Can TMJ Cause Shoulder Pain? The Jaw-Shoulder Connection

Temporomandibular joint disorders can indeed contribute to shoulder pain, and the connection is more direct than most people realize. In a cross-sectional survey of 186 people with TMJ disorders, more than half reported shoulder pain, and the severity of their jaw problems correlated with the severity of their shoulder complaints. The pathways linking these two seemingly distant body parts involve shared muscles, continuous sheets of connective tissue, changes in posture, and even shifts in how the nervous system processes pain signals.

How Common Is Shoulder Pain in People With TMJ Disorders

The overlap between jaw problems and shoulder pain is striking when you look at the numbers. A study of 186 individuals diagnosed with temporomandibular disorders (TMD) found that 56 percent reported shoulder pain, and 45 percent had already sought treatment for their shoulders at some point. The researchers also found a positive correlation between the severity of TMD symptoms and scores on a shoulder pain and disability questionnaire, meaning that worse jaw problems tended to come alongside worse shoulder problems.¹

A separate population-based study reinforced this pattern from a different angle. When researchers looked at people with clinical signs of TMD, they found that pain in the jaw muscles on palpation was associated with self-reported back, neck, and shoulder pain. The same was true for tenderness in the temporomandibular joint itself. These associations held up even after adjusting for confounding factors like age, sex, and general health status.²

These studies cannot prove that TMJ problems directly cause the shoulder pain. But the consistency of the association, combined with what we know about anatomy, makes a strong case that they are not just coincidental. Several distinct biological mechanisms help explain why pain in one region shows up in the other.

The Muscles That Link Your Jaw to Your Shoulder

Your jaw does not operate in isolation. Every time you clench, chew, or grind your teeth, muscles in your neck and shoulder girdle activate alongside the muscles that move your jaw. This is not a sign of dysfunction; it is just how the system is wired. The jaw needs a stable base to generate bite force, and the neck and shoulder muscles provide that anchor.

Research using electromyography, which records electrical activity in muscles, has documented this co-activation extensively. One study recorded what happens in the neck when healthy volunteers clenched their teeth at various intensities while lying down. The posterior neck muscles, including the trapezius and levator scapulae, contracted at levels between about 2 and 11 percent of their maximum capacity during jaw clenching. Different bite forces and bite directions produced different levels of neck muscle activation, showing that the two systems are functionally coupled.³

Another study examined this coupling during sleep bruxism, the involuntary grinding or clenching that happens at night. Researchers found significant coherence between the masseter muscle (the main chewing muscle in your cheek) and both the sternocleidomastoid and upper trapezius muscles during roughly 85 percent of bruxism episodes. In other words, when the jaw clenches during sleep, the neck and shoulder muscles fire too, almost every time.⁴ If you are grinding your teeth for hours overnight, your upper trapezius is working along with your jaw. Over weeks and months, that adds up to a significant amount of cumulative strain on the shoulder girdle.

The upper trapezius deserves special attention here because it is a muscle most people associate purely with shoulder and neck tension. It spans from the base of the skull and the spine down to the collarbone and shoulder blade. Research on maximum voluntary clenching in healthy young adults confirmed that the upper trapezius activates during hard biting tasks, reinforcing the idea that jaw activity directly loads the shoulder region.⁵

Connective Tissue That Runs From Jaw to Chest

Beyond the muscles themselves, a continuous web of connective tissue called fascia provides another physical link between the jaw and the shoulder. Fascia wraps around and between muscles, organs, and bones throughout the body, and in many areas it forms uninterrupted sheets that span multiple body regions.

The deep cervical fascia is one such sheet. Its superficial layer runs upward to become the fascia covering the masseter and temporalis muscles, the main chewing muscles on either side of your face. Running in the opposite direction, the same layer of fascia continues downward to merge with the fascia covering the pectoralis major and the latissimus dorsi, two large muscles of the chest and back that attach to the shoulder. A case report exploring this fascial continuum proposed that dysfunction or tightness in one part of this chain could transmit mechanical strain to distant regions, contributing to both jaw pain and pain in the shoulder and arm.⁶

The fascial connection is harder to study than the muscular connection because it does not produce clean electrical signals the way a contracting muscle does. But anatomically, the pathway exists: a continuous tissue highway from the side of the skull down through the neck and into the shoulder and chest. When tissues in one segment become restricted or inflamed, the mechanical pull can affect distant structures along the same fascial line.

Trigger Points and How Pain Travels

One of the more frustrating aspects of the jaw-shoulder connection is that the place where you feel pain is not always the place where the problem originates. Myofascial trigger points, those tight, tender knots within muscle fibers, are known to produce pain that radiates to other areas. The upper trapezius and sternocleidomastoid are particularly notorious for sending pain upward to the jaw, temple, and teeth. But the reverse also happens: trigger points in the jaw muscles can refer pain downward into the neck and shoulder.

A study of women with temporomandibular disorders found that the local and referred pain elicited from active trigger points in both the chewing muscles and the neck-shoulder muscles overlapped with the pattern of their spontaneous TMD pain. The researchers interpreted this as evidence that peripheral sensitization at the trigger point site and central sensitization in the nervous system both play a role in how myofascial TMD pain spreads.⁷ A separate analysis found that tenderness in the upper trapezius and sternocleidomastoid was strongly associated with increased severity of chronic dental and jaw pain, adding to the picture of these muscles as key players in how pain propagates between the jaw and shoulder region.⁸

This referral pattern is clinically important because it means a clinician who only examines the shoulder for shoulder pain, or only the jaw for jaw pain, may miss the true source of the problem. Trigger points in the suboccipital, trapezius, sternocleidomastoid, and temporalis muscles have all been implicated in referred pain patterns affecting the head, face, and neck.⁹

When the Nervous System Turns Up the Volume

In some people with chronic TMJ problems, the nervous system itself changes in ways that amplify pain across the body. This process, known as central sensitization, means the spinal cord and brain become more reactive to pain signals, lowering the threshold at which stimuli register as painful. A stimulus that would feel like mild pressure to a healthy person starts to feel genuinely painful.

A case-control study tested this directly by applying a pain-inducing stimulus to the forearm, well away from the jaw, in people with chronic TMD and in healthy controls. The area of secondary mechanical hyperalgesia, meaning the zone around the stimulus site that became sensitive to touch, was on average 76 percent larger in the chronic TMD group than in controls.¹⁰ The fact that this heightened sensitivity appeared in a limb, far from the trigeminal nerve that innervates the face, suggests that chronic TMD can shift the entire nervous system toward a state of generalized pain amplification. Once that happens, shoulder muscles that are already mechanically stressed by jaw clenching or poor posture become even more likely to produce noticeable pain.

Posture as the Common Thread

Forward head posture, where the head drifts in front of the body’s center of gravity, is remarkably common among people who work at desks, use smartphones, or spend long hours looking down. It is also one of the clearest links between TMJ problems and shoulder pain, because it affects both regions simultaneously.

When your head sits forward, the muscles at the back of the neck have to work harder to hold it up against gravity. The upper trapezius, which runs from the neck to the shoulder, takes on extra load. Research has confirmed this: subjects performing loaded shoulder movements with forward head posture showed significantly increased activity in both the upper and lower trapezius and decreased activity in the serratus anterior compared to a neutral head position.¹¹ Over time, this imbalance can lead to the stiff, sore shoulders that desk workers know well.

At the same time, forward head posture changes the resting position of the jaw. As the head moves forward and the neck extends to keep the eyes level, the mandible tends to retrude, shifting the bite and increasing strain on the temporomandibular joint. The muscles that stabilize the jaw compensate for this altered alignment, often with more clenching or asymmetric activity. So the same postural habit that overloads the shoulder also stresses the jaw, creating a self-reinforcing loop. Early research flagged video display terminal work as a risk factor for TMD precisely because of the combination of eyestrain, poor ergonomics, and sustained postural stress involved.¹²

Psychological stress compounds the problem. Sustained mental stress has been shown to produce prolonged low-level activation of the trapezius muscle, even when a person is not doing anything physically demanding. This mechanism, sometimes called the Cinderella hypothesis because the same low-threshold muscle fibers are always “on duty,” may help explain why stress-related shoulder pain and stress-related jaw clenching so often travel together.¹³

The Relationship Runs in Both Directions

An important nuance is that jaw dysfunction and neck-shoulder problems do not exist in a one-way cause-and-effect relationship. The influence runs both ways. People with neck problems develop jaw symptoms, and people with jaw problems develop neck and shoulder symptoms.

One study examined the correlation between jaw disability scores and neck disability scores in people with and without chronic TMD. The correlation was strikingly high, with a coefficient of 0.915, meaning the two disability measures moved almost in lockstep. About 82 percent of the variance in jaw disability was explained by neck disability. People with little jaw trouble also had little neck trouble, and those with severe jaw dysfunction also had severe neck dysfunction.¹⁴

This bidirectionality means that a persistent shoulder or neck problem you have not addressed could be feeding your jaw pain, and vice versa. It also helps explain why treatments that focus on only one area sometimes fall short. The system functions as a unit, and the entry point of the problem is often less important than the fact that the whole chain is involved.

Treatment That Addresses Both Regions

Given the tight functional link between the jaw and the neck-shoulder complex, it makes sense that treatments addressing both regions tend to outperform those targeting just one. A randomized controlled trial compared routine TMD care to a protocol that added manual therapy of the upper cervical spine and temporomandibular joint. The group receiving the combined approach showed significantly greater improvements in jaw pain, mouth opening range, and cervical flexion compared to the group that received standard care alone, with large effect sizes across all three outcomes.¹⁵

A systematic review and meta-analysis examining manual therapy and exercise for orofacial pain concluded that treatments targeting both the neck and jaw regions improved pain and pressure pain thresholds. Interestingly, manual therapy directed at the neck alone was also clinically relevant for jaw pain relief, further illustrating how intertwined these regions are.¹⁶

Occlusal splints, the custom-fitted mouthguards often prescribed for teeth grinding and TMD, have also shown downstream effects on the shoulder. A study of professional violinists, a group prone to both jaw and shoulder problems due to the demands of their instrument, found that wearing occlusal splints during performance significantly decreased muscle load in the masseter, temporalis, trapezius, and sternocleidomastoid muscles.¹⁷ In a follow-up on professional musicians with jaw dysfunction who were treated with oral splints, 76 percent reported a significant decrease in shoulder and upper extremity pain.¹⁸ While violinists represent a specific population, the principle holds: reducing strain at the jaw can measurably unload the shoulder.

Who Tends to Be More Affected

Certain groups appear more susceptible to the jaw-shoulder pain overlap. Women are disproportionately affected by TMD in general, and increased levels of estrogen have been identified as a biological factor affecting the temporomandibular joint, potentially influencing joint laxity and pain sensitivity.¹⁹ Since women also report higher rates of musculoskeletal pain more broadly, the overlap with shoulder symptoms may be even more pronounced in this group.

People with generalized joint hypermobility, sometimes referred to as hypermobility spectrum disorder or associated with conditions like Ehlers-Danlos syndrome, face a heightened risk for both TMJ and shoulder problems. A study comparing individuals with hypermobility joint syndrome to controls found that headache, neck and shoulder girdle pain, and TMJ pain were all more severe in the hypermobile group. Up to 37.5 percent of the hypermobile participants reported shoulder and neck pain at a moderate intensity level, compared to 75 percent of the control group reporting no pain at all.²⁰ Loose joints mean the muscles have to work harder to maintain stability everywhere, including the jaw and the shoulder blade, and the resulting fatigue and strain can drive pain in both areas.

Getting the Right Diagnosis

Because the jaw, neck, and shoulder share so many neural, muscular, and fascial connections, sorting out what is causing what can be genuinely difficult. An early clinical review of patients presenting with face, head, and neck pain found that headache was present in all patients, neck pain in about 83 percent, and ear pain in roughly 58 percent. Tenderness in the masseter muscle was strongly associated with tenderness in the sternocleidomastoid and with neck pain.²¹ The takeaway is that these symptoms travel in clusters, and a thorough evaluation should check for all of them even if you walked in complaining about only one.

If you have shoulder pain that has not responded to conventional shoulder-focused treatment, and you also experience any of the classic TMD signs like jaw clicking, difficulty opening your mouth wide, headaches, or ear pain, it is worth asking your provider to evaluate the jaw connection. Similarly, if you grind your teeth at night and have persistent shoulder knots, those two complaints may share a common root. A physical therapist or dentist experienced in TMD can assess jaw mechanics, neck mobility, and shoulder function together. Because the jaw-neck-shoulder system operates as an integrated unit, the most effective treatment plans are those that account for all three links in the chain rather than treating each complaint as if it exists in isolation.