Over the years, I’ve seen quite a few patients with temporomandibular disorder, or TMD. TMD is a dysfunction of the temporomandibular joint and/or the surrounding muscles. Often TMD, is incorrectly addressed as TMJ. TMJ is the temporomandibular joint, or the joint that connects the jaw to the skull.
Throughout my career as Physical Therapist, I have had conversations with various dentists and orthodontists regarding the treatment of temporomandibular disorder (or TMD). The thing that I hear over and over from dentists and orthodontists is that they often don’t know exactly what to do with these patients, other than providing them a splint and referring them to a TMD specialist. Physical Therapy for TMD can be quite effective as a conservative option for treatment, and if needed, often can be used in conjunction with splinting and/or referral to a specialist.
Patients with TMD can present differently from person to person. I have seen patients with very severe symptoms including intense pain on one or both sides of the jaw, the inability to chew or even open their mouth to get food into their mouth, clicking or popping of the TMJ, or a locking or inability to move the jaw. I have seen great outcomes in working with TMD patients resulting in a significant reduction in pain and dysfunction, and often complete resolution of symptoms. When working with a TMD patient, I do a comprehensive evaluation followed by a 4 step treatment approach.
During the evaluation, the assessment is focused on posture (including head, neck, and shoulders), ROM of the cervical spine (neck), thoracic spine (mid back) and TMJ, strength of muscles in the previously mentioned areas, and joint mobility and soft tissue flexibility of the previously mentioned areas.
Following the evaluation, the treatment consists of the following:
Step 1: Control inflammation and irritation with the use modalities
Modalities, such as ultrasound and electric stimulation can be used to reduce swelling and muscle spasms to decrease pain levels. Also dry needling can be quite beneficial in improving range of motion and decreasing pain.
Step 2: Patient education on the specifics of the injury and proper self management
Patient education is crucial and begins on the first day of physical therapy. If the patient doesn’t understand what they have, what is causing it and how to alleviate it, then they won’t get better in the long run and they definitely won’t understand how to self manage. It is our job as PT’s to provide that knowledge to the patient. A customized home exercise program will be provided that addresses all impairments that were found as well.
Step 3: Manual therapy including joint mobilizations and stretching of tight/inflexible muscles
As PT’s, we have the knowledge and skillset to assess and treat most joints and muscles of the body. Our goal is to restore normal joint mechanics and tissue flexibility. Also, a home exercise program that re-emphasizes that manual work, will be provided.
Step 4: Therapeutic exercises to address weak muscles
Muscle groups pertinent to the TMD include the muscles of the head, neck, mid back, shoulders and jaw. All impaired tissues will be addressed and a home exercise program that addresses the weak areas will be provided as well.
The results of TMD treatment with physical therapy can be significant. As a PT, I greatly value the benefits of using physical therapy to alleviate patients’ symptoms with conservative means of treatment.