TMJ; that's my jam

Differentials

Symptoms vary from incessant popping/clicking, inability to fully open, or strict pain. Females have a higher incidence (4:1) and “hardware” (dentures and such) should be evaluated first. While dysfunction of the temporomandibular joint, or TMJ, can be a primary cause of symptoms, it’s necessary to rule out other causes first.

  • Ear or Sinus (maxillary) infection

  • Dislocation/Dental malocclusion

  • Oral lesions (herpes)

  • Headaches, Emotional issues

  • Otherwise; myofascial pain/bruxism and discopathy (yep, there’s one in there too) can be successfully treated by manual medicine.

In certain cases the dysfunction can be from developmental issues and impact eating, speaking, breathing, and even sleeping. Multidisciplinary approaches will be necessary in these cases.

Anatomy

Assessment

Orofascial coordination should be rolled into the manual therapists screening exam (say during the posture exam). Simply observe for (what should be) smooth opening and closing of the mouth (depression & elevation). Opening should allow 3-fingers at end-range depression. If a primary concern, evaluating other motions (lateral deviation, retrusions, protrusion) may be necessary.

Muscles of the head and neck can either contribute as painful referral sources or from their contribution to coordinating movements. Investigate:

  • Masseter

  • Temporalis

  • Pterygoids (medial & lateral)

As it is a hinge and gliding joint, the TMJ can succumb to asymmetric patterns. And yet there exists a disc in the TMJ.

ERL the TMJ

As a joint with a disc, if the main issue is a discopathy the MDT practitioner is in luck! Following principles of Mackenzie assessment and treatment, providing ERL therapy in the direction of detriment (remember the six directions of movement?) can quickly resolve the issue. The exercise can also be offered to the patient for home care with even still improved outcomes.

Evidence?

Only poor evidence ratings exist for treatment of TMJ with medications and manual therapy. However, the manual therapy studies typically include, at best, the standard isometric exercises. I have yet to see reviews that include MDT treatments and those with more focused rehabilitative strategies. Currently, the best evidence for TMJ treatments are those promoting acupuncture and biofeedback management strategies.

Mathew DiMondTMJ, Temporomandibular joint, jaw painComment