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Movements of the TMJ and Treatment Considerations

Original Editor - Ewa Jaraczewska based on the course by Micaela Weinberg

Top Contributors - Ewa Jaraczewska, Jess Bell and Rachael Lowe  

Introduction

The temporomandibular joint (TMJ) is a unique structure.[1] It functions as both a hinge and a gliding joint (ginglymoarthrodial).[2] The two TMJs are linked through the mandible and work as a pair—they do not move independently, so dysfunction at one joint influences the other. Assessment and treatment must, therefore, address both sides regardless of where symptoms present. Understanding normal movement patterns is key to managing temporomandibular disorders (TMD).

Two-Compartment System

The TMJ has two compartments that are divided by an articular disc.[3][4] This division allows rotation and translation to occur either sequentially or simultaneously, depending on the movement required.[5][6] Each compartment has its own distinct mechanical functions.[7]

The inferior compartment is located between the mandibular condyle and the articular disc. Rotational movements occur in this compartment.[8] The inferior portion of lateral pterygoid controls rotation and maintains the disc-condyle relationship.

The superior compartment is positioned between the articular disc and the mandibular fossa of the temporal bone. Translational movements occur in this compartment.[8] The superior portion of lateral pterygoid controls translation, guiding the disc-condyle complex forwards and backwards.

TMJ Movements

TMJ movements include depression, elevation, protraction (protrusion), retraction, and lateral excursion.[9][10]

Depression and Elevation

Depression (mouth opening) occurs primarily through gravity, with assistance from the suprahyoid muscles. The suprahyoids reposition the hyoid bone inferiorly to allow full mandibular depression.[11] During the initial phase of mouth opening (0-20mm), the main action is anterior rotation of the mandibular condyle, which occurs in the inferior compartment. The inferior portion of lateral pterygoid contracts to rotate the condyle anteriorly while maintaining the relationship between the intermediate zone of the disc and the condylar surface. In the next phase of mouth opening (from 20mm to around 60mm), the main action is anterior translation of the mandibular condyle, which occurs in the superior compartment. The superior portion of lateral pterygoid guides the disc-condyle complex forward until maximum opening is reached. At end range, the discal temporal ligament reaches maximum tension, and the intermediate zone of the disc maintains contact between the condyle and the articular tubercle.[11]

While rotation dominates the initial phase and translation dominates the next, there is some translation in the superior compartment during the first 20mm, and some rotation continues in the inferior compartment beyond 20mm.

Elevation (mouth-closing) occurs in reverse order—posterior translation followed by posterior rotation. The suprahyoid muscles relax, and the muscles of mastication (masseter, temporalis, and medial pterygoid) contract to work against gravity to close the mouth.[11] During the initial phase, posterior translation occurs in the superior compartment, controlled by the elevator muscles (masseter, temporalis, medial pterygoid), with possible assistance from the superior head of lateral pterygoid in disc control. In the next phase, posterior rotation occurs in the inferior compartment, controlled by the masseter, temporalis, and medial pterygoid. The movement ends with teeth contact, which provides the most stable position for the TMJ.[11]

As with mouth opening, some posterior rotation occurs in the inferior compartment during the initial translation phase, and some posterior translation continues during the final rotation phase.

Protraction and Retraction

Protraction (protrusion) is the forward movement of the mandible. The mandible moves forward as a unit, maintaining the relationship between each condyle and its disc. Protraction begins with slight mouth opening to disengage the teeth. This is initiated by anterior rotation in the inferior compartment. Then, anterior translation and rotation occur together to bring the mandible forward. This movement is controlled by both portions of the lateral pterygoid.[11]

Retraction occurs in reverse order. Posterior rotation and translation occur simultaneously. Retraction ends when the jaw returns to its resting position, with the teeth in contact.[11]

Lateral Excursion

Lateral excursion is the side-to-side movement of the mandible. During lateral excursion, the working side (the side toward which the jaw is moving) acts as a pivot point. The condyle on this side rotates on its axis. This movement is controlled by the deep masseter and temporalis muscles. The non-working side (the side moving towards the midline) rotates anteriorly and medially. This movement is controlled by the inferior portion of lateral pterygoid and the medial pterygoid on that side.[12]

Self-Palpation Exercise

To better understand TMJ movement, try this palpation exercise on yourself.

Palpate your condyles by placing your fingers just anterior to the tragus of each ear.

At rest: Note if one condyle sits more prominently. A prominent condyle can indicate that the mandible is rotated laterally towards that side.[11]

During opening: The condyle should rotate anteriorly for approximately the first 20mm before anterior translation becomes dominant. If translation occurs immediately without this initial rotation, the condyle may already be positioned too far anteriorly at rest. This suggests an underlying pathology that requires correction before normal biomechanics can resume.[11]

Throughout movement: Assess symmetry throughout the movement. Both condyles should move symmetrically through rotation and translation. Asymmetry in range, speed, and/or sequence indicates dysfunction. This dysfunction may or may not correlate with the location of the patient's symptoms.[11]

Note that dysfunction on one side may cause compensatory symptoms to appear on the opposite side.[11]

TMJ Movement Assessment

The TMJ movement assessment includes a subjective interview, observation, range of motion assessment, and palpation.[11]

Interview

Ask about the presence, location and timing of sounds (e.g., click, pop, crepitus) and pain/discomfort. When discussing pain or discomfort, it can be useful to use the term "symptoms" rather than "pain". Patients may describe sensations such as pulling, tightness, or pressure that they don't associate with pain, but which still indicate dysfunction. Identify symptom location carefully. Symptoms within the joint space require different treatment approaches to symptoms in the surrounding musculature.

Observation

Begin observation during the subjective interview. Look out for any jaw deviation and head position (tilted, forward, straight, etc.) during conversation. These postural patterns may reflect chronic myofascial adaptations that could be contributing to TMD.

Measure active range of motion during mouth opening. The patient should be able to fit at least three fingers vertically. Ranges vary, but they should be able to achieve approximately 50mm on average. You can use a ruler to measure (see below) if the patient has range of motion limitations. Document whether the jaw opens in a straight line or deviates in a C-curve or S-curve pattern.[11]

Other movements may be assessed depending on the patient's presentation.

Palpation

Place fingers on either side of the mandibular condyles at rest to assess symmetry and positioning. During movement, assess for symmetry. Note if any movement components are missing (e.g., rotation or translation) or if one side overshoots the other. Check the smoothness of the transition between rotation and translation.

Assess the joint space by palpating the joint in protraction with your index finger. Inflammation within the joint creates a boggy, swollen feeling and may push the condyle out of an optimal position. Capsulitis presents as a firm, restricted tissue that limits the available space for normal condylar movement.

Feel for sounds during jaw movement. Clicks, pops, and crepitus provide information about disc position and joint surface integrity. Note when during movement these sounds occur. Earlier clicks typically indicate relatively minor disc displacement with successful reduction, whereas later clicks suggest more significant displacement.

Measurement Landmarks for the Range of Motion Assessment

Depression: Measure the linear distance between the upper and lower central incisors (i.e., the two front-most teeth).[13] This optional video demonstrates how to measure TMJ depression:

[14]

Protraction and retraction: Measure the distance between the upper and lower central incisors, as shown in the following optional video:

[15]

Lateral excursion: Measure the lateral distance between the midpoints of the lower and upper central incisors. Measure each side separately.[16] See the optional video if you would like to learn more:

[17]

Key Principles in Treatment Planning

The TMJs work as a pair, and dysfunction on one side affects the other.[11] Understanding this relationship is central to treatment planning. Treating only the painful side might address the symptom, but ignore the cause. Treatment needs to be holistic and consider all contributing factors.[11] Computer screen position, chewing preferences, sleeping position, and habitual jaw posture can all contribute to TMD. Treatment must address these lifestyle factors alongside manual techniques and exercise prescription.[18] Improving proprioceptive awareness of jaw position and movement patterns is also valuable.

Treatment should aim to restore normal biomechanics.[11] This means correcting resting position, rebalancing muscle function between sides, addressing tissue restrictions in both the joint space and surrounding structures, and retraining movement patterns through guided practice. Developing skilled palpation through practice is essential for both assessing and treating TMD.

Resources

References

  1. ↑ Lee YH. Functional anatomy of the temporomandibular joint and pathologic changes in temporomandibular disease progression: a narrative review. Journal of Korean Dental Science. 2024;17(1):14-35.
  2. ↑ Bodnar SE, Zdilla MJ. The relationship of the articular eminence with the mandibular fossa: implications for temporomandibular joint mechanics. Experimental Biology 2018 Meeting Abstracts. 2018;32(S1):639.
  3. ↑ Nagi R; Kumar SS; Kalladka M, Khan J. Diagnosis and management of arthrogenous temporomandibular joint disorders: a literature review. Frontiers of Oral and Maxillofacial Medicine. 2026;7:26.
  4. ↑ Ata N, Gül O, Çelik T. Temporomandibular Joint: Anatomy and Physiology. InPhysical Therapy and Rehabilitation in Otorhinolaryngology 2025 Nov 1 (pp. 667-671). Cham: Springer Nature Switzerland.
  5. ↑ Gharavi SM, Qiao Y, Faghihimehr A, Vossen J. Imaging of the temporomandibular joint. Diagnostics. 2022 Apr 16;12(4):1006.
  6. ↑ Wilkie G, Al-Ani Z. Temporomandibular joint anatomy, function and clinical relevance. British Dental Journal. 2022 Oct 14;233(7):539-46.
  7. ↑ Bender ME, Lipin RB, Goudy SL. Development of the Pediatric Temporomandibular Joint. Oral Maxillofac Surg Clin North Am. 2018 Feb;30(1):1-9.
  8. ↑ 8.0 8.1 Jeon KJ, Kim YH, Ha EG, Choi HS, Ahn HJ, Lee JR, Hwang D, Han SS. Quantitative analysis of the mouth opening movement of temporomandibular joint disorder patients according to disc position using computer vision: a pilot study. Quantitative Imaging in Medicine and Surgery. 2022 Mar;12(3):1909.
  9. ↑ Chagas-Neto FA, de Sá Neto JL, Agnollitto PM. Temporomandibular Joint: Review of the Anatomy, Pathology, and Magnetic Resonance Imaging Techniques. Craniofacial Pain: Temporomandibular Disorders and Beyond. 2024 Nov 30:91-122.
  10. ↑ Shu J, Ma H, Jia L, Fang H, Chong DYR, Zheng T, Yao J, Liu Z. Biomechanical behaviour of temporomandibular joints during opening and closing of the mouth: A 3D finite element analysis. Int J Numer Method Biomed Eng. 2020 Aug;36(8):e3373.
  11. ↑ 11.00 11.01 11.02 11.03 11.04 11.05 11.06 11.07 11.08 11.09 11.10 11.11 11.12 11.13 11.14 Weinberg M. Movements of the TMJ and Treatment Considerations Course. Physiopedia Plus, 2026.
  12. ↑ Pérez Del Palomar A, Doblaré M. Finite element analysis of the temporomandibular joint during lateral excursions of the mandible. J Biomech. 2006;39(12):2153-63.
  13. ↑ Dhissa NC, Gupta S. A Study of Range of Motion of Temporomandibular Joint in Adult Population of Western Uttar Pradesh. European Journal of Cardiovascular Medicine. 2025 May 30;15:847-51.
  14. ↑ Physical Therapy Education Solutions. Range of Motion: Temporomandibular (TMJ) Depression (opening). Available from: https://www.youtube.com/watch?p-a46uzIrcI [last accessed 24/01/2026]
  15. ↑ Physical Therapy Education Solutions. Range of Motion: Temporomandibular (TMJ) Protrusion. Available from: https://www.youtube.com/watch?fMoiJb6OSYU [last accessed 24/01/2026]
  16. ↑ Yıldız NT, Kocaman H, Yıldırım H, Canlı M. An investigation of machine learning algorithms for prediction of temporomandibular disorders by using clinical parameters. Medicine. 2024 Oct 11;103(41):e39912.
  17. ↑ Physical Therapy Education Solutions. Range of Motion: Temporomandibular (TMJ) Lateral Excursion. Available from: https://www.youtube.com/watch?brDxVYmgfsQ [last accessed 24/01/2026]
  18. ↑ Kayapınar İ, Usul M, Mazı İ, Rezafar Y, Mustafaoğlu R. Physiotherapy and Rehabilitation in Temporomandibular Joint Dysfunction. Bandırma Onyedi Eylül Üniversitesi Sağlık Bilimleri ve Araştırmaları Dergisi. 2025 Dec 12;7(3):998-1008.
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