TMJ Lecture Flashcards
What mm are involved with elevation (4)
Masseter, Temporalis, Medial Pterygoid,
Superior fibers of Lateral Pterygoid (Stabilize
disc
What mms are involved with depression
Inferior Fibers of Lateral Pterygoid,
Suprahyoids, Infrahyoids (Indirectly)`
What mm are involved with protrusion
Superficial masseter, Medial pterygoid, Lateral pterygoid
What mms are involved with retrusion
Deep fibers of masseter, temporalis, digastrics
What mm are involved with laterla excursion
Ipsilateral temporalis and masseter,
contralateral medial and lateral pterygoids
How would u perform an opening MET - agonist
- place hand below patients chin
- keep c spine neutral
- depress mandible to mm barrier without letting cervical spine move
- tell patient to give ight contraction , attempting to open mouth wider and then after 8 seconds have them relax and take a deep breath and open as if yawning and do it again
How would u perform an opening MET - antagonist
- place thumb on bottom teeth , grasping lower jaw
- depress mandible to mm Barrier without l;eating c spine move
- tell patient to give light contraction as if they were trying to close their mouth but PT stop them
- hold for 8 seconds then have pt take a deep breath and open mouth then repeat
What mm is the biggest mm involved with opening (depression)
Masseter
How do u perform protrusion MET - agonist
- grasp lower jaw with fingers under mandible
- position thumb behind the bottom lip at the bottom of teeth
- tell patient to give light contraction to prove jaw towards the ceiling (under bite)
- hold for 5-10 seconds and then relax
If you were trying to improve the L lateral excursion how would u work the agonist vs the antagonist
Agonist: PT retrsict on the L side and have patient move towards the restriction
Antagonist: PT restricts on the L and have patient move mouth to the R
How would u perform sub occipital MET agonist
- supine at barrier of upper cervical flexion
- instruct patient to look up as far as they can using only their eyes on contraction
- relax and repeat
Where does the therapist stand during TMJ mobilization
Contralateral side
What mobilizations can u do for the TMJ
- distraction
- anterior
- lateral capsule
- IR/ER rotation
What is 1 option when doing soft tissue massage for the masseter
Have pt make fists and place knuckles at the top of massester
Tell patient to slowly open mouth while applying pressure thru knuckles , while dragging fists down the chests
How to perform opening self MET (massester)
Upright posture
Take hand with thumb hooked on lower teeth
Patient depresses jaw to pain free barrier
Patient contracts with 10% isometric contraction for 8-10 seconds
Deep breath and perform “yawn”
Performed 3 times in a row, 6-8 times a day
May need to perform in front of a mirror to make sure posture is correct
If want to work on the agonist mm then put fist under jaw and try to open it
How to perform Protrusion Self MET (Lateral Pterygoid)
- Jaw is loaded with gravity or light push from arms straight posteriorly with
teeth slightly apart - Have patient rest elbow on knee and bend head to hand
- Patient performs isometric underbite
- Hold 5-10 seconds with 10% contraction
- Breathe deeply and relax jaw to new barrier
How to perform Lateral Excursion Self MET (Lateral Pterygoid)
- Have patient perform lateral excursion to maximum then resist into or away
from the motion (make sure teeth are slightly apart, ~2MM) - Hold 5-10 seconds with 10% contraction
- Breathe deeply and relax jaw to new barrier
What are some things to do for TMJ NM re ed/motor control/ strength
- rhythmic stabilization
- TUTALC opening
- tongue roll opening
- N exercise
- tongue clucking
What does TUTALC mean
Tongue Up, Teeth
Apart, Lips Closed
How can u progress TUTALC opening
Allying lips to part , but keeping tongue on roof of mouth
What is tongue rolling opening good for
Suprahyuoid facilication as well as opening
If a patient is doing the N exercise and u see their neck moving then what is happening
Suboccipiatals are on
What is tongue clucking good for
Suprahypid facilitation and forward head
What are the steps for midline assist exercises for normal opening/closing
Step 1: patient to manually assist the jaw to open in straight pattern
Step 2: patient to not manually assist, but provide tactile cueing through
hand while opening in straight pattern
Step 3: no tactile cueing. Patient instructed to open in straight pattern with
visual feedback from mirror
Step 4: instruct patient to perform straight opening without any visual or
tactile cues; PT to check how well patient is able to perform
