The Power of the Trigeminal Nerve
Trigeminal Nerve is one of the largest cranial nerves. This nerve provides sensation to the face, as well as motor innervates ion to the masseter muscle, the strongest muscle in our body (jaw). It also, however, does another powerful thing: innervates the tentorium and fallx in the cranium the thickening of the dura or meninges, and therefore has a direct effect on intracranial pressure and nervous system tension throughout the body.
In this episode, we explore the anatomy and anatomical relationships of the trigeminal nerve and its role in autonomic nervous system balance. I share my favorite treatment techniques and why this nerve is one of the nerves I treat very often.
Resources mentioned in this episode:
Manual Therapy of the Cranial Nerves: https://shop.iahe.com/Product-List/Neural-Manipulation-Products/Manual-Therapy-for-the-Cranial-Nerves
Netter’s Atlas of Neuroscience: https://amzn.to/3ED3qCI
Barral Institute: www.barralinstitute.com
Trigeminal Nerve Glide: https://youtu.be/e5SJs0Tp_-A
Trigeminal Extracranial Orfices: https://www.instagram.com/p/CFIhNxinIr7/
Trigeminal Nerve for sinuses: https://www.instagram.com/reel/CluYZ5gMHlk/
Trigeminal Scalp Massage: https://www.instagram.com/p/CAMKdiWHldP/
Trigeminal Nerve Tapping: https://www.instagram.com/p/CYZZdgKoLjP/
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Hey there, and welcome. I'm Anna Hartman, and this is Unreal Results, a podcast where I help you get better outcomes and gain the confidence that you can help anyone, even the most complex cases. Join me as I teach about the influence of the visceral organs and the nervous system on movement, pain, and injuries, all while shifting the paradigm of what whole body assessment and treatment really looks like.
I'm glad you're here. Let's dive in.
Hello, hello, and welcome to another episode of the Unreal Results so this week, what I want to talk about is the trigeminal nerve. The trigeminal nerve is a cranial nerve that I end up focusing on, talking about, treating quite a bit. Part of that reason is because it's so large. But then also, It has a powerful effect on the nervous system in many ways.
Uh, so, I wanted to dedicate a whole podcast episode for it because understanding the power of the trigeminal nerve opens up a lot of possibilities to treat different aches, pains.
So, you know, there's a lot of emphasis in the world right now, or the world, the industry, um, on the vagus nerve. Like everybody's all about how to treat or affect the vagus nerve, um, which I'm not mad about. The vagus nerve is also a very large cranial nerve and has a very powerful effect. However, the vagus nerve is, um, The majority of the bulk of the nerves is, are in the, um, trunk, going to the viscera.
And, um, and the trigeminal nerve, the bulk of it is all around the face and the head. And so, in terms of how we can leverage providing more information to the nerves, I think the trigeminal nerve is actually... A lot more accessible for us as manual therapists and even when you're taking care of yourself or teaching people how to take care of themselves.
So this is why I feel like the trigeminal nerve is such an important nerve to know about, learn about, et cetera. So the trigeminal nerve is cranial nerve number five. Like I said, it's really large. It is one of the largest cranial nerves and it The, the bulk of it, the majority of the nerve, if you even look at like the trunk of the nerve, it's huge.
It's like very thick trunk and the majority of those fibers are all sensory fibers. There is a portion of the trigeminal nerve that has a motor function and that motor function happens to be a very important. motor function as well, going to the strongest muscle in our body, which is our masseter, so our jaw muscle.
So the trigeminal nerve motor function is the closing of our jaw, so eating, which is fundamentally a very important function of our body, as well as obviously talking, because moving our jaw helps to create our words, creates our sound, right, in conjunction with other, um, muscles and nerves functioning.
But jaw movement is tied to very, two important things, um, associated with our safety and survival. And then the sensory function, which is the bulk of the trigeminal nerve. is sensory to the face, to the scalp, or head, as well as sensory to the meninges of the cranium. So the structures within the cranium that sort of hold the brain in place and house the venous structures of the brain.
So the dura sinuses are within these meninges that are innervated by The trigeminal nerve. So the trigeminal nerve, its power lies in its relationship to the autonomic nervous system to safety and survival. So from a parasympathetic nervous system, it is one of a few cranial nerves that have a parasympathetic ganglia.
That's where its power lies.
Just like the vagus nerve, right? We started off talking about how people are focused on the vagus nerve. Part of the reason people are so focused on the vagus nerve is this power of tapping into the parasympathetic nervous system, and we care about that, right? Because the parasympathetic nervous system is actually the dominant part of the nervous system for our autonomic nervous system function in terms of the parasympathetic kind of our Baseline is our sympathetic response.
That's sort of our older brain our order older operating system Totally wilder wired for survival and our parasympathetic Creates like adds a break to the system. That's what Drops our heart rate down drops our respiratory rate down and allows us into this state of safety in the state of safety We are That's where we eat.
We digest food We're you know feel like we can have a relationship with other humans So this is an important part of our parasympathetic nervous system and in this state When there is this good balance between the two and this resiliency within the autonomic nervous system and this robustness of our parasympathetic nervous system.
This is the state of which regeneration, recovery, healing, the self healing capabilities of the organism get expressed. And so being able to tap into this parasympathetic nervous system piece is really powerful, just from a self healing standpoint and from a decreasing pain, uh, standpoint as well. So the trigeminal nerve, um, Ganglion.
Right, so the, the, basically, the nerve root comes from the brainstem, like the rest of the cranial nerves, and then it, it branches out to this, like, thick ganglion. And the trigeminal nerve ganglion, the, the area that it rests, it sort of lives in, right in the, um, Suture or sort of the junction of the cranium, the cranial base, between the temporal bone, the sphenoid bone, the parietal bone, and the occipital bone, or the frontal bone, excuse me.
And in this area, especially in like the petrous part of the temporal bone, so the spongy sort of, there's this area, this is very, close to where the vestibular system lives within this part of the temporal bone too, that is where the trigeminal nerve ganglia is. And from that ganglia, I like to sort of tell my athletes that ganglia is, or when I'm teaching other professionals, the ganglia is like the supercomputer powerhouse of the cell where all the information comes back into.
It's almost like a little mini brain that sort of then transfers where other information goes within the nervous system. So, the, um, from there, from that trigeminal nerve ganglia, back in that, if you, if you took a, if you drew a line between the junction of those bones, which is an anatomical location right behind your temple called the terion, which is, starts with a P, like pterodactyl, terion.
It's H shaped, the suture lines. That tarion right there is sort of like where the trigeminal ganglia is if I did a line across there and then, you know, um, just off of midline. would be that spot. Almost right behind my orbit of my eye. And, um, that location is where then the three main branches of the trigeminal nerve come out.
So, the trigeminal nerve, like I said, is so big, each branch has its own name. So, um, you'll often see the, like, acronym, like, cranial, like, CN, cranial nerve. Five, which is... trigeminal nerve, granule nerve 5, which is Roman numeral V, and then a subscript 1, 2, or 3. And that's denoting the branches of the trigeminal nerve, the ophthalmic branch, the maxillary branch, and the mandibular branch.
So each of those three branches go to a different part of the face or a different part of the meninges within the cranium, right? And the cool thing about This meningeal piece, too, that I didn't mention, but is important, and I've probably talked about it in other podcasts, is By innervating the meninges, the sensory part of the meninges, you're also influencing the intracranial pressure a ton.
So, the ability to regulate or change intracranial pressure, even, either for the... Better or for the worse, right? Too much pressure or not enough pressure, um, can be influenced by the sensory components of the trigeminal nerve and the meninges are the base of the cranium. But then also, there is a main meninges that goes down the center of the cranium as well, and that separates the parts of the cerebrum.
And then there's another little part that separates the hemispheres of the cerebellum too. So, um. Another cool thing is the trigeminal nerve, anastomose. So joins has a recurrency with this cervical plexus nerves. So the cervical plexus coming from your neck are peripheral nerves and the, the upper cervical plexus nerves, the greater nerve of Arnold, the lesser nerve of Arnold, they innervate the back of your scalp and they actually sort of come up the back of your, uh, head and anastomose with branches of the ophthalmic.
nerve, providing sensation to the whole scalp. And so there is a relationship here too, between the trigeminal nerve and the cervical plexus. And then that means the cervical plexus and the brachial plexus and the phrenic nerve, right? So trigeminal nerve can influence a lot. Diaphragm, um, functions, sensory information from the phrenic nerve, brachial plexus.
Influence, that kind of thing, right? So, um, the other thing about this relationship. Oh, this anastomosis, the trigeminal nerve also has an anastomosis with the, um, vagus nerve and, or branches of the vagus nerve as well as the facial nerve. The facial nerve and the vagus, and the trigeminal nerve are, live right by each other.
And actually when you, when, when I do a nerve glide for these, um, They're actually very similar looking nerve blades, and they have to do with that area where it sort of comes out of the, um, cranium right behind or, uh, the, uh, TMJ. That's sort of like a main area where the big branches sort of fan out here.
So from a sensory standpoint, the ophthalmic nerve branch, the upper part, does sensory to the sort of upper. part, I said scalp for front of the forehead here, uh, over the eyes and the nose, and then the max, maxillary goes sort of temple and outer part of the eye underneath the nose, above the face, so like the maxilla bone, and the mandibular does below that.
So sensory to these areas are all three branches of the nerve. The motor branch that goes to the masseter So you can feel that when you clench your jaw. That is a branch off the mandibular branch. The, uh, TMJ, the actual joint of the jaw, is also innervated by one of the branches of the trigeminal nerve.
So people with TMJ can often have issues there as well. So, um, Another interesting relationship of all the cranial nerves, but again, like when we look at the cranial nerves, we look at how big this trigeminal nerve is, and we start to realize that, like, this is a big player in this role, is that the cranial nerves actually counteract the downward pull of the spinal cord.
And the peripheral nerves, especially as the spine is going into flexion or the legs are going into flexion. So this means that a good way, a helpful way to sometimes influence people's sciatica or nerve pain down the back of their legs or periphery, even in the arms, the peripheral nerve pain or nerve issues.
can sometimes be helpful by doing cranial nerve stuff, specifically the trigeminal nerve. And so this becomes a really powerful, um, treatment for those sorts of things. Um,
thinking about some of the relationships I want to share before we sort of talk about, like, treatment strategies. trigeminal ganglia...
was, is actually right next to the carotid artery, and so the trigeminal nerve has a great influence on the carotid artery and the blood flow, not just, well I already talked about how it relates to the venous drainage or venous flow from the cranium, but also the arterial flow into the cranium, because of this relationship.
to the carotid artery. And so, again, this can be a huge player in intracranial pressures, and just general health of the brain, or brain fog. Um, I always think about my athletes in this context, of like, they're having little micro traumas to their brain with all the starting and stopping and then if you add in any impact, you know, with football players or the soccer players, rugby, like all the people that are like hitting each other on a regular basis, right?
Each change in direction or stop is like a whiplash to the brain and the brain moves and there's little micro traumas to The brain itself to the meninges to, you know, so there's a little extra like inflammation in the brain. And studies have found that when the lymphatic in your brain, your glymph, it's called your glymph, your lymphatics in the brain are not able to drain that very well.
We're at. more risk to having neurodegenerative problems. This perhaps is sort of maybe the scenario of causing like CTE and Parkinson's in people with traumatic brain injury. Because we see that in people who didn't really have huge traumatic brain injuries. But again, these little micro traumas. But perhaps it's because the venous system is not able to flow.
and drain very well as well as the blood flow to the brain is not able to get there very well. And the trigeminal nerve is a nerve that can powerfully influence this relationship of fluid flow, blood flow, lymphatic flow to and from the brain. And so it's so important. And then the other thing that you might think of when I talk about intracranial pressure is headaches, right?
Because we've all felt that before, this vice grip sort of pounding headache. Sometimes they come up from the back, or sometimes they kind of radiate from the temple and the eyes, right? That should Trigger something in your head thinking interesting. Those are the paths of some of the sensory nerves, right?
and so the trigeminal nerve can actually be a big player in headaches and in Migraines and vice versa can also be a helper in those scenarios So it's like what and and this is what's cool about when you realize just how smart the body is because people will do things that naturally to relieve their pain,
like intuitively or naturally, and you look and you're like, oh yeah, that's stimulating the trigeminal nerve, so it makes sense. So what do some people do when they start to feel like they have a headache? They rub their temple, right? That's that area, that suture line, right where the trigeminal nerve ganglion is, plus rubbing the skin, that is stimulating the sensory component of the trigeminal nerve.
They pull their hair or, or like. You know, massage their scalp or just play with their hair, which is pulling on the scalp. They yawn, they sometimes like will massage their ears. They'll sometimes like tap. All these things that people do naturally when they start to feel a headache come on and it's like makes sense, right?
Because stimulating this sensory nerve can influence the intracranial pressures. So this is why it becomes such a nerve, powerful nerve to treat. So the ways I like to treat it, let's get to that. Well, one, let's talk about just those intuitive things. The rubbing, the skin stretch, the rubbing at the temple, why that might be even more powerful than skin stimulation to the rest of your face, which, you know, one of the things I give my aunt, she has trigeminal nerve.
Neurology, I have her, I bought her a facial roller and when she does that, her symptoms are almost non existent. So, that's an example of how simple the treatment can be. Um, but doing a skin stretch up at that tarion can be even more powerful because when you're manipulating the skin with a barrier stretch like that or even a skin lift, so sometimes I like to do a skin lift and the easiest way I can do that is with my hair.
I just pull my hair out in that area and then I add a little stretch to it. If you don't have hair, you can just pick up the skin if possible, or you can even use like a little facial cup. Um, and this skin lift or this skin barrier stretch is using the principles of Hilton's Law. Hilton's Law is that the, the nerve that innervates the area of the skin also innervates the structures beneath.
We know that, right? Because I just told you that's one of the functions of the trigeminal nerve to enter, innervate the meninges, but it also sort of inter, innervates the joints. And so we think of these sutures as They are. They're joints. They're very, um, closed joints, right? There's not a whole lot of movement, but there is movement there.
You actually will feel it when you're doing cranial work. These, these, like, nanometers or millimeters of movement happening within these sutures. And so, doing this right on that suture, line, that terion, that H of that terion, um, is, can be even more powerful and get, um, a reflexive effect on the trigeminal nerve ganglion by influencing it.
via the bones that make up the area where it sort of lives in the meninges there. So, that's one. The next one is, like I said, like a little scalp massage or a hair stretch all over, right? From the base of your skull, which is actually technically more cervical plexus. but anastomosis with the ophthalmic to all the way through that ophthalmic nerve.
So again, it can be a massage, it can be a skin stretch, it can be a skin lift, whatever feels best for you. You can do this as a therapist, or you can do this just on your own or teach the patient how to do it on themselves. Um, another one is specifically the, the intra orbital fissures, not orbital, well also orbital, but also the intra.
extra, I guess it's called extra cranial fissures of the face. Basically the little holes that these nerve branches come out of. And so there's, um, areas around the orbit, like the corner of your eyes, you'll feel them. They're like little notches in the bone. So everywhere there's a little notch around the rim of the orbit is actually a branch of the trigeminal nerve.
So same thing around your nose here, you'll feel a little. Divot there, that's another one. Along your cheekbones, there's a, uh, around, along your cheekbones it's a little harder to feel because the muscles on top, but again, like if you search for it, you'll feel a little divot right there. So we have this here, and then same thing at your divot of your chin here, just the sides of that.
There's branches that come out there, so basically, along the bones of your face, you can find these areas that the trigeminal nerve branches come out of and do a skin stretch or skin lift technique there, or if you are trained in acupuncture or dry needling, you can do little needles in those areas as well.
Those are great manual therapies to have a reflexive effect on the meninges. And by the way, I just was thinking about it as I was palpating these, this nerve, your trigeminal nerve also innervates the majority of the sinuses in our head, right? So if you're having any sort of congestion, again, it goes with that venous flow, the fluid flow in and out of the cranium and the face.
The Trigeminal nerve can be really powerful in treating congestion, so it's something that I use quite a bit and when, when allergies come up or, um, colds, those kind of things, so that's another powerful way. So, basically, too, like, wherever there is a nerve branch, you can. You can do this treatment, right?
The other thing is doing treatment right at sort of where the bulk of the branches come out. This is where the trigeminal nerve glide comes in and it's very similar to the facial nerve glide. We're basically sort of playing with that spot, putting some tension on the nerve by doing capital flexion. So lengthening the spine, lengthening the spinal cord, adding a little...
Side bending away from the side we're doing jutting our head out again, putting more tension on that nerve, 'cause the nerve's in the front of our face. And then we're opening our jaw halfway and then sliding it towards the side. You can also add a little rotation and you can get crazy. And remember, spine flexion and hip flexion adds coddle pull to it.
So if that doesn't feel like quite enough tension, you can start to flex the spine down below. And see how that changes things. As with our peripheral nerves, even when it's a cranial nerve glide, we don't want the intensity to be over three. So don't kill yourself here, but then to remember innervated the TMJ joint.
So you could just do jaw circles, jaw mobility exercises. Wouldn't be what I picked for someone with TMJ pain, because that. That's going to be more of their objective dysfunction we're looking at is like basically what's your you know Open clothes look like and then do some other trigeminal nerve things.
How does it change? But for someone without TMJ pain TMJ pain doing jaw movement can be really good for the trigeminal nerve as well Um, and then you can check in with just the general, um, quality of even the clenching of the jaw, the masseter muscle there too. It can be a check in for changing function.
But, you know, what you're going to notice is globally a big change. Because, again, globally we have this... It's checking the caudal pull of the pons cord tract and the peripheral nerves. So it's going to be involved in whole body range of motion, specifically to flexion. And then, um, it's also going to influence our pain quite a bit because of where it lives on the brainstem and then its role in sensory information and this parasympathetic response, right?
It's a parasympathetic ganglia. It's also. Um, you know, one of the things when you're co regulating with someone, when you're in relationship with someone is like, um, grooming type of, um, touch. So, um, that, especially around the face, so like, you know, when we think of it as animals, this nuzzling, obviously people do it too when they're making out.
Um, or, you know, just hugging like this area around the face and neck, we can, we can involve that. It is, um. This is why the trigeminal nerve is one of the nerves of, um, social engagement, um, social engagement nerves. Again, the talking part of it too, the moving of the jaw is a piece of that social engagement.
And these are also very powerful parasympathetic movers. Uh, because social engagement is one of the top ways to, uh, feel safe, right? Um. And so that's going to influence, again, when you feel safe in your nervous system, your nervous system grants you more mobility and decreases your pain, period. Uh, so, so many powerful...
I'm going to be talking about some of the different kinds of effects for it. Some other pathologies I didn't talk about. So I talked a little bit about trigeminal nerve neuralgia and I talked about TMJ dysfunction and I talked about headaches. What I didn't talk about was shingles. Uh, specifically, the first branch, the ophthalmic branch of the trigeminal nerve tends to be an area where the herpes zoster virus, uh, can be dormant in.
So, again, it can be a pretty common spot to get, uh, shingles at. So, Um, I don't deal with a lot of those patients, but it would be interesting to me to see like doing other things influence different part of the trigeminal nerve, if it would help to regulate some of the pain that's involved with things like shingles, since the trigeminal nerve neuralgia, I get such good out.
comes, I would assume that would be helpful, but again, don't know. You'd have to test it and try it. And then also, there's the time and a place for treating the trigeminal nerve, and so having tools Like the LTAP, um, the Locator Test Assessment Protocol, allow me to know when I need to treat the Chai Gem Owner, right?
It's not always going to be the first place I treat. And it can be really powerful, but when it's not treated, when it's supposed to be treated, it's going to be less powerful. So, knowing where to start is key. That's why I teach the free... Results cheat code, you know, I teach the first test of the LTAP, that first test of the LTAP actually tells us a ton of information and can tell us, you know, quickly, do, are we in and get, The most bang power backs starting with the trigeminal nerve or not.
So, anyways, as you can see, you know, I love this nerve. I think it is like the coolest, one of the more important nerves out there. Um, whenever I talk about the nerves, at least when I'm teaching in my courses, people are always asking me for like a resource. First of all, most of the time I just Google that shit.
GTS. That's the beauty of having a computer in our hands all the time. But, with that said too, my other favorite resources are going to be from the Barral Institute. They have a whole book called Manual Therapy of the Cranial Nerves. Obviously, I always recommend going to their courses and if you sign up for their courses, please let them know that I referred you.
Um, but also, um, their books are written so well, I think you could actually learn a lot of the treatments without having to go to a course. Um, so their book, and I'll link these in the show notes, and then, I mean, You can't argue with Netter being like the go to anatomy thing and Netter has a whole atlas just dedicated to neuroscience.
So this is also a great resource that I open up quite a bit when I'm learning about Or just like thinking about the nerves. Um, but yeah, like I said most of the time I google that shit So I look at different pictures on the internet. Not all pictures are great So, you know look at a few and kind of decide, you know, there's some places that I like better for the nerves specifically I like Kenhub and I like Nysora and Nysora is actually a um, Company that sort of, basically it's for like pain, physi pain med and like physical re rehabilitation docs.
It's all about like where you would do injections on nerves for like nerve blocks. So, it's actually really helpful for the information I need. But, uh, yeah. The more you understand the anatomy and the locations and the function. And the relationships with anything, right, that's pretty much what I end up talking about in, on these podcasts.
The more treatment possibilities it opens up for you. So, I hope that was helpful. Um. Would love to hear any feedback if you have it about this podcast, but then just the podcast in general, too. Uh, I haven't ever really asked, but if you would love to rate and leave a review, of course, I'd love that. Um, but, uh, more than that, I just love it when you share.
So, hit me up in the DMs, send me an email, whatever you would like. I'd love to connect. So, have a great day. Thanks for listening.
