TMJ treatments Flashcards
(17 cards)
What has been shown to be most effective when treating TMD?
- therapeutic exercise and manual therapy
What is some patient education for those w/ TMD?
- Tongue position on roof of mouth w/ teeth 2-3mm apart
- lips together, breathing thru nose (diaphragmatic breathing)
- softer food, smaller bites
- avoid: uncontrolled yawning, gum chewing, nail biting, resting chin in hands, stomach sleeping
- stress reduction and sleep (7-8 hours)
- night splint, bite guard for nighttime
What needs to be strengthened and lengthened for proper posture?
Activate/strengthen:
- DCF
- cervical extensors
- scapular retractors
Lengthen/flexibility:
- suboccipitals
- scalenes, SCM
- Pectorals
What is the best treatment for joint inflammation?
- joint protection (parafunctions, chewing & ROM)
- ice
- iontophoresis
- education
What is the best treatment for joint mobility?
- joint mobilization
- PROM/AROM with caution
What is the best treatment for disc or articular dysfunction?
- address impairments of joint pain and reduced ROM
- conservative therapy will not alter disc displacement or degeneration significantly
- DDWOR: educate pt about remodeling phase, noise and motion should minimize over time
What is the best treatment for masticatory muscle dysfunction?
Things for muscle pain/guarding:
- modalities
- manual therapy
- stretching
Things for muscular imbalance/motor control:
- stabilization exercises
- proprioception
What is the best treatment for the psychological aspect?
- education about parafunctions, pain sensitization, joint protection
- pain modulating strategies (exercise, diaphragmatic breathing, stress reduction techniques, relaxation)
What are the parameters for soft tissue mobilization for TMD?
Focus on masseter, pterygoids, and temporalis:
- gloves if intraoral
- 5-30 seconds at a time
- communicate w/ pt
- expect soreness and possibly rebound headaches
- LESS than 7/10 pain (hurts so good)
What are parameters for joint mobs for TMJ?
- same as normal ones
- focus on hypomobility motions
- be gentle
What are the Rocabado 6x6 exercises?
1) nasal breathing
2) controlled TMJ rotation on opening
3) mandibular rhythmic stabilization
4) upper cervical distraction (OA nodding)
5) axial extension of cervical spine (chin tuck)
6) shoulder girdle retraction (w/ thoracic ext)
What is involved with nasal breathing?
- diaphragmatic breathing
- tongue position on roof of mouth w/ teeth 2-3mm apart
- lips together, breathe through nose
What is involved w/ controlled opening?
- tongue on roof of mouth
- palpate TMJ
- slowly open/close mouth as far as possible with tongue still on roof of mouth
What is involved w/ joint stabilization exercises?
- isometrics on mandible
- ALL directions w/ the force of 1 finger
- hold 5-10 seconds
What is involved w/ cervical postural exercises? (4-6 rocabado)
Cranio-cervical nod, axial retraction (chin tuck), and scapular squeezes/thoracic extension
- upper trap, levator scap, and scalene stretching
- pectoral stretching
- strengthening of rhomboids, middle/lower trap
What is involved w/ TMJ proprioception?
Use surgical tubing or heavy theratube
1) deviate away from pain
2) deviate, soft bite, relax, return to midline
3) deviate, soft bite, maintain bite, back to midline
4) protrude (then repeat 3 & 4)
5) deviate or protrude, gently pull-on tube
What is the theory of condylar “remodeling”?
- idea is to normalize forces between disc and musculature
- co-contraction enhances stabilization
contralateral lateral deviation will gap and glide the condyle anteriorly on the eminence while the disc remains positioned correctly
- biting in this position creates a co-contraction of the musculature acting on the disc and facilitates stabilization
