32 Temporomandibular Disorders
Temporomandibular disorders (TMDs) affect up to 15% of adults and 7% of adolescents, this umbrella term may include jaw pain, movement limitations, and clicking of the jaw (List et al., 2017).
Many factors may play a role in the progression of TMDs, this may include soft-tissue dysfunction, joint disorders and central sensitization. On its own TMDs can have a significant impact on quality of life and there are other comorbidities associated with TMDs, as it may be a contributing factor to cervicogenic headache (von Piekartz & Hall, 2013).
A thorough health history intake can be done to gather information about patients’ limitations, course of pain, and prognostic factors for delayed recovery (e.g., low self-efficacy, fear of movement, ineffective coping strategies, fear-avoidance, pain catastrophizing) and answers to health-related questions. Screen patients to identify those with a higher likelihood of serious pathology/red flag conditions. Then undertake a physical examination: neurological screening test, assess mobility and/or muscle strength.
Incorporate one or more of the following outcome measurements when assessing and monitoring patient progress:
- Self-Rated Recovery Question
- Patient-specific Functional Scale
- Brief Pain Inventory (BPI)
- Visual Analog Scale (VAS)
- Numeric Pain Rating Scale (NRS)
- Jaw Functional Limitation (JFL‐8)
- Mandibular Function Impairment Questionnaire (MFIQ)
- Tampa Scale for Kinesiophobia for Temporomandibular disorders (TSK/TMD)
- Neck Disability Index (NDI)
Incorporate one or more of the following physical examination tools to determine the likelihood of temporomandibular disorders and interpret examination results in the context of all clinical exam findings.
- Physiological temporomandibular joint movements
- Trigger point palpation of the masticatory muscles
- Trigger point palpation away from the masticatory system
- Accessory movements
- Articular palpation
- Noise detection during movement
- Manual screening of the cervical spine
- The Neck Flexor Muscle Endurance Test
Provide reassurance and patient education on condition and management options and encourage the use of active approaches (lifestyle, physical activity) to help manage symptoms.
A massage therapy treatment plan should be implemented based on patient-specific assessment findings and patient tolerance. Intra-oral and extra-oral massage can be performed in the clinic or as self-care. Structures to keep in mind while assessing and treating patients suffering from temporomandibular disorders may include neurovascular structures and investing fascia of:
- Medial Pterygoid
- Suprahyoid Muscle Group (digastric, stylohyoid, geniohyoid, and mylohyoid)
- Infrahyoids Muscle Group (sternohyoid, sternothyroid, thyrohyoid, and omohyoid)
- Scalene Muscle Group (anterior scalene, middle scalene, and posterior scalene)
- Upper Cervical Spine (suboccipitals, upper trapezius, splenius cervicis, splenius capitis)
Massage therapists not only provide hands-on treatment they can also develop self-management programs to help patients manage symptoms. Simple home-care recommendations such as self-massage, jaw strengthening, jaw stretching, and cranio-cervical and temporomandibular joint exercises have been shown to be useful for temporomandibular disorders (Bond et al., 2020).
Massage Sloth: Self-Massage for TMJ Pain
The therapeutic effects of intra-oral, extra-oral massage, and self-care management of temporomandibular dysfunction has been demonstrated in several randomized control trials and systematic reviews (La Touche et al., 2020; Martins et al., 2016; Randhawa et al., 2016).
Contemporary multimodal massage therapists are uniquely suited to incorporate a number of rehabilitation strategies for temporomandibular disorder based on patient-specific assessment findings including, but not limited to:
- Manual Therapy (intra-oral and extra-oral massage)
- Education that is Person-Centered (e.g., biopsychosocial model of health and disease, self-efficacy beliefs, active coping strategies)
- Stretching & Loading Programs (e.g., concentric, eccentric, isometric exercises)
- Hydrotherapy (hot & cold)
- Self-Management Strategies (e.g., engaging in physical activity and exercise, social activities, and healthy sleep habits)
References and Sources
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