By: Dale J. Buchberger, PT, DC, CSCS, DACBSP
Temporomandibular joint disorder, also known as TMD, is a disorder of the jaw and surrounding structures where the jawbone (mandible) meets the skull (temporal bone). A cushioning cartilaginous disk, also known as the meniscus, lies between the mandible and the temporal bone. Stress and trauma, such as working at a computer for long hours or being involved in a whiplash type accident, can cause damage or misalignment of the temporomandibular joint (TMJ). Clenching or grinding the teeth at night during sleep is also a common pattern of stress. This all leads to breakdown of the joint structure and the disk. Over time, the muscles that control the TMJ become tighter, causing the joint to compress and eventually tear the meniscus. As the meniscus tears, the joint surfaces begin to grind, causing further wear and breakdown. This grinding can usually be heard as popping or snapping sounds, also known as crepitus. It is not uncommon for the meniscus to “slip” out of the joint. When this happens it is called a “disk derangement”. The muscles that attach the jaw to the neck and head also cause a large number of TMD symptoms once they become “hypertonic”, meaning that these muscles are not given the opportunity for rest and recovery.
The most common symptoms of TMD are popping, clicking, and snapping sounds with opening and/or closing the mouth. It is common for patients to complain of the jaw actually locking in place and not being able to open or close the jaw for several hours. Patients with TMD have difficulty opening the mouth wide as in yawning and find it difficult to eat hard or dense foods such as pretzels, steak, or even a large sandwich. Dental examination often reveals a noticeable change in bite or uneven breakdown of the tooth surface. If the patient continues to experience chronic TMD syndrome, they will begin to develop generalized headaches, neck pain, dizziness, and even ringing of the ears.
While this disorder is commonly associated with dental care, physical therapy can offer a large number of patients with TMD significant relief of their pain and dysfunction. TMD has been associated with two key areas today: stress and postural dysfunction or breakdown. With today’s technology-driven society, stress in the neck and upper back is increasing dramatically. This can result in grinding of the teeth in an attempt to relieve stress. This is why patients are prescribed a mouth guard for sleep or even daytime hours to help cushion the grinding effect. However, the mouth guard by itself is limited and will not strengthen or correct the postural dysfunction that may have started the disorder in the first place. The keystone to physical therapy treatment for TMD is postural retraining and improved endurance of the muscles of the neck, upper back, and jaw. The Rocabado 6×6 is an established program of postural and jaw exercises developed by a physical therapist specifically for TMD. When performed as prescribed by your doctor, dentist, oral surgeon, physical therapist, or chiropractor, they can significantly reduce your TMD symptoms.
Physical therapists may also apply additional treatment methods when exercise alone is not resolving the TMD symptoms. Manual therapy techniques such as joint mobilization may be applied in order to improve the mobility and range of motion of the temporomandibular joint itself. Advanced soft tissue techniques such as Active Release Techniques® (ART®) can be used to correct joint and muscular misalignments. You can find a certified ART® provider by going to www.activerelease.com. Modalities such as ultrasound and electrical stimulation can be used to reduce inflammation of the joint and the surrounding tissues. Extracorporal Shock Wave Therapy (ESWT) is a new technology that uses an acoustic wave, or “shock wave”, to treat many chronic painful conditions of the musculoskeletal system. Also known as Acoustic Compression Therapy (AST), ESWT uses an intense but very short energy wave that can be applied to the TMJ and surrounding muscles to decrease restrictions and improve circulation. Combining a program of postural exercises with manual joint mobilization and advanced soft tissue techniques provides a comprehensive approach in the physical therapy management of TMD.
If you believe that you display symptoms of TMD, you should make an appointment with your dentist and/or oral surgeon for a complete dental evaluation to be sure that there is not an underlying dental cause of the TMD. Once a dental cause has been ruled out, you can request a physical therapy order from your doctor, dentist, or oral surgeon for treatment of TMD. Physical therapy treatment can be safely rendered in conjunction with dental management strategies. In the end, the best chance for resolving TMD pain and symptoms is a medical-dental team approach that includes physical therapy treatment and rehabilitation.