What is the physical therapy (PT) for severe degenerative right Temporomandibular Joint (TMJ)?

From the Guidelines

Physical therapy for severe degenerative right temporomandibular joint (TMJ) disorder should prioritize a multimodal approach including supervised jaw exercise and stretching, manual trigger point therapy, and cognitive behavioral therapy (CBT) with or without biofeedback or relaxation therapy, as recommended by the most recent guideline 1. The goal of physical therapy is to reduce pain, improve jaw function, and prevent further degeneration.

• A comprehensive program should include gentle jaw exercises, such as controlled mouth opening exercises, lateral jaw movements, and isometric resistance exercises, performed 3-4 times daily with 10 repetitions each.
• Manual therapy by a skilled physical therapist should include gentle joint mobilizations, massage of the masseter and temporalis muscles, and myofascial release techniques, twice weekly for 4-6 weeks 1.
• Heat application for 15-20 minutes before exercises and cold packs for 10-15 minutes after can help manage pain and inflammation.
• Patients should also adopt lifestyle modifications, including a soft diet, avoiding extreme jaw movements like wide yawning, and practicing proper posture to reduce TMJ stress.
• Biofeedback training may help patients recognize and reduce jaw clenching or teeth grinding, as part of a CBT program 1. This approach is supported by the most recent guideline, which issued strong recommendations in favor of supervised jaw exercise and stretching, manual trigger point therapy, and CBT with or without biofeedback or relaxation therapy 1. In contrast, older studies, such as the one published in 2013 1, may not reflect the current best practices, and their recommendations should be considered in the context of more recent evidence 1.

From the Research

Physical Therapy for Severe Degenerative Right Temporomandibular Joint (TMJ)

• The treatment of temporomandibular joint disorders (TMJDs) can include physical therapy, with the goal of reducing pain and improving jaw mobility 2, 3.
• A study comparing different treatment modalities for TMJ arthralgia found that the use of a nocturnal bite splint, with or without intra-articular injections, improved maximum pain-free mouth opening and reduced pain intensity 2.
• The combination of a bite splint with platelet-rich plasma injection yielded the best results after six months, while patients treated with sodium hyaluronate or betamethasone obtained the best results at the end of the first week 2.
• A systematic review of treatment approaches for temporomandibular joint dysfunctions found that physiotherapy techniques, including therapeutic exercise protocols and manual therapy, are effective in controlling primary symptoms of TMD, such as pain, functionality, and quality of life 3.
• The review also found that the combination of different therapies within physiotherapy achieves the best results in treatment 3.
• A prospective cohort study comparing the efficacy of a combined approach using injection and home physical exercise with physical therapy alone found that both approaches improved pain intensity, maximum mouth opening, and jaw functional limitation scale scores in older patients with temporomandibular degenerative joint disease 4.
• The study found that the combined treatment group had a significantly lower number of visits than the physical therapy group, but the treatment duration was longer 4.
• Infiltration of sodium hyaluronate has been shown to be a promising treatment for patients with symptomatic degenerative joint disease who do not respond to conservative medical therapy, with statistically significant positive variations in mouth opening, pain, and masticatory efficiency 5.
• Pharmacologic treatment options for temporomandibular joint disorder include noninvasive therapies, such as nonsteroidal anti-inflammatory drugs and muscle relaxants, as well as minimally invasive injections, such as botulinum toxin and platelet-rich plasma 6.