Ever wondered about TMJ?
Perhaps you or someone you know was told that they have TMJ, or that they needed to have their TMJ looked at. But for many, “TMJ” is simply a term thrown around to describe jaw pain, or clicking/popping. In this article, we’ll explore the basics of temporomandibular joint (TMJ) issues, including temporomandibular disorders (TMD) as well as treatment options supported by the research.
Let’s start with the basics…
The Basics: TMD & TMJ
For starters, TMJ stands for temporomandibular joint. It’s the joint responsible for connecting your jaw to your skull. We use the TMJ during chewing, sucking, swallowing, speaking, and opening our mouths. So it’s a pretty important facial joint. And pain or dysfunction at that joint leads to often times serious limitations in daily activities.
Now, what is a TMD? Temporomandibular disorders (TMD) include a group of symptoms such as pain of the temporomandibular joints (TMJ), masticatory muscles (muscles involved in chewing), or surrounding areas, dysfunction of the TMJ including decreased mobility and crepitation (crackling or clicking) [2].
Patients experiencing pain from TMDs often are left with expensive treatment options, if they’re able to find treatment options at all. Often times, these patients seek out treatment and evaluation from dentists and orthodontists. In fact, up to 65% of adult patients seeking orthodontic treatment experience a painful TMD [3].
Now, despite the fact that physical therapy (PT) has ben shown to be one of the most successful conservative treatment options for TMD, many dentists and orthodontists are unaware of its benefits [1]. So, most patients who seek out treatment for a painful TMD, don’t ever get referred to a physical therapy clinic. That’s one of the reasons that we advocate for a multidisciplinary approach to management of patients with TMD. Basically, having different disciplines (like dental and physical therapy providers) work together to help a patient in pain can yield improved clinical outcomes & patient satisfaction.
Given the research findings about physical therapy’s effectiveness in treating TMD, it’s important to take the time to understand understand those benefits more fully. Who knows? It might actually save your or someone you know time, effort, and money in the long run.
Treatment Options for TMD: What the Research Shows
So what exactly does the research say about physical therapy treatment for the TMJ and painful TMDs? Check out this quote from a study published in 2021:
“Physical therapy (PT) has been shown to be one of the most successful conservative therapies for Temporomandibular disorders (TMD).” [1]
Well that sounds promising, doesn’t it?
Now, as I often tell patients: there’s no silver-bullet treatment for any diagnosis or disorder, TMD included. In many cases, physical therapy treatment may best work alongside treatment by a dentist or orthodontist; hence that multidisciplinary approach mentioned above. But the research suggests that, if you’re experiencing pain at your jaw or TMJ, a referral to physical therapy is a good idea.
Let’s a take a closer look at what the research says about PT treatment for the TMJ.
How affective is physical therapy treatment for TMD?
According to one study, PT treatment showed statistically significant improvements in patient-reported pain levels following treatment for TMD [4]. Basically, “statistically significant” is a fancy way of saying that those improvements were not likely due to random chance, but that the PT treatment actually had a positive effect.
PT treatment has also been shown to be effective in reducing myofascial pain & restoring coordination in the TMJ in patients with hypermobility joint syndrome (HJS) [2]. Put another way: PT treatment for TMDs has been shown to decrease muscle pain in the TMJ. This also helps improve coordination and movement at the TMJ.
Patients who received PT treatment for TMD also demonstrated statistically significant improvement in maximum mouth opening with & without pain [4]. One of the limitations that TMDs cause is a decreased ability to open the mouth fully. It stands to reason that, if the pain and coordination gets treated effectively, that you’ll be able to open your mouth more without pain.
And finally, patients with TMD referred to PT showed greater improvements in reported average pain, worst pain, and maximum range of mouth opening than those who do not undergo PT treatment [4]. Again, another finding in favor of treating TMDs with PT.
What may PT treatment for TMD include?
Now, that we understand how effective PT treatment can be for TMDs, let’s look at what treatment may include.
According to the research, treatment for TMD aims at reducing myofascial pain and restoring coordination of the mandible. Basically, the goal is to reduce the overall pain felt at the jaw/TMJ and improve the strength, motion, and coordination.
Treatment techniques often include manual therapy of some kind. This may involve myofascial release and other manual techniques aimed at addressing the muscle pain & tension that may be present at the TMJ. Post isometric relaxation techniques, trigger point therapy, fascia relaxation techniques, stretching of the neck muscles, exercises, and home programs are also included in PT treatment of TMDs [2].
Summary
TMDs can be complex and there’s often no one-size-fits-all treatment technique to address them. For best results, PT and dental/orthodontic providers should coordinate care to ensure that all the bases are being covered.
References
[1] Dr. Aatif Riaz Sayed, Dr. Nainik Mehta, Dr. Kanwar Singh, Dr. Karandeep Singh, Dr. Pranav Handa, Dr. Atul Arunrao Sanap. (2021). Knowledge and Attitude of Dentists towards Physical Therapy for the Management of Temporomandibular Disorders. Annals of the Romanian Society for Cell Biology, 986–994. Retrieved from https://www.annalsofrscb.ro/index.php/journal/article/view/9389
[2] Kulesa-Mrowiecka M, Piech J, Gaździk TS. The Effectiveness of Physical Therapy in Patients with Generalized Joint Hypermobility and Concurrent Temporomandibular Disorders—A Cross-Sectional Study. Journal of Clinical Medicine. 2021; 10(17):3808. https://doi.org/10.3390/jcm10173808
[3] Lai, Y. C., Yap, A. U., & Türp, J. C. (2019). Prevalence of temporomandibular disorders in patients seeking orthodontic treatment: A systematic review. Journal of Oral Rehabilitation, 47(2), 270– 280. https://doi.org/10.1111/joor.12899
[4] MI, B., JO, N., & JE, Q. (2018). Using physical therapy to treat temporomandibular disorders. A cohort study. Journal of Dental Science, Oral and Maxillofacial Research, 1(1), 31–35. https://doi.org/10.30881/jdsomr.00008
