In this episode of Unclenched, Dr. Priya Mistry and Dr. Alexandra George welcome special guest Dr. Emily Iverson, a Postural Restoration Institute (PRI)–certified physical therapist with deep experience in craniosacral therapy, breathing mechanics, and neuro-optometry.
If you’ve ever wondered how posture, breathing, vision, and even birth trauma can influence TMJ symptoms, this conversation connects all the dots.
Why TMJ Treatment Sometimes Needs a Team
Dr. Alex opens with a patient story that perfectly illustrates the power of collaboration.
A patient with severe headaches, neck pain, poor sleep, and tingling in his fingers improved dramatically with TMJ treatment. But one symptom lingered: brain fog.
Because of a traumatic birth history and long-standing patterns, Dr. Alex referred him to a craniosacral therapist to address deeper cranial and autonomic layers that dentistry alone couldn’t fully resolve.
The message is clear:
Sometimes the bite is the driver. Sometimes it’s the responder. Often, it’s both.
What Is Postural Restoration (PRI)?
Dr. Emily explains that Postural Restoration Institute (PRI) therapy is not about “standing up straight.”
It’s about understanding that posture is influenced by:
- Breathing patterns
- Diaphragm function
- Asymmetries in the body
- Nervous system tone
- Vision
- Organ position
- Pelvic and rib orientation
- Cranial bone movement
PRI looks at the body in three planes (sagittal, frontal, transverse) and evaluates how asymmetries create compensatory torque that can eventually affect the neck, jaw, and temporomandibular joints.
In other words, if the pelvis rotates and the rib cage twists, the skull and mandible may follow.
How Breathing Impacts the Jaw
One major takeaway:
If your diaphragm is stuck in an inhaled, extended position, your neck and jaw will overwork.
Many chronic TMJ patients live in subtle fight-or-flight:
- Overusing accessory neck muscles
- Clenching for stability
- Holding tension in the suboccipitals
- Living in extension
PRI therapy often begins by restoring diaphragmatic breathing and neutral positioning. When the rib cage settles, the cervical spine relaxes. When the neck relaxes, the temporals and mandible can reposition more comfortably.
The Bite–Posture Connection in Real Time
Dr. Priya shares something she sees daily in practice:
When she balances a patient’s bite with a neuromuscular orthotic and has them:
- Rotate their neck
- Bend forward
- Test balance
- Walk or step outside
- They immediately feel differences:
- Improved range of motion.
- Improved grounding.
- Improved symmetry.
Dr. Emily explains why
A stable occlusal position can calm the nervous system and give the brain a reliable reference point. That “grounded” feeling often reduces compensatory muscle guarding throughout the body.
But she also emphasizes something critical:
If the body remains twisted below the jaw, the muscles may simply pull everything back to the old bite.
That’s why collaborative care can be so powerful.
Why Orthotics Matter and Why Not All Guards Are Equal
Dr. Alex makes an important distinction:
Not all mouth guards are therapeutic orthotics.
Some appliances:
- Lock the jaw in the wrong position
- Increase muscle firing
- Worsen posture
- Increase headaches
A properly designed neuromuscular orthotic:
- Balances occlusion
- Allows functional movement
- Reduces muscle hyperactivity
- Improves cranial mobility
Dr. Emily adds that as patients progress, appliances can evolve. Early stabilization may require more rigid guidance. Later phases may allow more freedom and movement once neutrality is established.
The goal isn’t locking the jaw forever.
It’s restoring stability, then restoring function.
Neuro-optometry: The Overlooked TMJ Driver
One of the most fascinating parts of the episode focuses on vision.
Dr. Emily explains that neuro-optometry and behavioral optometry look beyond “20/20 vision.”
They evaluate:
- Binocular function
- Peripheral awareness
- Eye dominance
- Convergence and divergence
- Post-concussion changes
- Prism needs
The eyes, sphenoid, temporals, and jaw are intimately connected.
If one eye overworks:
- Suboccipital muscles tighten
- Temporalis muscles fire
- Head posture shifts
- Jaw torque can increase
She describes astigmatism as “scoliosis of the eye,” a powerful concept for understanding how small asymmetries can cascade into global tension.
Dr. Priya shares that she has seen vision prescriptions change after TMJ treatment, reinforcing the interconnected nature of the cranial system.
Cranial Work and Temporal Bone Mobility
Dr. Emily also discusses the movement of temporal bones and their relationship to:
- The mandible
- The sphenoid
- Cranial nerves
- Arterial flow
- Autonomic tone
When cranial motion improves, some patients report:
- Their bite feels different
- Head pressure decreases
- Neck movement improves
- Jaw tension softens
Again, this doesn’t replace dental stabilization when needed, but it may reduce compensatory strain.
Hypermobile Patients and TMD
Dr. Emily shares her own history of hypermobility and injury and explains why many hypermobile patients struggle with:
- Recurrent pain
- Muscle imbalance
- Jaw instability
- Chronic compensation
For these patients, creating “neutral” isn’t just muscular; it’s neurological. They need grounding cues, sensory stability, and sometimes orthotics or vision correction to stop chasing stability with clenching.
Collaboration Is the Real Game Changer
A powerful part of the episode revisits how Dr. Priya, Dr. Parker (her mentor), and Dr. Emily used to work together:
- Priya would adjust the orthotic.
- Emily would immediately test cranial rhythm and neck mobility.
- They would confirm whether the adjustment improved neutrality.
It was real-time interdisciplinary validation.
While logistics now make that exact setup harder, the philosophy remains: TMJ is rarely “just the jaw.”
Small Changes with Big Impact
- From breathing retraining
- To pelvic alignment
- To cranial work
- To bite correction
- To neuro-optometry To orthotics
- Each layer can influence the others.
No single provider holds all the pieces. But when providers collaborate, the puzzle often starts to make sense.
Is It Time to Think Bigger About Your TMJ?
If you have:
- Persistent headaches
- Clicking or locking
- Unexplained asymmetry
- Chronic neck tightness
- Post-concussion symptoms Vision strain
- Hypermobile joint instability
Your bite may be involved — but it may not be acting alone.
Dr. Priya Mistry believes TMJ care works best when the whole system is considered: muscles, joints, breathing, posture, vision, and nervous system regulation.
If you’re ready for a comprehensive evaluation and a plan that looks beyond “just a mouth guard,” schedule a consultation with The TMJ Doc.
Your jaw might be the symptom. The solution might be bigger.
