We use our jaw joints anywhere from 1500 to 2000 times a day, for things we take for granted such as chewing, swallowing, talking, yawning and sneezing.

The hinge between the skull and lower jawbone is known as the temporomandibular joint (TMJ) and every time any of the above functions are performed a disk in the joint slides between the two bones and allows the jaw to move.

The joint's constant use and complex structure make it a prime candidate for problems and a source of pain for approximately ten million people of all ages.

TMJ dysfunction can cause a variety of symptoms, including: pain in or around the ear and/or face headaches sore jaw muscles clicking or popping sounds when the jaw is opened or closed difficulty opening the mouth temporary (and sometimes permanent) locking or sticking of the jaw pain when chewing, yawning or opening the mouth wide head, neck and shoulder pain which can vary from dull and nagging to acute.

Physiotherapist Shirlene Dill has been seeing patients with the disorder and, like a dentist, she goes inside the mouth to provide relief for the pain and discomfort. Dentists have recommended patients with the disorder to her.

"TMJ is a very complex syndrome, it involves the only bilateral joint in the body, near the ears, and can create a vast array of symptoms throughout the entire body,'' explained Mrs. Dill.

"If the TMJ is not functioning as it should mechanically, it can create neck pain, back pain and shoulder pain and can literally go throughout the whole body.

"One case that I saw when I was first exposed to TMJ was when I worked at the University of Pennsylvania Hospital in Philadelphia and there was a lady who had extreme head and neck pain and upper back pain to the point where she could hardly move. She could barely open her mouth to speak and couldn't get a fork in her mouth and had the classical symptoms of salty and copper taste in the mouth.

"Some of the ones I have seen here haven't been quite as involved. I've had some who have had mouth and jaws involved, some who have had shoulder and/or neck problems and back problems. I have had some who have the inability to speak properly whereby they talked with their lips almost closed.'' Pauline Mackowiak, a physical therapist, writer and teacher, has written a book about the TMJ and its connection to all kinds of pain, including headaches.

It is conservatively estimated that ten million people in the United States have TMJ, a large majority of them (75 per cent) being women between the ages of 20 and 50. However, there has been an increase in the incidence among men and children.

In Ms. Mackowiak's book "Relief of Pain From Headaches and TMJ'', Dr. Harold Gelb, a leading specialist in the area of TMJ, proposes that the condition is a primary initiating factor in 80 per cent of all chronic pain disorders and that one third of the population presently has some medical condition which is aggravated by a jaw imbalance.

"I had a young girl who had back pain for years and years, since she was in her early teens, and had been to all kinds of people for help and they treated her back which never got better,'' explained Mrs. Dill.

"She came to me and I listened to her history and she had some trauma when she was in primary school. She was playing netball and was much taller than the other children and another child's head hit her in her mouth, knocked out her teeth and she had jaw surgery to replace her teeth.

"I think that started her back pain and when she came to see me I didn't even touch her back, I worked inside her mouth, along her gum line and the muscles inside her mouth and from that first treatment her back pain went away.'' Mrs. Dill says neck pain is commonly associated with TMJ.

"I get some patients who come to me for neck pain and if they don't seem to make any improvements in the first two or three treatments, then I immediately start to think TMJ,'' said Mrs. Dill.

"I'll ask them if they clench their teeth and a lot of times they do. They either do it while they are sleeping or as a stress response if they are working with deadlines.

"When you clench it's a major cause of TMJ problems, it creates a lot of tension on the muscles inside your mouth, the medial pterygoid and masseter muscles in particular. Because of the muscle attachments to the jaw it pulls the jaw forward and when that happens it create a lot of neck tension.'' Mrs. Dill puts her fingers inside the patient's mouth to perform the myofascial release technique. The procedure is designed to specifically affect the fascia of the body by releasing the restrictions that form three dimensionally due to trauma or inflammation, thus restoring the muscular and fascial system to normal.

"I put my finger on the muscle and wait for it to soften,'' she explained.

"Sometimes I stroke it until it softens and most of the time that one thing creates the biggest relief for them.'' Mrs. Dill provides exercises for the patients to do on their own to stabalise or stretch their jaw if they have an opening problem.

"I haven't seen that many opening problems here, most of them have an instability problem just because they are clenchers,'' she revealed.

"Sometimes they will clench or grind at night and they are not aware of it.

In some patients it causes them to breath differently at night and they will snore. But their spouses will start noticing when they get better.'' Added Mrs. Dill: "I have an orthodontist who refers to me quite regularly, normally refers teenage girls who are having orthodontic work done.

"I have another Dentist who sends to me if she can't perform her dental work because of it, like they can't open their mouth or have too much pain and she is not sure if it is purely dentistry or TMJ.'' According to the National Institute of Dental Research, there is actually more than one type of TMJ disorder. They fall into three main categories: Myofascial pain: The most common form. Discomfort or pain in the muscles that control the jaw as well as the neck and shoulder muscles.

Internal derangement of the joint: A dislocated jaw or displaced disc, or injury to the condyle.

Degenerative joint disease: Osteoarthritis or rheumatoid arthritis in the jaw joint.

You can have more than one of those conditions at the same time.

Mrs. Dill was first introduced to TMJ in 1987 when the Dentistry Association here had a TMJ Symposium and she and another Physiotherapist attended.

"John Barnes (an American Physiotherapist who refined the myofascial release technique) was a lecturer there and what he had to say made so much sense,'' said Mrs. Dill.

"Later, when I could afford to, I went on and did all of the courses he has offered to date. That's where I'm going this week, again.'' Tuesday: In the final part of the series on Physiotherapy Month, Osteoporosis is explored.