Manual Therapy For TMJ Pain
There are a variety of treatment approaches for TMJ Pain. One method that consistently shows a good outcome is Manual Therapy. Manual Therapy is the application of a small force to a joint and it's surrounding soft tissue structures in order to improve range of motion and position. Manual Therapy can be accomplished by hand or by a hand held instrument that applies a predetermined amount of pressure. Appropriate questions for this approach would be the following:
- Does it work ?
- Does it hurt ?
- What are the risks ?
- Who shouldn't receive manipulation ?
- Who should provide it ?
Does It Work ?
The short answer is yes. A recent article in the Journal of Clinical Medicine looked at the outcome of manual therapy in the medium to long term effects on both pain and maximum mouth opening. They concluded the following:
" A significant improvement in pain and mouth opening compared to baseline was observed after manual therapy treatment."
These authors looked at the effects of both manual therapy alone, and manual therapy with the addition of exercise and found that combining the two gives a better long term outcome. Makes sense to me.
Does it Hurt ?
Who doesn't want to know the answer to this one before they get started ? The short answer: a little. While some people present for care with little pain to start with ( more clicking or limited opening) most come in with pain and tenderness associated with limited mouth opening. This represents inflamed and tender muscles, ligaments and joint tissue. If it starts out sore, just about anything you do to work on it manually is going to provoke a little pain. Treatment should never be unbearable or more than you can handle! If it is it will activate your normal guarding reflex and this is counterproductive. A good manual therapist knows how much pressure to apply and when to back off. In addition some additional physical modalities like cold laser, ice and heat can be helpful as can natural and over the counter anti-inflammatories. Typically as normal function is restored to the TMJ subsequent manual therapy sessions will be less and less painful.
What Are The Risks ?
Risks are going to be directly related to the proper patient selection, and the experience of the practitioner. The TMJ is a delicate joint with a lot of neurology around it, and when it is not working right it can be very sensitive to even the slightest insult, even therapeutic ones. A proper assessment and diagnosis will determine if you have a condition that would benefit from manual therapy or should be treated in another way. Assuming the initial assessment was correct (make sure you see someone who knows what they are doing !) the biggest risk of using manual therapy would be aggravating the existing pain. This does occur, but when manual therapy is done properly and in stages the pain boundary can be determined and respected while at the same time allowing progress.
Who Shouldn't Receive Manual Therapy ?
There are definitely some patients in whom manual therapy is contraindicated, but they are rare. The following would fall into the category of those who shouldn't receive manual therapy, at least not initially: Acute Jaw Trauma (being punched in the face etc. ) Potentially patients with active inflammatory conditions like Rheumatoid Arthritis of the Jaw Patients with Jaw pain from active infection in the Jaw As indicated above these conditions can typically be ruled out by a good initial evaluation. While these conditions do occur they are rare. A more common group who shouldn't receive manual therapy, at least not initially would be those patients who have a dental primary condition (abscess, cracked filling, lose crown etc. ) causing abnormal mouth opening and closing. Until the dental issue is corrected, no amount of manual therapy will give lasting relief.
Who Should Provide Manual Therapy ?
Manual Therapy is the application of a small force to a joint and it's surrounding soft tissue structures in order to improve range of motion and position. Manual Therapy can be accomplished by hand or by a hand held instrument that applies a predetermined amount of pressure. In addition manual therapists usually include therapeutic exercise instruction and modalities like laser and electro-therapy. Not all manual therapists have experience working on the TMJ even though they would have the basic fundamentals and would likely be able to help some. Manual therapy like dentistry and surgery takes time, experience and expertise to perfect. Typically manual therapy is practiced by massage therapists (usually the passive portion of muscle release), physical therapists and chiropractors. The latter two usually incorporate muscle work and exercise. Some also go a step further and understand and apply manipulation to the TMJ. Some incorporate additional advanced technology like cold laser. While all of these techniques can be helpful, getting the initial diagnosis right is key!
If you would like some help determining if manual therapy might offer you some relief for your TMJ issue, feel free to give me a call. I would be happy to help point you in the right direction if I can.
Yours in Health,
Doug Williams, D.C.
TMJ Relief Center at Care Chiropractic
134 Executive Drive #3
Lafayette, Indiana 47905
(765) 448-6489
