Medial Pterygoid Trigger Points

Introduction

The medial pterygoid is a deep jaw muscle responsible for jaw closure, side-to-side movement, and TMJ stabilization. When trigger points develop in this muscle, they can cause jaw pain, difficulty chewing, and throat discomfort, often mimicking TMJ dysfunction, dental pain, or throat issues.

Name and Area

  • Name: Medial Pterygoid

  • Area: Located deep inside the jaw, running from the sphenoid bone and maxilla to the inner side of the mandible.

Indications

Medial pterygoid trigger points may contribute to:

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

  • Pain That Extends to the Ear and Neck (Can Mimic Ear Infections or Throat Tightness)

  • Jaw Stiffness or Tightness That Worsens with Chewing or Talking

  • Pain or Clicking When Moving the Jaw Side to Side

  • Difficulty Fully Opening the Mouth (Common in Those with TMJ Dysfunction or Teeth Grinding)

  • Pain That Increases with Stress, Clenching, or Poor Posture

Pain from this muscle is often mistaken for TMJ dysfunction, dental pain, or throat issues.

Muscle Action

  • Elevates the Jaw: Closes the mouth for chewing and biting.

  • Assists in Side-to-Side Jaw Movements: Helps with grinding and lateral jaw motion.

  • Supports the TMJ: Stabilizes the jaw during movement and speaking.

The medial pterygoid is essential for proper chewing, speaking, and TMJ function.

Signs and Symptoms

Individuals with medial pterygoid trigger points often report:

  • Pain in the Jaw and Near the Ear That Feels Like a Deep Ache

  • Pain That Extends to the Neck or Throat (Can Mimic a Sore Throat or Swollen Lymph Nodes)

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

  • Clicking, Popping, or Pain When Moving the Jaw Side to Side

  • Pain or Discomfort While Eating Tough Foods, Chewing Gum, or Talking for Long Periods

  • Throat Tightness That Worsens with Stress or Anxiety

Pain worsens with excessive chewing, teeth clenching, stress, or prolonged speaking.

Perpetuating Factors

Common causes of medial pterygoid trigger points include:

  • Chronic Teeth Clenching or Grinding (Bruxism, Often Due to Stress or Anxiety)

  • Excessive Talking or Singing (Overuse of the Jaw Muscles)

  • Frequent Chewing of Gum or Hard Foods (Increases Muscle Strain in the TMJ Area)

  • Forward Head Posture (Places Extra Strain on the TMJ and Jaw Muscles)

  • Dental Procedures That Require Holding the Mouth Open for Long Periods

Trigger Point Referral Pattern

Trigger points in the medial pterygoid refer pain to:

  • The jaw and TMJ (Mistaken for TMJ Dysfunction or Dental Issues)

  • The ear and side of the face (Can Mimic Ear Infections or Sinus Pressure)

  • The neck and throat (Mistaken for Swollen Lymph Nodes or Throat Infections)

Pain from this muscle is often confused with dental problems, throat infections, or TMJ disorders.

Differential Diagnosis

Medial pterygoid trigger points may be mistaken for:

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

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

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

  • Throat Infections (Pain and Tightness in the Throat, Often Without Signs of Infection)

  • Cervical Spine Dysfunction (Neck Pain That Can Refer to the Jaw and TMJ Area)

A thorough jaw, throat, and TMJ examination is necessary to rule out these conditions.

Associated Trigger Points

Medial pterygoid trigger points often co-exist with:

  • Masseter (Cheek and Jaw Pain, Common in Teeth Clenchers and TMJ Sufferers)

  • Lateral Pterygoid (Inner Jaw and Ear Pain, Affects Jaw Opening and TMJ Function)

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

  • Temporalis (Temple and Head Pain, Can Resemble Tension Headaches or Migraines)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Medial Pterygoid Medial surface of lateral pterygoid plate, maxillary tuberosity Inner surface of mandible (near the angle) Mandibular branch of the trigeminal nerve (CN V3)

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

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules inside the jaw, near the TMJ and throat.

  • 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 medial pterygoid, reducing jaw tightness and improving TMJ function.

Manual Therapy

  • Trigger Point Release: Apply gentle sustained pressure inside the jaw 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 medial 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 Medial Pterygoid Overuse)

Conclusion

The medial pterygoid plays a crucial role in jaw movement, TMJ function, and chewing, but trigger points in this muscle can cause significant jaw pain, headaches, and throat discomfort. 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

➡️ Explore our Trigger Point Index

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.