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I am a newly qualified physiotherapist and getting very confused by the appropriate treatment for TMJ dysfunction. There seems to be so many very varied ways to treat this problem its hard to decide what route to follow! Any advice or links for further info? CHeers
The causes can be varied with treatments ranging from stress management to dental devices to minimise night grinding of the teeth. The thorough assessment of all possible precipitating factors is perhaps the most important starting place. Carefully check the cervical spine for any anomolies. I am sure any craniosacral readers would have a field day on their input into this? Also the trigger point fraternity will offer comment. TMJ dysfunction presents from a range of possible causes, each person being different to the last. Assess, treat, assess, treat. If you follow that simple process you won't waste time exploring in the wrong direction.
In my experience, Bowen therapy is an excellent treatment option for this condition.
Note: It has been found that people with TMJ may suffer an adverse reaction to cervical traction - beware.
Assessment is the key . I would always check for the presence of myofascial trigger points especially pterygoid mm which is relatively easily amenable to treatment if you have Acupuncture skills. Pterygoid exercises are also cery valuable, as are relaxation skills as TMJ dysfuction often carries a significant psychological component
Take note of the dental history. Any orthodontic treatment at an earlier age, any teeth removed, which would change the occlusal bite.
Symmetry of bite at back of teeth and side. Where are the teeth meeting.
The sub-occipital muscles are related to the TMJ, if one area is affected the other will also be protective, hypertonic and have restricted movement, hence it does not like stretch, but would respond to inhibition techniques.
Check the tone of masseter, and medial and lateral pterygoids. these can be massaged from the inside of the mouth.
The balance of the mandible at both TMJ's is the key hence dentists who use mouth splints and are aware of how the jaw can be changed. This maybe essential to help you treat the patient.
Most important what state is the disc of the TMJ in. Is there a click, can the condyle click on and off the disc, does the disc stay pushed out of the joint and not click back. This stage of clicks will tell you about the disc, without this in a reasonable state you will not help the TMJ very much.
The right assessment working through all the related structures will tell you how and where to work.
Strangely if you do use Cranial osteopathy then it would help to understand the way in which the bones fof the area move relate and can be altered, even so a dentist is often useful to speed things up or change long term problems. Hope this helps.
Yes I agree, I have worked with a number of patients with TMJ problems and bowen technique has been the most effective by far. look on www.bowtech.com for more information.
Remember the TMjt biomechanics in openning and deviation and how the condyles moves in both rotational and translational planes.
If you have learnt maitland mobs, apply it to restore the biomechanics during opening and or deviation.
But be very careful and gentle ie grade 2- or less and short duration. They irritate easily. And always warn your patients abt pain after the session. If they do experience pain after the session, do it even gentler.
Ultrasound seems to help TMJt. They can be quite effective in reducing pain. Low intensity, pulsed (high frequency) and 3Mhz.
If it clicks like the earlier writer wrote, 2 things. If the disc reduces immediately, there would be pain often and pain relief would be good follow by movement re-education. If the disc does not reduce..... the disc is stuffed and the elastic tissue attaching has lost its elasticity.. Now, that is difficult to treat.. mainly pain relief..
The evaluation of the movements in the opening and the proprtionality with the lateral movements (4:1) is going to give you a hint about the position of the disc and his possible reduction. If in the opening you have deviation to one side, it's possible that the disk can't be reduced and stops the traslational movement in that side.
One of the most importants procedure in TMD is to stretch the joint capsule using slight forces. With this the pain will relief enough to relax the elevator muscles. Also you can use the relaxation reflex of the elevator muscles activity touching with the tip of the tongue the palate and doing the rotational movement of the opening movement (10 mm), this is before the mandible condyles move outwards with the gliding.
The reduction of a luxated disk it's more possible if the reduction click occur on the first 10 mm of the opening. WithMRI you can asses if the disc can be reduced in protrusion movements, if the condyle can locate under the disk in the mid section. Then you can try to move backwards with the disc to a condyle centric relation position.
So, the first step is to reduce pain. And then without pain, try to restore the normal movements relationaship using mobilization techniques and propioception exercises.