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Treatment of the Temporomandibular Joint (TMJ) by Debbie Cameron

Updated: Sep 16


Are you experiencing jaw pain? This is becoming increasingly common. Read more about what is causing it and how physiotherapy can help.

Do you have facial pain, or experience earache or pain if your jaw clicks or locks up, do you have difficulty chewing? Does the thought of eating a good steak or a slice of crusty sour dough bread give you a headache? If so, your temporomandibular joint is not functioning optimally, and you are suffering from temporomandibular disorder (TMD). Physiotherapy can help you to take control and regain normal movement of your mouth and neck. Research indicates that physiotherapy combined with regular practice of Rocabado exercises, created by Dr. Rocabado, help to relieve TMJ pain and return the jaw to its normal abilities.


Your temporomandibular joint is a hinge that connects your jaw to the temporal bones of your skull, which are in front of each ear. The joint lets you move your jaw up and down and side to side, so you can talk, chew, and yawn.


The term temporomandibular disorder (TMD) was first used in 1983 by the American Dental Association to describe the condition of frustratingly problematic ability of the jaw joint which could affect their patients’ chewing ability and cause them a pain that can be described as agonising.

It can be thought that jaw or TMJ disorders consist only of the jaw itself, however, the condition of temporomandibular disorder (TMD) includes any problem that affects the function of the jaw and its masticatory muscles. The diagnosis of TMD is made from clinical presentation. If you suffer with TMD, a typically sign is the reduced ability to open your mouth. Your jaw can be stiff, click or lock. Your facial muscles can ache, you can have a constant headache, pain in your jaw or neck. You can even have vertigo and ringing in your ears (tinnitus). Your jaw does not function well and activities, such as biting a carrot or chewing a piece of biltong, are impossible and cause you to miss out on so many of the things that others enjoy.

An article published in February 2020, in the Journal of Orthopaedic and Sports Physiotherapy, showed that the prevalence of coexisting neck pain for TMD sufferers ranges between 43.7% to 68%. Physiotherapists find that treating both the jaw and the neck together when working with TMD sufferers is the most effective in the pursuit to remedy disorders of the TMJ.


What can you expect from a Physiotherapy session for TMD? Your physiotherapist will assess your ability to open and move your mouth, the range of movement and quality of the upper neck vertebrae movement. The muscles in the area, along with the joints are palpated and checked for painful spasm. You may have a comfortable hot pack placed under your neck whilst your physiotherapist gently mobilises your upper cervical spine, using clinically researched techniques. To stretch out the joint capsule of the TMJ, your physiotherapist will place his/her thumb inside your mouth which is surprisingly pain relieving for your TMJ. Your physiotherapist will continue with various soothing TMJ treatment techniques to improve the condition of the TMJ joint and its disc. The treatment will end with postural correction of the jaw and an exercise programme given.


Recent research shows the benefit of postural and cervical exercises in the treatment of TMJ dysfunctions (Armijo-Olivo et al 2016). There was a good response to physiotherapy when a multi-modular approach was used that included: upper neck and jaw mobilisations, massage of the suboccipital muscles, education of the jaw anatomy and movement, posture correction, ergonomic assessment of workstations, with a home exercise programme of Rockabardo exercise plus one or two extra upper cervical stretches.


Inflammation of the TMJ needs to be considered and it is advisable for you to apply principles of protected motion such as a soft food diet for the first two weeks of treatment to prevent further strain during healing.


For some TMD sufferers where they have experienced pain over a prolong period, education of the science of pain is important. Your physiotherapist will go through with you information such as the sensitisation of the brain in response to pain and its responding overactivation of the sympathetic nervous system.


In general, people suffering with TMD have a good recovery from a six-week physiotherapy programme and experience more confidence to use their jaws normally. There are no adverse effects from physiotherapy for TMD though you may feel a little tender post treatment. Whilst your jaw will feel more comfortable after your physiotherapy session - keep in mind that full benefit is achieved usually at the end of the programme.


TMJ Rocabado Exercises

These exercises were created by Dr. Rocabado decades ago and have continued to be the exercises of choice by physiotherapists for TMJ sufferers. They are performed by the person at home, consist of six different exercises and six repetitions of each exercise, performed six times per day until symptoms subside. This might sound like a lot of exercises, but it will only take one to two minutes to complete the six.


The aim of the Rocabado exercises is to correct what physiotherapists call proprioception which means your postural position and to change the soft tissue memory of your old posture.


The programme that Dr. Rocabado created to treat TMJ includes six fundamental components: the rest position of the tongue, TMJ rotation control, rhythmic stabilisation technique, liberation of the cervical joint, axial extension of the cervical spine and shoulder girdle retraction.


The 6 Rocabado Exercises

1. Exercise number one of the Rocabado exercises has you place your tongue on the roof of your mouth. Position the tip just behind your teeth and take six deep breaths.


2. For the second exercise, keep your tongue on the roof of your mouth and open and close your mouth six times.


3. In exercise three, your tongue remains on the roof of your mouth and two fingers are placed on the chin to open your mouth against gentle resistance. Following that, place your fingers on both sides of your jaw and open six times.


4. For exercise four, place your hands behind your neck and bend your chin down as if nodding your head.


5. Move your chin down and back as if making a double chin for exercise five.


6. Hold your head back over the midline of your shoulders, i.e., don’t poke your chin forward. In this position gently nod your head whilst keeping your neck still for six repeats.


If you need help with your temporomandibular disorder (TMD) book in with us at Debbie Cameron Physiotherapy. Phone Michelle or Chantal on 031 765 8898 to make an appointment.


References:

Armijo-Olivo S et al (2016) Effectiveness of Manual Therapy and Therapeutic exercise for temporomandibular disorders: systemic review and meta-analysis. Phys Ther.

Harrison A L et al (2014) A Proposed Diagnostic Classification of Patients with Temporomandibular Disorders: Implications for Physical Therapists. Journal of Orthopaedic & Sports Physical Therapy


Reynolds B et al (2020) Effectiveness of Cervical Spine High-Velocity, Low-Amplitude Thrust Added to Behavioral Education, Soft Tissue Mobilization, and Exercise for People With Temporomandibular Disorder With Myalgia: A Randomized Clinical Trial, Journal of Orthopaedic and Sports Physical Therapy


Rocbado exercises https://youtu.be/NiqJmDHV6FI



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