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1st Jul

2012

Orthopedic Manual Therapy for Temporomandibular Disorder

Temporomandibular disorder (TMD) describes conditions where a person has pain and altered function of the jaw joint, or temporomandibular joint (TMJ) and related soft tissues and musculature. These conditions are quite common, in particular in women, and have been estimated to affect up to 20% of the population.

People with TMD typically have pain in the jaw itself, sometimes extending to the temple and neck, limitations or deviations of jaw movement, and there may be clicking or popping sounds in the jaw. Others also have buzzing or ringing in their ears, reduced hearing, dizziness, headaches or other symptoms.

Common forms of TMD include muscular or myofascial pain, disk (cartilage) displacement in the TMJ with or without locking and reduced jaw movement, and joint pain due to various forms of arthritis or wear and tear.

The goal of treatment is to minimize pain, and restore normal jaw mobility and muscle function as well as jaw and head posture, to recover normal jaw function with daily activities and prevent recurrence. Physical therapy, and especially orthopedic manual therapy, can be an important part of TMD treatment. Dental treatment may also be indicated, including fitting with an appropriate splint. At times, additional medical treatment is warranted.

The physical therapist will look at the head-neck and trunk posture and mobility and function of the spine-in particular the upper neck, since this has a direct impact on the position and movements of the jaw. Relaxation techniques are helpful in particular for the person who clenches her jaw, and education in keeping the teeth apart while not eating. Soft tissue mobilization treatment can help guarded and painful jaw and neck musculature and the person can be taught to do some to herself.

If the disk in the joint has been displaced, gentle manual joint mobilization to the TMJ can often be helpful to at least partially reduce the disc displacement. Self mobilizing exercises and joint distraction techniques can be taught. Likewise, a tightened jaw joint capsule, or arthritic joint, may also move better and with less discomfort after joint mobilization. Often the person must at first go on a soft food diet, to reduce compression and strain on the joint, and prevent recurrent disc displacement.

Gentle exercises can be performed once there is sufficient jaw mobility, to restore normal coordination of jaw, tongue and neck musculature, and to maintain a proper TMJ and disc position with movements and normal daily activities. The person may lack strength and stability of the neck, important since the jaw functions best from a stable base, which can be corrected with specific neck exercises. Many women with TMD and disc displacement have overly lax or mobile joints in their bodies, making such stabilization exercise of particular importance for them.

Please feel free to pass this information on to anybody who could benefit from it.

With wishes for a happy and healthy summer,

Gunnar

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