Lateral Pterygoid Trigger Points

Introduction

The lateral pterygoid is a key jaw muscle responsible for jaw movement, stabilization, and chewing. When trigger points develop in this muscle, they can cause jaw pain, clicking, and difficulty opening the mouth, often mimicking TMJ dysfunction, ear pain, or headaches.

Name and Area

  • Name: Lateral Pterygoid

  • Area: Located deep inside the jaw, running from the sphenoid bone to the condyle of the mandible and TMJ disc.

Indications

Lateral pterygoid trigger points may contribute to:

  • Pain in the Jaw and Near the Ear (Mistaken for TMJ Dysfunction or Ear Infections)

  • Pain That Radiates to the Temple or Cheek (Can Mimic Tension Headaches or Sinus Pain)

  • Clicking or Popping in the Jaw When Opening or Closing the Mouth

  • Pain or Locking When Trying to Open the Mouth Fully

  • Difficulty Chewing or Speaking for Long Periods

  • Pain That Worsens with Stress, Clenching, or Teeth Grinding (Bruxism)

Pain from this muscle is often mistaken for TMJ dysfunction, headaches, or inner ear issues.

Muscle Action

  • Protracts the Jaw: Moves the jaw forward.

  • Assists in Jaw Opening: Helps lower the mandible.

  • Aids in Lateral Jaw Movements: Important for chewing and grinding food.

The lateral pterygoid is crucial for TMJ function, chewing, and jaw alignment.

Signs and Symptoms

Individuals with lateral pterygoid trigger points often report:

  • Jaw Pain That Worsens with Talking, Chewing, or Clenching

  • Clicking or Popping in the TMJ (Often Mistaken for TMJ Dysfunction)

  • Pain That Radiates to the Ear or Temple (Can Feel Like an Ear Infection or Tension Headache)

  • Difficulty Fully Opening the Mouth (May Feel "Locked")

  • Pain When Eating Tough Foods (Chewy Meat, Hard Bread, Gum, etc.)

  • Increased Jaw Tension During Stress or Anxiety

Pain worsens with prolonged talking, chewing, stress, or poor posture.

Perpetuating Factors

Common causes of lateral pterygoid trigger points include:

  • Chronic Teeth Clenching or Grinding (Bruxism, Often During Sleep or Stressful Situations)

  • Poor Posture (Forward Head Posture Increases Jaw Strain)

  • Overuse From Chewing Gum, Nail Biting, or Hard Foods

  • Frequent Yawning or Excessive Mouth Opening (Dental Procedures, Singing, or Yawning Repeatedly)

  • Jaw Imbalances or TMJ Misalignment (Can Lead to Overuse of the Lateral Pterygoid)

Trigger Point Referral Pattern

Trigger points in the lateral pterygoid refer pain to:

  • The jaw joint and ear (Can Mimic Ear Infections or TMJ Dysfunction)

  • The temples and forehead (Mistaken for Tension Headaches or Migraines)

  • The cheek and upper teeth (Can Resemble Sinus Pressure or Dental Pain)

Pain from this muscle is often confused with TMJ dysfunction, tension headaches, or ear infections.

Differential Diagnosis

Lateral pterygoid trigger points may be mistaken for:

  • TMJ Dysfunction (Pain, Clicking, and Limited Jaw Movement, Common in Clenchers and Bruxers)

  • Ear Infections (Otitis Media – Pain and Fullness in the Ear Without Infection Present)

  • Tension Headaches (Pain in the Temples That Worsens with Stress or Jaw Tension)

  • Sinus Infections (Facial Pain or Pressure, Often Misdiagnosed When Jaw-Related Pain Refers to the Sinus Area)

  • Trigeminal Neuralgia (Sharp, Shooting Facial Pain That Can Resemble Nerve Compression)

A thorough jaw, neck, and dental assessment is necessary to rule out these conditions.

Associated Trigger Points

Lateral pterygoid trigger points often co-exist with:

  • Masseter (Cheek and Jaw Pain, Can Lead to Teeth Clenching and TMJ Issues)

  • Temporalis (Temple and Head Pain, Contributes to Tension Headaches)

  • Medial Pterygoid (Inner Jaw and Throat Pain, Affects Chewing and Jaw Opening)

  • Sternocleidomastoid (SCM) (Neck and Jaw Pain, Can Mimic Ear and Sinus Pain)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Lateral Pterygoid (Superior Head) Greater wing of sphenoid TMJ disc and capsule Mandibular branch of the trigeminal nerve (CN V3)
Lateral Pterygoid (Inferior Head) Lateral pterygoid plate Neck of mandible (pterygoid fossa) Mandibular branch of the trigeminal nerve (CN V3)

The lateral pterygoid is innervated by the mandibular nerve (CN V3), which also controls jaw movement and chewing.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the jaw joint and inner cheek.

  • Jaw Mobility Testing: Assess pain or tightness when opening and closing the mouth.

  • TMJ Function Testing: Look for clicking, popping, or locking symptoms.

  • Postural Assessment: Rule out forward head posture, which increases jaw strain.

Corrective Actions

Dry Needling

  • Dry needling can release trigger points in the lateral pterygoid, reducing jaw tightness and improving TMJ function.

Manual Therapy

  • Trigger Point Release: Apply gentle sustained pressure inside the cheek and near the TMJ.

  • Myofascial Release: Massage techniques to loosen tight jaw muscles and reduce facial tension.

Stretching

  • Jaw Relaxation Stretch: Open the mouth slightly and move the jaw side to side to release tightness.

  • Neck and Posture Stretch: Helps reduce compensatory strain on the jaw from poor head posture.

Strengthening Exercises

  • Controlled Jaw Opening Drills: Improves jaw mobility and reduces excessive tension in the lateral pterygoid.

  • Tongue to Roof of Mouth Exercises: Encourages proper jaw alignment and reduces clenching.

Postural and Behavioral Adjustments

  • Avoid excessive jaw clenching or grinding (use a night guard if necessary)

  • Maintain good head and neck posture (reduces jaw strain and TMJ overuse)

  • Limit excessive talking, chewing gum, or nail biting (prevents lateral pterygoid overuse)

Conclusion

The lateral pterygoid plays a crucial role in jaw movement, TMJ function, and chewing, but trigger points in this muscle can cause significant jaw, ear, and headache pain. By incorporating dry needling, manual therapy, stretching, and relaxation techniques, individuals can reduce pain, improve mobility, and prevent TMJ dysfunction.

➡️ Learn more about Trigger Points

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.