TEMPOROMANDIBULAR JOINT PAIN (TMJ ) AND ITS TREATMENT - myofascial perspective view for physiotherapist

 

Hello,my dear budding therapist, 

This is an article regarding physiotherapist perspective of TEMPOROMANDIBULAR JOINT PAIN…… 

Everything I talked about in this article is completely based on my personal experience such as HOW I handled my first client who had a temporomandibular joint pain & HOW DOES  trigger point dry needling therapy  and myofascial trigger point release plays an important role in  alleviating the symptoms. 

 I am a PHYSIOTHERAPIST cum ANATOMIST having some sort of experience in manual therapy stuffs like myofascial trigger point therapy, dry needling procedure & I am successfully running a PTERYGOID CLINIC in Coimbatore,Tamilnadu, India.

Before I really get into the topic further, let me clarify one thing…!!!So many good blogs and resources are available  about temporomandibular Joint (TMJ) issues.

But Here,I wish to add my personal outlook towards TMJ disorder.

If you get bored while reading this blog NO WORRIES  please find some good articles, which are freely and readily available on the internet. But if you have GUTS to continue to read this, then you will definitely get a 2  BONUS one at the middle of this article other one is the end of this article.

Let us start our journey...now!!!! 

Wear a seatbelt…!!

One day evening in my clinic, 

I was treating a patient who had severe shoulder pain, during that very moment, like any other Physiotherapists in the world HOW they manage their client…?

In that similar way myself engaged in myofascial release stuff on that shoulder guy. Sooner, the day of his treatment session is about to get over.....

As soon as I completed the shoulder guy …!!!!!!!!!!!!!!!!!

Next, the new client enter a room and she was about middle age respected women,

I asked her, How can I help you, madam,..?

Mmmmm...She told her chief complaints & history as follows with a broken hoarseness voice (similar to an alto type of voice.) 

Three weeks before, she went to the dental clinic for her ROOT CANAL procedure and she completed her treatment course

Due to that some time consuming  procedure she had pain over the temporomandibular joint since she must open her mouth in open static posture for a period of the time and She got an ulcer in and around buccal mucosa of the mouth due to that same procedure.

Chief complaints is following :

1.Severe pain over the right temporomandibular joint region which often extend into the right , front and top  side of the head,

2. She couldn't even open her mouth  slightly due to pain,

3. Whenever she tried to open her mouth she felt tremendous pain is appreciated over the right TMJ region.She is always ouch…..when she attempts, she takes her hand to cover the temporomandibular joint to protect response.

4.For time being ,she is totally depending on a liquid diet since she was unable to open her mouth fully.

5. Even though she tried to open her mouth slightly it got a deflection.  

 

6. Moreover ,Importantly she is not under any medication though she's having severe pain.

And last but not least she told me shocking news which was, "Dr.Anand is the person who referred me to you doctor."

As soon as she said, 

Seriously, I was weird and I got angry at him.

You guys really want to know the reason why I got angry at him...?

Please continue to read to know the true answer.

The answer is very quite simple, 

I don't  KNOW ANYTHING ABOUT & HOW TO HANDLE THE TEMPOROMANDIBULAR JOINT DYSFUNCTION PATIENTS expect anatomical parts. 

Now I can guess.!!!, you are also weird.

I do remember, once upon a time I released temporalis muscle for my mother for her headache management.

      

Except for that incident which I did above with my mother, I never ever touched the tiny part of the temporomandibular joint to treat TMJ dysfunction.

YES, you should believe me. 

I didn't see any single case of temporomandibular joint dysfunction in my career, Even though I got trained and certified from renowned expert persons like Dr.Rajkannan and Dr. Mohammad Kasim ( one of the mentors in my life) who treated  'N' number of patients and trained  'N' number of physiotherapists. 

Here, I would love to share a few words about both of them. These two people are not only having excellent skills, they are always dedicated, dynamic and passionate about the physiotherapy profession.

Once in a while 

My dear friends, Now you came to know the reason why I got angry at Dr. Anand? 

I can recall now, I talked about once regarding my certification of TMJ to Dr.Anand.

Guys don't mistake me, he is no stranger, he is one of my best friend too.That's why I have the right to have anger at him.

I thought he could have said earlier so I can be prepared at least.........

like that, so many things running on my mind on that very moment.

But, all of sudden she entered 

inside the clinic for her treatment, I have to do something, so that I take a tour on assessing her TMJ issues, I did the general examination & taking all of her history clearly.

when it happened ? how did it happen?

How long have you suffered from the problem?

Does it hurt all the time?

Is this pain disturbing your sleep?

Asking so many questions to her, I  got a clear picture of her history 

I don't even know that was a correct diagnosis, but I concluded the issue might be a myofascial in origin.

Then I started explaining the treatment plan and protocol to her. Since, I was an  Anatomist, having a little clarity about muscular attachments & palpation skills which I have led to promote the dry needling technique.

Forget to tell you, I was so obsessed and more confident with dry needling technique and a firm believer in trigger point release therapy, that the reason I promote those techniques.

Unfortunately, she won't agree because she is having a needle phobia. 

Then I said, no problem. don't worry

It's ok we can try alternative methods called a trigger point releasing technique.

I did some release stuff on temporalis and masseter muscles with that first-day session.  I asked her to  review day after tomorrow

you know why I do have an extra one day,  meanwhile, I can be prepared well about the condition.

People You know life sucks sometimes, due to my busy schedule I have forgotten that lady ...

I continue my work on the next day as on my regular schedule basis.. 

Like everyone 

Day after tomorrow comes to me,...

The evening I entered my clinic, I got another surprise waiting for me...

That was nothing, the temporomandibular joint dysfunction lady sitting in the reception of my clinic as a first client for her review on that day. 

In my mind, I said oh my God ... What am I going to do now.........?

Then somehow I develop confidence within me, calling her inside for the treatment . I repeat the same stuff on her TMJ which I did on my first day of her treatment.

But, the major difference is this time I handle the situation more confidently.

Friends, with NO exaggeration seriously I have not yet updated or done any research about TMJ ISSUE till on the 3rd day of her review. 

I did my reassessment. Pain level comes down, the pain extends into the face and the top of the head (referred pain )is abolished.

But, still, mouth opening is restricted...

This time she said to me, "I am much better now I can open my mouth a few centimetres doctor."

Literally speaking, I couldn't figure out or I was unable to find the difference in her mouth opening. 

You know why?

REASON :

Perhaps, all of you know because you are people are so BRILLIANT 

YES, YOU ARE EXACTLY CORRECT!!!!

I couldn't treat any TMJ dysfunction clients.

 

I said to her, ``That was fine and you're doing great." Can I start the today session?

"Okey" doctor, immediately she replied.

Then I just before starting the treatment.

She suddenly asked me please wait for a doctor,

" can I try  DRY NEEDLING PROCEDURE which you explain me on the DAY ONE "

Have you remembered?  you told it's too much effective.

I was very much impressed when she asked about that dry needling !!!!!! 

Without wasting on my time, 

Once again I explained all the techniques of dry needling procedures and got concern form from her. With extreme safety precautions, I did 25 mm dry needling on her masseter and the temporalis muscle, then I  did some jaw distraction technique, taught self-massaging technique on masseter temporalis muscles.  

Then I ask her to review on.....?

REASON, no fun telling, already you know guys, as the usual day after tomorrow.

I already said no, you guys are AMAZING and BRILLIANT !!!!

Then, she visited the clinic for her 4th review, 

Though I don't know how to properly assess the TMJ.

Still, I am eager to assess her to see whether she has improved or not...... So and so... 

Please forgive me one more time guys. Unfortunately, this time I also have not read anything about the TMJ issue... Whatever I said is true and told from my heart.

But what really happens after 4 days???

The beauty of 4th-day visit, 

She said doctor I completely CURED. 

I very much Conscious using the word CURED, yeah she cured. 

She said: Now I can open my mouth with no pain or restricted or deviation 

"I completely cured the doctor "

I surprised with her words, you did some 

" MAGIC "doctor and she continues to narrate her story....... 

Initially, I couldn't open my mouth due to severe pain. Now everything has gone. I can open my mouth fully...

In my mind I said 

It's not about the magic of me .,

It was about the MAGIC of trigger point release therapy and dry needling stuff...... 

After that, I started to do more research on TMJ issues from a physiotherapy perspective as well as dentist, research is continuing till date.

Due to my hard work on this topic, real magic has happened in my life and changed my career into a different level. I want to share those things also to you..

The magic is to change my  life into totally a different path and become an........ 

You want to do that, hey please wait ……!!!! wait …..!!!!!!!!! wait……. 

I will explain those secrets in my next BLOG..!!!!! 

Conclusion and take-home message of this my experience to all of the therapist is 

Whenever you get patients on TMJ issue 

1. Don't panic or be scared, it is like any other joint in your body so easy to treat.

2. Learn some basics about trigger points and it's releasing technique which may help to educate and convince the patient as well as treating patients who have TMJ disorders. 

     3.Master with a Masticatory muscular system once you did, you will most of the time be successful in treating TMJ clients, Because more than half TMJ  issue is often myofascial in origin.

      4. The temporomandibular joint, the only joint is coming under both DENTISTS & PHYSIOTHERAPISTS curriculum. and both of them are giving their own way of treatment for patients who are all having TMJ issues. 

So,  the  final key point is,

DON'T IGNORE this joint, because extremely very few dentists know about myofascial trigger point, even though they knew they don't know how to release it.

 

The dentist was busy with operative procedures. But I can promise as a physiotherapist you guys are expert in those releasing stuff.

Once you master to treating TMJ, 

you can stamp your footprints in the field of head and neck department... 

Remember you are taking the physiotherapy field into the next level in our society and improving their quality of life in so many people... 

before I close,

I won’t tell you one more point, remember once you followed me what I said so far... 

You are great and you are building relationships with more and more people in life..... 

To become successful in life 

Build the relationship we can't get success in our life without the help of someone, what I mean whoever alive on the earth is dependent on somebody or something.....!!!??

Wish you all the very best for a future career in TMJ disorders 

Thanks and best wishes from

Dr.Mahendran.M