From the Guidelines
Physical therapy for temporomandibular joint (TMJ) disorders should include supervised jaw exercise and stretching with or without manual trigger point therapy, as recommended by the most recent clinical practice guideline 1. This approach focuses on reducing pain, improving jaw function, and preventing further damage. Treatment typically includes gentle jaw exercises to improve mobility and strength, such as controlled opening and closing of the mouth, lateral movements, and resistance exercises. These should be performed 3-4 times daily with 10 repetitions each. Some key aspects of TMJ physical therapy include:
- Manual therapy techniques like massage of the jaw muscles, stretching, and joint mobilization to reduce tension and improve range of motion
- Heat or cold therapy applied for 10-15 minutes several times daily to decrease pain and inflammation
- Posture correction exercises, as poor posture can contribute to TMJ problems
- Relaxation techniques to reduce jaw clenching and avoid habits like chewing gum, biting nails, or clenching teeth
- Use of ultrasound or electrical stimulation by physical therapists to reduce pain and inflammation The most recent guideline 1 provides strong recommendations in favour of cognitive behavioural therapy (CBT) with or without biofeedback or relaxation therapy, therapist-assisted mobilisation, manual trigger point therapy, supervised postural exercise, supervised jaw exercise and stretching with or without manual trigger point therapy, and usual care. It is essential to note that the guideline also provides conditional recommendations against certain interventions, such as reversible occlusal splints, arthrocentesis, and low-level laser therapy 1. The treatment typically lasts 6-8 weeks, with improvements often seen within 2-3 weeks, and works by reducing muscle tension, improving joint mechanics, decreasing inflammation, and breaking harmful habits that contribute to TMJ dysfunction 2.
From the Research
TMJ Physical Therapy
- Temporomandibular joint (TMJ) disorders can be managed with a multidisciplinary team approach, including physical therapy 3.
- Exercise therapy, including mobilisation exercise, muscle strengthening exercise, coordination exercise, and postural exercise, can be effective in managing painful TMJ disorders 4.
- Physical therapy modalities, such as physiotherapy, can be used in conjunction with other forms of treatment, such as occlusal splints, to manage TMJ disorders 5.
Effectiveness of Exercise Therapy
- Exercise therapy has been shown to be effective in reducing pain and improving mouth opening in patients with TMJ disorders 6, 7.
- A systematic review and meta-analysis found that exercise therapy was not superior to occlusal splint therapy for pain reduction, but was equivalent in improving maximum mouth-opening range 6.
- Another systematic review with meta-analysis found that exercise therapy improved pain and mouth opening in patients with TMJ disorders, and was more effective than physiotherapy approach (manual therapy and electrotherapy) in improving pain pressure threshold 7.
Types of Exercise Therapy
- Mobilisation exercise, including manual therapy, passive jaw mobilisation with oral appliances, and voluntary jaw exercise, has been shown to be a promising option for managing painful TMJ disorders 4.
- Muscle strengthening exercise, coordination exercise, and postural exercise can also be effective in managing TMJ disorders 4.
- Exercise therapy can be tailored to individual patient needs and can be used in conjunction with other forms of treatment, such as occlusal splints, to manage TMJ disorders 3, 5.