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Insights from a Physiotherapist: TMJ & Manual Therapy

Herrera-Valencia et al.'s (2020) systematic review underlines the synergy when manual therapy meets exercise in treating temporomandibular disorders (TMD). As a devoted manual and movement therapist, I emphasize the crucial mix of clinical reasoning in crafting effective treatment plans for the intricate TMJ.

Knowledge is Power

To master TMJ care, clinicians must grasp the joint's anatomy, physiology, and biomechanics, coupled with a deep understanding of TMD etiology and classifications. It's the foundation for precision in patient management.

Snell, R. S. (2012). Clinical Anatomy by Regions (9th ed.). Lippincott Williams & Wilkins.
Phydiotherapist performing upper cervical spine mobilization for a patient  in prone position.
Simple mobilization techniques for the upper cervical spine - from June 2023, Primephysio Training UK's visit to Al Reem Hospital, AD.

Hands-on Expertise

In my physiotherapy journey, the touch of manual therapy has consistently added a layer of reassurance to my patients. It's the comforting feeling of expertise at work. But, before we embark on any hands-on journey, empowering patients with the knowledge that they hold the keys to their well-being is paramount.

To colleagues with a discerning eye on mobilization techniques, no apologies needed. Every mobilization serves a purpose, enhancing our ability to provide tailored care.

Teaching

As I guide my students, I emphasize the approach: "What, How, and Why."

Class notes for assessing and treating any musculoskeletal condition
A rough assessment-treatment scenario from my class.

Applying any treatment method to the TMJ requires-

a. Knowledge of the functional anatomy, physiology, and biomechanics of the TMJ and cervical spine.



b. Understanding of the etiology, differential diagnosis, and clinical classifications of TMJ disorders.




Manual Therapy & the TMJ - What it means to be hands-on

Throughout my career as a physiotherapist, I could never help but notice that the addition of a hands-on element to my patients' treatment plans almost always gives them the feeling of security: "The expert has his hands on me - this MUST be good."

But before any of this, it's always best to give the patient the confidence that they can resolve their problem on their own. Patient education is key. If a few repetitions of the right exercise make a difference right away, we've both won. If not, then a little push with hands-on therapy shouldn't hurt. Any mobilization should do the job.


References:

Herrera-Valencia, A., Ruiz-Muñoz, M., Martin-Martin, J., Cuesta-Vargas, A., & González-Sánchez, M. (2020). Efficacy of Manual Therapy in Temporomandibular Joint Disorders and Its Medium-and Long-Term Effects on Pain and Maximum Mouth Opening: A Systematic Review and Meta-Analysis. Journal of clinical medicine, 9(11), 3404. https://doi.org/10.3390/jcm9113404


Snell, R. S. (2012). Clinical Anatomy by Regions (9th ed.). Lippincott Williams & Wilkins.





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