Jaw Surgery Diet
Physical therapy

TMJ exercises & rehabilitation reference

Movement is a central part of TMJ recovery — it restores range of motion, retrains coordination, and helps prevent severe scar tissue. This page is a reference for the exercise programs your surgeon or physical therapist may prescribe, so you can recognise the technique and understand why the dosing matters.

⚠
Do only the exercises your own clinician has prescribed, at the dose they gave you. TMJ exercise selection is diagnosis-specific: an exercise that helps one presentation can worsen another. Nothing here is a substitute for assessment, and starting jaw exercises after surgery requires your surgeon's clearance.
On this page
  1. Core principles
  2. About the exercise videos
  3. Stage I post-operative exercises
  4. Stage II post-operative exercises
  5. The Rocabado 6×6 protocol →
  6. Symptom reference
  7. Three common mistakes
  8. Exercise library by category
  9. Why selection is diagnosis-specific
  10. Exercise, chewing & your diet stage

Core principles

About the exercise videos

Written instructions only go so far with jaw movement — whether your tongue stays anchored, whether the jaw tracks straight, and how far "to tension" actually is are all much easier to judge by watching. Each exercise below has a video slot reserved for a short demonstration.

Every exercise is being filmed as a pair of clips, because the two questions patients ask are different:

1How to do it

Step-by-step performance: the anchor position, where to place your fingers, the movement itself, and the dosing — filmed close-up so tongue and jaw position are actually visible.

2What not to do

The common technique errors demonstrated deliberately, so you can recognise them in yourself — over-opening, uneven tracking, and finishing in a clench.

Clips are short, captioned, and filmed front-on or in profile depending on what needs to be seen — the framing note under each slot says which. Timed exercises carry an on-screen countdown so you can follow the hold without watching a clock.

ⓘ
An original animated diagram of the 6×6 hinge and its timing is in that section below. Our own per-exercise videos are in production and will appear in the slots on this page as they're released — technique, indications, and dosing are being clinically reviewed before publication. Until then, follow the program your own clinician gave you.

Post-operative exercise stages

Stage I re-establishes gentle, controlled movement early after surgery; Stage II builds back toward normal range; the Rocabado 6×6 is a separate low-repetition protocol your clinician may prescribe instead. Move between them with the tabs below — your surgeon decides which stage you are on.

Stage I dosing

Three times per day, 20 repetitions each. Slowly and comfortably, to the point of tension and slight discomfort — never so strongly as to cause sharp pain.

1
Vertical opening

Tuck your tongue onto the roof of the mouth into the "punching bag" position. Open to one fingerbreadth, or as far as is comfortable without disengaging your tongue from the roof of your mouth.

▸ Video coming soonFront-facing close-up — tongue stays anchored to the palate; watch that opening stays symmetrical.
2
Right lateral movement

Move the jaw to the right side until the canine teeth line up, or your dental midline moves one tooth to the right.

▸ Video coming soonFront-facing close-up — midline reference marked on screen to show one-tooth travel.
3
Left lateral movement

The same as the right lateral movement, with the movement to the left.

▸ Video coming soonFront-facing close-up — mirror of the right excursion.
4
Protrusion (jaw forward)

Bring the lower jaw forward until the lower teeth line up with the upper teeth. If your bite already has the lower teeth lined up with the uppers, move the lower jaw forward 3–4 millimetres.

▸ Video coming soonProfile view — shows the lower teeth travelling forward to meet the uppers.
5
Isometrics in neutral

Touch the tongue to the roof of the mouth in the "punching bag" position with the teeth slightly apart. Using your hand, gently resist the muscles that open the jaw, close the jaw, move it to the right, move it to the left, and protrude it.

Key point: you are resisting the muscles themselves — the jaw should not actually move.
▸ Video coming soonFront-facing — hand placement for each of the five directions; emphasise zero jaw movement.
Stage II dosing

Three times per day, 20 repetitions each. Light stretch only — never a sharp or "ripping" sensation. Begin only when instructed by your doctor.

The goal is a range of motion approaching normal function — typically 35–40 mm of opening, or at least a two-knuckle-breadth distance. The three vertical-opening techniques are ordered by intensity of stretch.

1
Vertical opening A — contract & relax

Open your mouth as far as you comfortably can. Using your hand, try to resist opening and closing. Then try to open a little further. Repeat.

▸ Video coming soonFront-facing close-up — hand resisting open and close, then the extra opening.
2
Vertical opening B — hook & pull

Hook your index finger around your chin, open as wide as you can, then give a gentle downward pull with the finger. Repeat.

▸ Video coming soonProfile close-up — index finger hooked at the chin, gentle downward direction of pull.
3
Vertical opening C — pry bar

Place the pad of your thumb on the cutting edge of your upper front teeth and the pad of your middle finger on the cutting edge of your lower front teeth. Gently pry your mouth open until you feel resistance without pain, then open slightly further to the point of discomfort. Hold for a count of two, then release back to the opening you had before resistance was met.

Most intense of the three opening techniques — light stretch only, never a sharp or "ripping" sensation.
▸ Video coming soonProfile close-up — thumb and middle finger placement on the incisal edges; hold for two, then release.
4
Assisted lateral excursion

To assist movement to the left, place your right thumb on the upper left teeth on the cheek side and your left index finger on the lower right teeth on the cheek side. Squeeze the fingers together to move the jaw to the left, keeping the jaw slightly open. Hold for a count of two and relax. Switch hands and repeat toward the other side.

▸ Video coming soonFront-facing — cross-hand placement on upper and lower cheek-side teeth, jaw slightly open.
5
Protrusion — forward glide

Move your jaw forward as far as you comfortably can, bringing the lower teeth past the upper teeth position. Aim to move the lower teeth 3–4 millimetres past the uppers.

▸ Video coming soonProfile view — on-screen scale showing the 3–4 mm target past the uppers.
Why 6×6

Conventional high-repetition dosing can trigger muscle spasm in the jaw. This protocol uses low repetitions at high frequency to reprogram jaw tracking without fatiguing the muscles.

6×
per day
6
reps per set
6 s
hold
6 s
rest between
PROFILE VIEW palate tongue anchor joint fingertips here HOLD REST 6 SEC
Exercise 1 · original diagram
The goldfish hinge
The jaw rotates about the joint while the tongue stays fixed to the palate. Open only as far as the anchor holds — if the tongue peels away, you have gone too far.
Tongue anchor — must not move
Lower jaw — rotates down
Joint — rest your fingertips here
An original schematic, not a patient demonstration. It shows the mechanics and the 6-second hold / 6-second rest timing only. It cannot show whether your jaw tracks straight or how far your own safe range extends — that needs your clinician. Filmed demonstrations with a clinician are in production.
1
Controlled vertical opening — the "goldfish" hinge

Setup. Click your tongue against the palate, then rest the tip flat against the fleshy ridge behind your upper teeth — without pushing against the teeth themselves. Movement. Rest your index fingers gently over the jaw joints, just in front of your ears, to monitor symmetry. Drop the lower jaw straight down, slowly. Dosing. Hold open 6 seconds, return to relaxed closed (teeth slightly apart), repeat 6 times.

Constraint: open only as wide as you can without the tongue peeling off the roof of your mouth, and don’t let the joint click or pop. The tongue is your safety brake.
▸ Video coming soonFront-view for lateral deviation, plus a 6-second countdown ring. Audio cue: the tongue cluck.
2
Tongue resting position & nasal breathing

Keep the tongue tip gently suctioned to the roof of the mouth with the lips lightly sealed but the teeth entirely apart. Breathe purely through the nose, which reduces active tension in the accessory neck and jaw muscles.

▸ Video coming soonTight close-up — lips lightly sealed, teeth apart; graphic showing nasal breathing.
3
Rhythmic stabilisation (isometrics)

Maintain the tongue resting position. Place an index finger on the side of your chin and apply extremely gentle sideways pressure while your jaw muscles resist — with zero visible movement. Hold 6 seconds, then switch sides, and repeat forward and backward.

▸ Video coming soonFront-facing — finger at the side of the chin; caption reinforcing zero visible movement.
4
Cervical axial extension — the "chin tuck"

Look straight ahead. Imagine a string pulling the crown of your head upward as you glide your head straight back, creating a subtle "double chin". This decompresses the upper cervical spine, which directly reduces protective TMJ guarding. Hold 6 seconds.

▸ Video coming soonTight profile close-up to showcase alignment, with a 6-second countdown ring.

If you are used to 20 repetitions at a time this will feel like very little work — that is the point. With the 6×6 rule the frequency does the retraining, not the effort.

Symptom reference — orthognathic & TMJ

What to expect after jaw or joint surgery, what helps, and what should prompt a call. Filter by stage — the third group is the red-flag list.

Swelling, bruising & facial tightnessExpected in the first days

What helpsIce in the first 48–72 hours, and sleep with your head above the level of your heart so fluid drains away from the site. Serve food just warm — heat increases swelling.

Jaw stiffness & fatigueThe joint tires quickly early on

What helpsSmaller portions and smaller bites; jaw fatigue is a stop signal, not something to push through. Moist heat before gentle stretching helps persistent stiffness.

Numbness of the face, ear, scalp or jawCommon after surgery

What helpsUsually improves gradually as nerves recover, though some people have lasting changes in sensation. Report sudden or worsening numbness.

Ear fullness, pressure or poppingThe joints sit immediately in front of the ears

What helpsNormally settles as swelling resolves, since surgery affects nearby muscles and tissue. Severe ear pain, drainage, or sudden hearing change needs review.

ConstipationPain medication, low activity, dehydration and a changed diet

What helpsFluids, adequate fibre as tolerated, staying as active as recommended, and stool softeners as directed. Call your provider if it becomes severe or persistent.

A bite that feels differentTeeth meeting in a new way

What helpsOften a normal part of adapting to a new jaw position and healing tissue. Raise it with your surgeon — a sudden change is different and should be reported promptly.

Reduced mouth opening (trismus)Range of motion is limited

What helpsThis is what the exercise stages address. Work the opening and stretching program your clinician prescribed — consistency over weeks matters more than intensity in a session.

Clicking or popping during exerciseA sign the technique needs adjusting

What helpsStop and check the three common mistakes below — most clicking during the tongue-on-roof work comes from opening too wide or losing the tongue anchor.

Muscle pain in the cheek or templeMasseter and temporalis tension, not the joint itself

What helpsSelf-massage of the masseter and temporalis, plus relaxation and jaw-awareness work. See the Relaxation and Soft tissue categories in the library below.

ScarringIncisions are required, so scars are expected

What helpsMost fade over time. Ask your surgeon for incision care and scar management instructions; silicone gel with SPF is commonly recommended once healed.

Quiet weight lossEating has become slow and tiring

What helpsTrack it with the weight tracker — more than about 5% below your starting weight is a signal to contact your team. Include a protein source in every meal, even on a limited texture.

FeverPossible infection

What helpsContact your surgeon promptly. Infection is uncommon after joint replacement but is one of the most serious complications.

Pain that increases rather than eases after the first few daysNot the normal healing pattern

What helpsContact your surgeon promptly.

Increasing redness, warmth, swelling or drainageSigns of infection at the site

What helpsContact your surgeon promptly.

Foul taste or dischargePossible infection

What helpsContact your surgeon promptly.

Bleeding that will not stopNeeds assessment

What helpsContact your surgeon promptly.

A sudden change in how your teeth meetDifferent from gradual adaptation

What helpsContact your surgeon promptly.

Severe ear pain or sudden hearing changeNeeds assessment

What helpsContact your surgeon promptly.

Unable to keep fluids downRisk of dehydration

What helpsContact your surgeon promptly.

Jaw locking, or sharp pain during an exerciseThe exercise should be completely pain-free

What helpsStop immediately and contact your surgeon or physical therapist before continuing.

⚠
Anything in the Contact your surgeon group above warrants a prompt call rather than waiting for your next appointment. This reference is general education — your surgeon's own post-operative instructions always take precedence.

Three common mistakes

Still clicking or aching while doing the tongue-on-roof exercise? These are the errors that most often explain it.

1. Over-opening

If your tongue peels away or flips backward just to get your mouth wider, you have gone too far. The tongue is the safety brake — once it detaches you lose control and risk compressing the joint.

2. Ignoring the zig-zag

Watch yourself in a mirror. If your jaw tracks left or right as you open, your muscles are pulling unevenly. Use your fingers on the joints to guide the jaw straight down, like a train on a track.

3. The clench finish

When you close at the end of a repetition, your teeth should never slam or bite down hard. Stop just before the teeth touch and keep the masseter muscles relaxed.

⚠
These exercises should be completely pain-free. If you feel sharp pain or clicking, or your jaw locks, stop immediately and talk to your physical therapist about modifying your range.

Exercise library by category

The full range of exercises a TMJ physical therapy program may draw on. Filter by category to find where a prescribed exercise fits — this is a reference, not a menu to self-select from.

Pick a category above to see its exercises.

Resting jaw positionReduce jaw tension / build awareness

HowLet the jaw hang so the teeth are slightly apart, lips together, muscles slack. Check in through the day — if your teeth are touching, you are holding tension.

Selected forBroad self-management

Tongue-up resting positionRelaxation / positioning

HowRest the tongue tip lightly on the ridge behind your upper front teeth, lips closed, teeth apart, breathing through the nose. Do not press the tongue into the teeth.

Selected forBroad self-management

Controlled jaw opening — tongue-upMotor control

HowHold the tongue to the palate and open only as far as that contact holds, then close slowly. The tongue is the limit — not how wide you can get.

Selected forTMD pain; coordination

Controlled jaw opening — mirror-guidedStraight opening path

HowFace a mirror and open slowly, watching your chin against the midline of your nose. If it drifts sideways, close and repeat with a smaller opening that stays straight.

Selected forOnly when the jaw deviates on opening

Combined tongue-up + mirrorMotor control with visual feedback

HowDo the tongue-up opening while watching in a mirror, so you control the limit and the path at the same time.

Selected forSelected patients

N-stretch / coordination trainingJaw alignment & coordination

HowOpen, then guide the jaw along a straight path as you close — this retrains alignment through the closing phase rather than the opening one.

Selected forMay benefit TMD pain of any type

Active openingMaintain / improve range of motion

HowOpen the mouth slowly and comfortably using your own muscles only — no hands — then close. Stop at tension.

Selected forSelected restricted-motion presentations

Static opening stretchIncrease restricted opening

HowOpen to a light stretch and hold there for the time your clinician set, letting the tissue lengthen. A sustained hold, not a repeated pumping motion.

Selected forReduced mouth opening only — not for normal opening

Lateral excursion, right & leftMobility / coordination

HowWith the teeth slightly apart, slide the lower jaw sideways to one side, return to centre, then to the other side. Keep it level, without opening.

Selected forSelected patients

ProtrusionMobility / coordination

HowWith the teeth slightly apart, glide the lower jaw straight forward, then back. Keep it level — no opening or sideways drift.

Selected forSelected patients

Lateral mobilisation with cotton rollJoint mobilisation

HowA clinician-directed technique: a cotton roll is placed between the back teeth on one side and used as a fulcrum while you bite gently, creating space in the opposite joint. Not to be improvised at home.

Selected forFormally diagnosed disc displacement with reduction, plus limited opening — clinician-guided

Isometric openingMuscle strengthening / stabilisation

HowPlace a fist or fingers under the chin and press gently upward while you try to open. Resist so that nothing actually moves; hold, then relax.

Selected forMuscular TMD

Isometric lateral movementMuscle strengthening / stabilisation

HowPlace a hand against the side of the jaw and push gently while you resist sideways movement. No visible movement — hold, relax, then switch sides.

Selected forMuscular TMD

Isometric opening + protrusionDiagnosis-specific strengthening

HowHold the jaw slightly forward and slightly open, then resist gentle backward pressure at the chin so the muscles work without the joint travelling.

Selected forDisc displacement with reduction only

Chin tuck / cervical retractionHead & neck positioning

HowLook straight ahead and glide the head straight back, making a subtle double chin, without tipping the nose down. Hold, then release.

Selected forCervical or postural contribution

Supine cranio-cervical flexion (gentle nod)Deep neck-flexor control

HowLie on your back with the head supported and nod gently, as if saying yes using only the top of the neck. A small movement — do not lift the head off the surface.

Selected forCervical motor-control deficits

Deep neck-flexor progressionCervical stabilisation

HowThe supine nod held for longer, or with a light head-lift added as your therapist advances you. Stop the moment the small nodding muscles hand over to the big surface ones.

Selected forSelected patients — progression PT-reviewed

Isometric cervical flexion, extension, side-bend & rotationNeck strength / stability

HowPlace a hand on the forehead, the back of the head, the side of the head, or the temple, and press gently while resisting so the head does not move. Hold, relax, and repeat in each direction.

Selected forSelected patients

Scapular retractionPostural control

HowDraw the shoulder blades gently back and slightly down, as if sliding them into your back pockets. Hold, then release — without shrugging up.

Selected forPostural / upper-quarter contribution

Wall posture / alignment, wall angelsPostural awareness; thoracic & scapular control

HowStand with your back, head and arms touching a wall to feel neutral alignment. For wall angels, slide the arms slowly up and down while keeping that contact.

Selected forSelected patients — screen shoulder limits

Thoracic extensionThoracic mobility

HowWith a chair back or foam roller supporting your mid-back, ease the upper back gently backwards into extension. Keep the low back still and do not force it.

Selected forSelected patients

Doorway pectoral stretchAnterior chest mobility

HowRest a forearm on a doorframe at about shoulder height and step gently forward until you feel a stretch across the chest. Hold; never force the shoulder.

Selected forSelected patients — shoulder precautions

Upper trapezius & levator scapulae stretchCervical / scapular mobility

HowSitting tall: tilt the ear toward the shoulder for the trapezius; for the levator, turn the head slightly away from that side and look down. Gentle holds only.

Selected forSelected patients — gentle technique

Gentle cervical rotation & side-bendingNeck mobility

HowSlowly turn the head to look over one shoulder, then the other; then tilt the ear toward each shoulder. Small, comfortable range — stop with any dizziness.

Selected forSelected patients — dizziness & neurologic precautions

Diaphragmatic breathing with relaxed jawRelaxation / down-regulation

HowHand on the belly, breathe in slowly through the nose so the belly rises rather than the chest, jaw slack and teeth apart. Breathe out for longer than you breathed in.

Selected forBroad self-management

Relaxed jaw / gentle jaw-dropReduce guarding & tension

HowLet the jaw fall open slightly under its own weight and simply stay there — teeth apart, tongue and lips soft. Do not hold it open with muscle.

Selected forSelected patients — teeth stay apart

Progressive jaw & facial relaxationAwareness / relaxation

HowWork through the face in turn — forehead, eyes, cheeks, jaw, tongue — tensing each gently for a few seconds, then releasing completely.

Selected forBroad self-management

Masseter self-massageMuscle tension & discomfort

HowFind the muscle at the angle of the jaw — it bulges when you clench — then make small circles with your fingertips at comfortable pressure while the jaw stays relaxed.

Selected forMuscle pain / tension

Temporalis self-massageMuscle tension & discomfort

HowMassage the flat fan of muscle at the temple, above and in front of the ear, with small circles, working upward and back across the area.

Selected forMuscle pain / tension

Suboccipital relaxationCervical tension

HowLying down, rest the base of the skull on your fingertips or a small soft ball and let the weight of the head sink in for about a minute, breathing slowly.

Selected forSelected patients

Gentle SCM self-releaseCervical muscle tension

HowTurn the head slightly to find the rope-like muscle at the side of the neck, hold it lightly between thumb and fingers, and use very light pressure. Never press into the front of the throat.

Selected forSelected patients — careful technique near anterior neck structures

Why selection is diagnosis-specific

Published TMD programs deliberately separate exercises that are broadly useful for self-management from those that only suit a specific presentation. Some concrete examples of that distinction:

This is why "which exercises should I do?" is a question for your clinician, and why copying a program from someone else with TMJ pain can make things worse rather than better.

⚠
Newcastle Hospitals NHS Foundation Trust publishes a patient-facing facial pain and TMD program that maintains this diagnostic specificity: newcastle-hospitals.nhs.uk/services/facial-pain. Techniques and dosing there should still be reviewed with your own clinician before you adopt them.

Exercise, chewing & your diet stage

Rehabilitation and diet progression run in parallel, and they interact:

Ice, heat, and head elevation all fit alongside this work — follow the timing and duration your surgeon and physical therapist gave you.

Eat well while you rehabilitate

Every recipe in our library is graded on the IDDSI framework, so you can filter to the texture you've been cleared for and hit your protein targets without guesswork.

Browse recipes by IDDSI level →
This page is general education, not medical advice, and is not a substitute for assessment by a qualified clinician. Exercise programs, techniques, and dosing shown here are summaries of published patient materials and protocols; your surgeon and physical therapist decide which are appropriate for you, when to begin, and how much to do. Stop any exercise that causes sharp pain, clicking, or locking, and contact your care team.