Manual Therapy For The Treatment Of Temporomandibular Disorder New Research
You notice some pain in your jaw when chewing, which progressively worsens over several weeks. Occasionally you feel a clicking or catching in your jaw when opening and closing your mouth. Eventually you are unable to fully open your mouth and experience pain even when you speak. If you have never experienced this, count yourself very lucky. If you have, you are already familiar with the relatively common condition known as TMD.
TMD, short for temperomandibular disorder, is estimated to affect as much as 40% of the population at some point in their lifetimes, and is especially prevalent in the young. Initial diagnosis is typically made through a visit to the dentist, and the eventual treatment multidisciplinary with various management techniques. One of the lesser known treatment techniques, but something that is gaining in popularity, is soft-tissue therapy of the masticatory muscles the muscles used to move the jaw.
As a sports chiropractor using manual soft-tissue therapy on a daily basis, I have treated TMD on many occasions with success, however good research on the subject has been lacking. Recently however, this type of myofascial therapy for TMD was tested for efficacy in a randomized, controlled clinical trial. Researchers from Macquarie University in Sydney, Australia examined the clinical effectiveness of manual therapy in the treatment TMD. Specifically, they compared myofascial therapy to myofascial therapy plus self-care and education and no care (the control group in the study).
This was a private clinic-based study, with eligible participants ranging from age 18-50 presenting with jaw pain with or without joint sounds of at least 3 months and a willingness to participate in the study. Patients with physical or psychological contraindications were excluded. The outcome measures were jaw pain at rest, jaw pain upon maximal active opening, and jaw pain upon clenching.
The primary therapy consisted of myofascial release of the masticatory muscles, including the temporalis, medial and lateral pterygoid, and masseter. The subjects were treated twice per week over a period of 6 weeks for a total of 12 therapy sessions. Additionally, one group was given additional education and self-care consisting of self-mobilization, exercises and stretching, as well as general education on TML anatomy, biomechanics, disc displacement and dysfunction, and the role of psychoemotional factors contributing to TMD.
The results showed a statistically significant positive efficacy for both the myofascial therapy only, and the myofascial therapy plus education and self-care groups. Not surprisingly, the therapy plus self-care group showed a better 1 year outcome than the therapy alone group a trend that has been supported for the care of most musculoskeletal conditions.
Although the results of this study are no surprise to those practicing manual therapy, it serves to reinforce what we already know anecdotally. For patients suffering from TMD there is now evidence for another great intervention, and for manual therapists not currently treating TMD, there is a great opportunity to expand your skillset and serve those in need.