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TMJ issues impact 5 out of every 100 persons and can be severe. One in every five TMJ patients seeks treatment. TMJ therapy may be expensive and impose a significant socioeconomic hardship on the client. Physiotherapy at home, chiropractic, and splint therapy are available. Tempero-mandibular disorders (TMD) can result in various symptoms, such as headaches, ringing in the ears (tinnitus), face discomfort, and neck pain. TMD can result in considerable functional constraints, such as the inability to consume hard foods or yawn comfortably and persistent, intractable pain.
TMD is categorized into many groups based on the pathology; the most prevalent diagnoses include TMJ discomfort of myofascial origin, intraarticular disc subluxation with relocation, intraarticular disc subluxation without relocation, arthritis, capsulitis, and sprain/strain.
Patients’ therapy options can be complicated as well as costly. Physical therapy at home with Gold Medal Physiotherapy can be a low-cost and effective treatment option for TMD sufferers. Biological treatment and splint therapy have frequently been contrasted in studies, with splint therapy proven more beneficial than physical therapy.
Physical treatment in this research was confined to ultrasonography and exercises. A physical therapist does far more than provide US and practices. A physical therapist who specializes in TMJ treatment has a toolbox full of treatments such as manual therapy, manipulation, postural retraining, iontophoresis, ASTYM, soft tissue mobilization techniques, and guided relaxation. This blog aims to educate patients on the efficacy of various treatments used by physical therapists and certain self-management strategies.
PTs frequently recommend exercises for self-management, to establish a balance/relax the muscles of mastication, to enhance neuromuscular coordination, mobility, and to counteract joint clicking. Moraes et al. discovered activities useful for treating muscular TMD’ in a systematic analysis of 7 studies that explored therapeutic exercises for TMD, which included stretching, relaxing, coordination, strengthening, and endurance.
Soft tissue mobilization: A professional and trained TMJ therapist must employ intra-oral methods. Localizing and treating the Lateral pterygoid, frequently a source of discomfort for patients, is highly difficult. The lateral pterygoid has been demonstrated to be difficult to find and treat. However, with sufficient training in intra-oral finger insertion, the trigger point may be identified and treated. Most studies have found soft tissue mobilization ineffective as a stand-alone therapy for jaw discomfort.
Manual Therapy: Manual physical therapists treat TMD with various joint mobilization and high-velocity thrust procedures. A few studies have indicated that when combined with a home exercise regimen, there is a considerable increase in jaw mobility and pain reduction. These findings are intriguing since joint mobilization may treat the deep muscles of the jaw more effectively than soft tissue mobilization approaches.
Joint manipulations: Jaw and upper neck joint manipulations have been demonstrated to enhance jaw mobility and reduce pain in treating jaw discomfort. While spinal manipulation targeting the upper cervical spine has been proven to improve pain and motor function in TMD patients, the long-term effects are unclear. However, considering that Dunning et al. observed a substantial improvement in neck discomfort, disability, and motor function of the deep cervical neck flexors 48-h after spinal manipulation at C1-C2 and T1-T2 vs. grade IV mobilization, the effects are unlikely to be transitory.
Dry needling and acupuncture: Acupuncture and dry needling can help patients regulate their discomfort and increase mobility. Few studies have indicated that frequent dry needling reduces pain and improves mobility in TMD patients. The chart depicts the many spots that are commonly utilized in dry needling. ST7 is significant because it targets the inferior bundle of the lateral pterygoid. Masseter and temporalis muscles are frequently implicated in TMD patients, and treating them may give positive outcomes. Traditional acupuncture has been demonstrated to be useful in people suffering from jaw osteoarthritis.
Several studies have found that increased blood flow to joints due to acupuncture may assist the recruitment of opioid-producing immune cells needed to lower inflammatory cytokines. There is also evidence that acupuncture may improve hyaluronic acid levels, allowing synovial fluid to lubricate the joint better. Given Scully’s TMD mechanism, it may be especially beneficial to target classic acupoints GB2 and SI19, which are physically positioned immediately above the TMJ posterior capsule.
Electrotherapy: PTs frequently employ modalities such as TENS, US, iontophoresis, and interferential treatment. TMD is also treated by physiotherapists using ultrasound and laser. Even though no strong data supports using these electrotherapeutic modalities, PTs never utilize them as a stand-alone treatment.
Splint therapy: Even though PTs are not part of the PT’s treatment plan, we believe patients must grasp the advantages of splint therapy. Al-Ani et al. discovered inadequate evidence to support the use of splint therapy for TMD treatment in a 2004 Cochrane study. Niemela observed that splint therapy, counseling, and masticatory muscle exercises were no more helpful than counseling and masticatory muscle exercises alone after treating 80 consecutive TMD patients. Similarly, Nagata et al. discovered no additional short-term effect of splint therapy in TMD patients receiving multi-modal treatment (self-exercise, cognitive therapy, self-management education, and manipulation).
Quintus et al. looked at the long-term effects of splint therapy. After one year, 27.6% of TMD patients who underwent splint therapy and 37.5% of TMD patients who received counseling and directions for strengthening masticatory muscle exercises reported very good’ therapeutic outcomes, respectively. Even though 16/40 individuals in the counseling and exercise group were shifted to the splint therapy group due to unpleasant TMD symptoms, both groups saw a moderate decrease in pain. Furthermore, splint treatment did not outperform counseling and self-exercise recommendations.
This data shows minimal evidence supports splint therapy, strengthening exercises, electrotherapy, and massage in treating TMD. According to the research, a combination of mobilization and manipulation of the neck and jaw, dry needling, and acupuncture or electro-acupuncture can be beneficial in treating TMD.TMD is managed by therapists, chiropractors, and massage therapists at Gold Medal Physiotherapy in Gurgaon.