Temporomandibular Disorders (TMD) is the result of dysfunction to the jaw muscles, joints, and other structures. These dysfunctions can lead to impairments and functional limitations affecting everyday tasks. It becomes important to recognize potential strategies to manage TMD.
Treatment of TMD is not only directed at the temporomandibular joint (TMJ) but can be because of the cervical and thoracic spine. Also, it is beneficial to recognize any postural dysfunction that can affect functional mobility.
Exercises should be directed to the TMJ if there is suspected involvement in that anatomical region. However, there may be other contributing factors that may be causing TMD.
There are various exercises and manual techniques that are used for TMD as they can be helpful when the cervical/thoracic spine is involved. Some areas that we should incorporate are postural reeducation, directed manual therapy for the cervical and thoracic spine, and to develop strategies to reduce potential impairments and functional limitations.
Some common exercise used in the clinic are retraining deep neck flexors:
- Chin tucks
- Isometric holds
- Deep neck flexor exercises
We also want to make sure that we are targeting postural musculature. Our postural muscles help us with various tasks throughout the day and are responsible for ensuring we don’t compensate with other strategies, potentially resulting in injury or dysfunction. Some common exercises may include:
- Band rows
- Low rows
- Shoulder scaption
- Core stabilization
- Motor control
Exercise is a great way not only to become stronger, but to help our body learn how to use our muscles more efficiently. Sometimes to enhance motor learning, we may need to implement additional interventions to help us achieve the desired outcome.
Manual therapy is a terrific intervention to help create a stimulus to a targeted area to reduce pain, decrease disability, and improve overall function.
Furto et al1 looked at clinical outcomes (pain, disability, and function) for patients with TMD that were treated with manual physical therapy (2006). Manual physical therapy interventions included nonthrust manipulations for facet upglides and downglides to facilitate normal facet joint motion, subcranial forward bending and side bending non thrust manipulations, and subscranial myofascial distraction.1 Stretching was also included to cervical musculature as well as non-thrust temporomandibular joint manipulations consisted of long axis distraction, medial glides, and lateral glides.1 Acupressure was also applied to the lateral pterygoid musculature as well as condylar remodeling exercise program, by Rocabado, was implemented and iontophoresis with dexamethasone was use for patients where range of motion was restricted primarily due to pain.1 The patients had a follow-up 2 weeks after where disability and pain improved.1
Exercises + Manual Therapy
Evidence has demonstrated that a multimodal approach including manual physical therapy interventions plus exercise, with or without iontophoresis with dexamethasone, can yield clinically meaningful improvements in disability and perceived change.1 Nicolakis et al2 used similar interventions that included nonthrust manipulative therapy directed at the TMJ and isometric exercise program to promote stabilization of the TMJ. The results demonstrated exercise can be helpful for treatment of anterior disc displacement with reduction.1-3 Further research is warranted as these results provide valuable insight for the management of patients with TMD.
The combination of exercise and manual therapy has been heavily researched. Literature has demonstrated that the use of both exercise and manual therapy is optimal. Manual therapy helps to create a stimulus, while the exercises help to reinforce it.
Article Written By Eric Trauber, PT, DPT, OCS, CSCS, FAAOMPT
Furto ES, Cleland JA, Whitman JM, Olson KA. (2006). Manual physical therapy interventions and exercise for patients with temporomandibular disorders. The Journal of Craniomandibular Practice, Volume 24, Number 4: p. 283-291.
Nicolakis P, Burak EC, Kollmitzer J, Kopf A, Piehslinger E, Weisinger GF, Fialka-Moser V. (2001). An investigation of the effectiveness of exercise and manual therapy in treating symptoms of TMJ osteoarthritis. Journal of Craniomandibular Practice, 19: p. 26-32.
Nicolakis P, Burak EC, Kollmitzer J, Kopf A, Djaber-Ansari A, Piehslinger E, Fialka-Moser V. (2000). Exercise therapy for craniomandibular disorders. Arch Phys Med Rehabil, Volume 81: p. 26-32. 1137-1142.