcting the jaw reduces postural sway
That occlusion and posture are related has been confirmed repeatedly by different researchers using different methods: the correlation between dental occlusion and posture; craniofacial dimensions, head posture and bite force in children with TMD; the relationship between mandibular position and body posture; occlusion and posture seen through surface electromyography; occlusion and postural control in adults. The approaches differed, but the conclusions pointed the same way.4
One study deserves particular attention. Eleven male astronauts — people who must adapt to a different gravitational environment — were measured while their occlusal surface was altered. With an occlusal splint in place, the sternocleidomastoid muscle contracted more symmetrically, and the sway area of the centre of foot pressure was smaller both with the eyes open and with them closed. The greater the gain in muscular symmetry, the greater the reduction in sway.3
Clenching has also been shown to change head position. When occlusal support was removed on one side at the molars, the head tilted further toward the opposite side during clenching — meaning that the loss of posterior support on one side leads to imbalance in the neck muscles.5
This is why the masticatory system serves as a postural sensor. Through the act of swallowing, a misaligned jaw twists the cervical vertebrae behind and breaks the symmetry of the sternocleidomastoid in front, bringing posture down from the head to the feet.
Unsteady posture overloads the knee
An unsteady posture means that unnecessary load is concentrated in the lower body with every step and every stride.
Research bears out the clinical impression that knee pain is common in people with a temporomandibular disorder. Compared with people without one, they were 5.5 times more likely to have pain in another joint, and knee pain was the complaint reported most often. An association with low back pain was reported as well.6
The jaw disorder unsettles posture, and an unsteady body loads the knee with every step.
Correcting the jaw also changes torsion at the pelvis
One study followed children with a Class II malocclusion, in which the jaw sits further back than normal. Fifty-four children with a mean age of 8.2 years received early orthodontic treatment, and their spinal posture and dental measurements were compared before and after.
After an average of one year and eight months of treatment, overjet decreased and posture improved in most of the children, and a statistically significant, moderate correlation was found between the reduction in overjet and the change in pelvic torsion. No significant association was found for the other spinal posture indices, so this cannot be read as orthodontic treatment changing overall spinal posture.7
Headache, the neck and tinnitus — connections confirmed again and again
The association between temporomandibular disorders and headache has been confirmed in several studies. TMD, sleep bruxism and primary headache occur in a mutually associated way8, and the link between bruxism and primary headache has been summarised in a systematic review.9
That the neck is affected when a temporomandibular disorder is present is something different research groups have each confirmed. A systematic review and meta-analysis found cervical musculoskeletal problems in patients with temporomandibular dysfunction10, and specific types of TMD have been reported to relate to impaired upper neck performance.11
The association with tinnitus is being confirmed from several directions as well: a systematic review treating tinnitus as a comorbidity of TMD12, a systematic review of the association between subjective tinnitus and cervical spine or temporomandibular disorders13, and a study reporting that the severity of somatic tinnitus falls as the temporomandibular disorder improves.14
An oral appliance improves athletic performance
If the jaw is bound up with posture, then findings that athletes perform better while wearing an oral appliance are, in a sense, what one would expect.
- Ballet dancers — after six months with a custom occlusal splint, both the flamingo balance test and electromyography showed statistically significant improvement.15
- Target shooters — comparing four mandibular positions, postural stability and the quality of gaze stabilisation were best in centric relation, and among the shooters the gain in postural stability was proportional to the rise in their scores.2
In fairness, a systematic review that gathered the research on occlusal splints and exercise performance concludes that the type of appliance and the measurement methods vary so much between studies that the size of the effect cannot be stated with confidence.16 The direction is consistent, but it is not yet possible to say that everyone will gain to the same degree.
The jaw also affects how the brain works
The problem does not stop at structure. In a study that observed patients with bruxism and TMD-related pain with functional MRI while they clenched their teeth, activity was reduced in regions overlapping the core of the default mode network (DMN), which is involved in pain modulation, and the degree of reduction was related to pain intensity. Clenching does not produce pain in a healthy person; in a patient whose brain activation pattern has already changed, the same stimulus is more likely to be felt as pain.17
What deserves more attention is that it reverses. In a study comparing brain activity during clenching between 30 patients with a temporomandibular disorder and 20 controls, the patients showed reduced activity in regions related to motor and cognitive function. Eleven of them wore an oral splint for three months, after which neural activity in those same regions returned to normal.18
With 11 participants this is a small study, and its conclusions cannot be applied broadly. Even so, it is a meaningful result: it shows that a problem in the jaw can lead to a change in brain function, and that working on the jaw may bring that change back.
Set out in an international journal
In August 2026 the author of this article published a narrative review in the international journal Medicina, bringing this material together. It looks at temporomandibular disorders beyond the confines of orofacial pain, alongside their connections to the musculoskeletal system, headache and the central nervous system.20
The jaw is entangled with a range of structural problems — from disturbance of central function and headache, through the neck, down to the legs. Its association with tinnitus is being confirmed from several directions.
Could the cause be in the jaw?
It would be good if more people took an interest in the jaw, and came to see it afresh, given how it connects to so many structural and functional problems elsewhere in the body.
If you have a discomfort that has not resolved despite going from clinic to clinic, it is worth checking at least once whether the cause lies in the jaw.
At the TMJ Balance Medicine clinic of Sandol Korean Medicine Clinic in Sejong, the whole body is examined with the balance of the jaw as the axis. A temporomandibular examination and consultation can tell you whether your current discomfort begins there.
Frequently asked questions
Why would the jaw affect somewhere as distant as the knee or the pelvis?
The masticatory system is one of the three main postural sensors, together with the eyes and the feet. When the jaw is out of position, the act of swallowing twists the neck vertebrae behind and breaks the symmetry of the sternocleidomastoid muscle in front, so posture gives way from the head downward. An unsteady posture concentrates unnecessary load on the lower body with every step. In one study, people with a temporomandibular disorder were 5.5 times more likely to have pain in another joint, and knee pain was the complaint reported most often. This is an association found in observational research, so it cannot be taken as proof of cause.
Does wearing an intraoral appliance really improve posture or athletic performance?
In a study of 11 male astronauts, wearing an occlusal splint made the contraction of the sternocleidomastoid muscle more symmetrical and reduced the sway area of the centre of foot pressure. In 20 ballet dancers given a custom occlusal splint for six months, balance testing and electromyography both improved significantly. A systematic review of occlusal splints and exercise performance, however, concludes that the type of appliance and the measurement methods vary so much between studies that the size of the effect cannot be stated with confidence, so it is too early to say that everyone will improve to the same degree.
Can treating the jaw affect brain function?
In a study using functional MRI while patients with bruxism and TMD-related pain clenched their teeth, activity was reduced in regions overlapping the core of the default mode network, which is involved in pain modulation, and the degree of that reduction was related to pain intensity. In another study, 11 patients with a temporomandibular disorder wore an oral splint for three months, after which neural activity in motor and cognitive regions returned to normal. These are small studies, so their findings cannot be applied broadly.
References
- Stancker TG, Silva AC, Neto HP, Rodrigues CDA. Malocclusion influence on balance and posture: a systematic review. Man Ther Posturology Rehabil J. 2015;13:320.
- Gangloff P, Louis JP, Perrin PP. Dental occlusion modifies gaze and posture stabilization in human subjects. Neurosci Lett. 2000;293:203–206.
- Sforza C, Tartaglia GM, Solimene U, Morgun V, Kaspranskiy RR, Ferrario VF. Occlusion, sternocleidomastoid muscle activity, and body sway: a pilot study in male astronauts. Cranio. 2006;24(1):43–49.
- Milani RS, De Periere DD, Lapeyre L, Pourreyron L. Relationship between dental occlusion and posture. Cranio. 2000;18:127–134. / Sonnesen L, Bakke M, Solow B. Eur J Orthod. 2001;23:179–192. / Sakaguchi K, et al. Cranio. 2007;25:237–249. / Bergamini M, et al. Cranio. 2008;26:25–32. / Tardieu C, et al. Neurosci Lett. 2009;450:221–224.
- Yoshino G, Higashi K, Nakamura T. Changes in head position due to occlusal supporting zone loss during clenching. Cranio. 2003;21(2):89–98.
- Bonato LL, Quinelato V, De Felipe Cordeiro PC, De Sousa EB, Tesch R, Casado PL. Association between temporomandibular disorders and pain in other regions of the body. J Oral Rehabil. 2017;44(1):9–15.
- Klostermann I, Kirschneck C, Lippold C, Chhatwani S. Relationship between back posture and early orthodontic treatment in children. Head Face Med. 2021;17(1):4.
- Fernandes G, Franco AL, Gonçalves DA, Speciali JG, Bigal ME, Camparis CM. Temporomandibular disorders, sleep bruxism, and primary headaches are mutually associated. J Orofac Pain. 2013;27(1):14–20.
- Réus JC, Polmann H, Mendes Souza BD, et al. Association between primary headache and bruxism: an updated systematic review. J Oral Facial Pain Headache. 2021;35(2):129–138.
- de Oliveira-Souza AIS, de O Ferro JK, Barros MMMB, Oliveira DA. Cervical musculoskeletal disorders in patients with temporomandibular dysfunction: a systematic review and meta-analysis. J Bodyw Mov Ther. 2020;24(4):84–101.
- Greenbaum T, Dvir Z, Emodi-Perelman A, Reiter S, Rubin P, Winocur E. Relationship between specific temporomandibular disorders and impaired upper neck performance. Eur J Oral Sci. 2020;128(4):292–298.
- Skog C, Fjellner J, Ekberg E, Häggman-Henrikson B. Tinnitus as a comorbidity to temporomandibular disorders — a systematic review. J Oral Rehabil. 2019;46(1):87–99.
- Bousema EJ, Koops EA, van Dijk P, Dijkstra PU. Association between subjective tinnitus and cervical spine or temporomandibular disorders: a systematic review. Trends Hear. 2018;22:2331216518800640.
- van der Wal A, Michiels S, Van de Heyning P, et al. Reduction of somatic tinnitus severity is mediated by improvement of temporomandibular disorders. Otol Neurotol. 2022.
- Didier H, Assandri F, Gaffuri F, et al. The role of dental occlusion and neuromuscular behavior in professional ballet dancers’ performance: a pilot study. Healthcare (Basel). 2021;9(3):251.
- Cesanelli L, Cesaretti G, Ylaitė B, Iovane A, Bianco A, Messina G. Occlusal splints and exercise performance: a systematic review of current evidence. Int J Environ Res Public Health. 2021;18(19):10338.
- Kluskens TJ, Kessler PA, Jansma BM, Kaas A, van de Ven V. Neural correlates of tooth clenching in patients with bruxism and temporomandibular disorder-related pain. J Oral Facial Pain Headache. 2023;37(2):139–148.
- He, et al. Altered neural activation pattern during teeth clenching in temporomandibular disorders. Oral Dis. 2016. doi:10.1111/odi.12465
- Song X, Yu SB, Yuan XY, et al. Evidence for chronic headaches induced by pathological changes of myodural bridge complex. Sci Rep. 2024;14:5285.
- Choe G, Hwang JH. Temporomandibular disorders beyond orofacial pain: a narrative review of musculoskeletal, headache, and central nervous system implications. Medicina (Kaunas). 2026;62(8):1546. doi:10.3390/medicina62081546
If you have a discomfort that has not resolved despite going from clinic to clinic, it may be worth checking whether the cause lies in the jaw. Please feel free to ask the TMJ Balance Medicine clinic at Sandol Korean Medicine Clinic in Sejong.
This column is general health information and does not replace diagnosis or treatment of an individual. Many of the studies cited here are observational or small in size, so more evidence is needed before concluding that a change in the jaw causes a whole-body symptom. The cause of a symptom and the right treatment differ greatly from person to person, so please be examined by a clinician. Emergency symptoms such as high fever, chest pain, reduced consciousness or sudden paralysis require immediate emergency care.
References: see the list above.