How can physiotherapy help patients with Temporomandibular Disorders (TMD)?

Why should patients with TMDs see a physiotherapist?

TMDs are musculoskeletal disorders (affecting muscle, bone and joints) that cause pain and dysfunction in the jaw joint and the muscles that control jaw movement. For some people their condition causes long-term, persistent and debilitating pain, interferes with their daily life and often results in high levels of distress and anxiety (1). Physiotherapists are experts in musculoskeletal disorders and are trained to manage patients with chronic pain and dysfunction.

The temporomandibular joint is different from the body’s other joints. The combination of hinge and sliding motions makes this joint among the most complicated in the body. Also, the tissues that make up the temporomandibular joint differ from other load-bearing joints, like the knee or hip. Because of its complex movement and unique makeup, the jaw joint and its controlling muscles can pose a tremendous challenge to both patients and health care providers when problems arise (1). Some physiotherapists have had specific training in the management of patients with TMDs. Patient with a TMD should be seen by a physiotherapist who has training in the management of these conditions.

Experts strongly recommend using the most conservative, reversible treatments possible. Conservative treatments do not invade the tissues of the face, jaw, or joint, or involve surgery. Reversible treatments do not cause permanent changes in the structure or position of the jaw or teeth (1). Physiotherapy is a conservative, reversible treatment. It does not invade the tissues of the face, jaw, or joint, or involve surgery and does not cause permanent changes in the structure or position of the jaw or teeth.

Ongoing physiotherapy research aims to gain a better understanding of temporomandibular disorders and develop management strategies that improve the quality of life for people affected by these disorders. The good news – there is increasing evidence that physiotherapy is helpful in reducing pain and increasing jaw function for patients with TMDs (2)(3)(4).

How are patients referred to physiotherapy?

Patients with a TMD may be referred to physiotherapy via their doctor, general dentist or hospital dentist. Other patients may be able to self-refer to NHS physiotherapy or to a physiotherapist working in a private practice.

How will the physiotherapist know if I have a TMD?

The physiotherapist will make a diagnosis of TMD from the patient’s description of symptoms, the history of the condition, other medical history and an examination of the problem areas, including the head, neck, face, and jaw.

What techniques do physiotherapists use to treat TMDs?

  • Reassuring explanation about TMD
  • Education on anatomy, function, pain physiology and contributing factors to TMD
  • Advice on long term self management strategies including joint and muscle stress reduction and how to manage flare-ups
  • Home exercises
  • Postural correction
  • Manual therapy (massage, manipulation and stretching)
  • Acupuncture
  • Laser therapy

If the patient has self-referred and has not seen another health professional about their TMD, the physiotherapist may advice the patient to make an appointment with their doctor to discuss pain medication or with their dentist to discuss oral splints.

Why might the physiotherapist decide not to treat a patient with jaw pain?

If the physiotherapist believes that the patient’s problem is not a TMD, is a complex case, or if the patient is not improving with conservative treatment the physiotherapist should advise the patient to see their doctor for further assessment or contact their doctor and recommend a referral to a dental hospital for further assessment by a team of experts.

References

  1. National Institute of Dental and Cranial Research, USA
  2. Medlicott, MS, Harris SR (2006). A Systematic Review of the Effectiveness of Exercise, Manual Therapy, Electrotherapy, Relaxation Training, and Biofeedback in the Management of Temporomandibular Disorder. Physical Therapy. Volume 86. Number 7. July
  3. McNeely ML, Armijo Olivo S, Magee DJ (2006). A Systematic Review of the Effectiveness of Physical Therapy Interventions for Temporomandibular Disorders. Physical Therapy. Volume 86. Number 5. May
  4. Schiffman E, Look J, Hodges J, Swift J, Decker K, Hathaway K, Templeton R, Fricton J (2007)Randomized Effectiveness Study of Four Therapeutic Strategies for TMJ Closed Lock.J Dent Res 86(1):58-63

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