Physiotherapy for Temporomandibular joint disorder
Temporomandibular joint disorder (TMD) is a collection of symptoms which affects the jaw and surrounding structures. Unfortunately, there is still no clear consensus as to which is the most effective way to manage this condition.
This study explored whether a combination of manual therapy and exercise could improve symptoms of TMD and found that such a program was able to yield positive outcomes in both orofacial pain and headache symptoms.
Opting for a single-blind randomised controlled trial, 61 females with TMD were recruited and randomised into either a control group (no intervention) or the intervention group. The intervention group received twice weekly physiotherapy sessions over a 5-week period. All physiotherapy sessions involved the same treatment, which included:
- Suboccipital inhibition technique;
- Passive anterior-posterior upper cervical mobilization;
- Sustained natural apophyseal glide (SNAG) mobilization with rotation on C1-C2 vertebrae;
- Craniocervical flexor stabilization exercises.
Participants were not encouraged to practice the exercises at home.
Following the 5-week period, the intervention group, compared to the control group, demonstrated significant improvements in both orofacial pain (current pain, minimum pain and maximum pain), headache impact and mandibular function. There was no change in pressure pain threshold of the masticatory muscles in either group.
Based on the results of this study, a combination of manual therapy and exercise can yield positive results in females experiencing TMD symptoms.
Expert opinion by Ann Le
This study opted for a combination of treatment modalities, therefore we are unable to determine whether an individual technique or the combination resulted in the positive outcomes. However, this does reflect general practice, whereby a clinicial would typically utilize several techniques in one treatment session.
Furthermore, it was interesting to note that the same manual therapy techniques applied at the same upper cervical spine joints, regardless of individual presentiation, still resulted in positive outcomes. This may suggest the importance of addressing the upper cervical spine when managing patients with TMD.
> From: Calixtre et al., J Oral Rehabil 46 (2019) 109-119. All rights reserved to John Wiley & Sons Ltd. Click here for the online summary.