Massage Therapy and Temporomandibular Disorders

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Conservative Management of Jaw Pain

Temporomandibular Disorders (TMD) is a condition that affects up to 15% of adults and 7% of adolescents, this umbrella term may include jaw pain, movement limitations, and clicking of the jaw (List et al. 2017).

A comprehensive complementary treatment for temporomandibular disorder should incorporate a number of rehabilitation strategies based on patient-specific assessment findings including, but not limited to:
• Manual Therapy (intra-oral and extra-oral massage)
• Acupuncture/electroacupuncture (local, segmental and distal stimulation sites)
• Education on psychosocial factors (eg. BPS framework of pain, fear avoidance)

Why Does Massage Therapy Work For TMD?

Therapeutic effects of intra-oral and extra-oral massage, and self-care management of temporomandibular dysfunction has been demonstrated in a number of randomized control trials and systematic reviews (Martins et al. 2016, von Piekartz & Hall 2013, Randhawa et al. 2015).

Evidence also suggests that temporomandibular disorder may be a contributing factor to cervicogenic headache (von Piekartz & Hall 2013).

A biopsychosocial framework helps put into context the interconnected and multidirectional interaction between: physiology, thoughts, emotions, behaviors, culture, and beliefs. In terms of clinical responses to massage therapy there are a couple of proposed mechanisms of action, including but not limited to: Affective Touch, Contextual Factors, Endogenous Pain Modulation, Mechanical Factors, and Neuroplasticity.

Acupuncture for TMD?

Medical acupuncture is an approach that is based upon a theory that is inline current scientific understanding of how the body works. Using occam's razor the insertion of an acupuncture needle is a form of novel stimuli, that functions by sending anti-nociceptive input to the neuroimmune system (Chen et al. 2017).

Preferential sites for acupuncture stimulation are associated with areas rich in specialized sensory receptors such as muscle spindles, Golgi tendon organs, ligament receptors, Paciniform and Ruffini’s receptors (joint capsules), deep pressure endings (within muscle belly), and free nerve endings (muscle and fascia). All of these areas are highly innervated and as a result there are a number of physiological responses that help modulate the experience of pain.

Structures to be aware of when treating TMD

Intra-oral and extra-oral massage is not complicated, it can be preformed in the clinic or as self care. In its simplest form it could include working on:
• Medial pterygoid
• Temporalis
• Masseter
• Sternocleidomastoid
• Suprahyoids
• Infrahyoids
• Scalene Muscle Group
• Upper Cervical Spine (Suboccipitals, Upper trapezius, Splenius Cervicis, Splenius Capitis)

More to Explore

Armijo-Olivo et al. (2016). Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis. Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/26294683

Banigo et al. (2018). Orofacial pain. BMJ.
https://www.ncbi.nlm.nih.gov/pubmed/29769194

Butts et al. (2017). Pathoanatomical characteristics of temporomandibular dysfunction: Where do we stand? (Narrative review part 1). J Bodyw Mov Ther.
https://www.ncbi.nlm.nih.gov/pubmed/28750961

Butts et al. (2017). Conservative management of temporomandibular dysfunction: A literature review with implications for clinical practice guidelines (Narrative review part 2). J Bodyw Mov Ther.
https://www.ncbi.nlm.nih.gov/pubmed/28750962

Chen, L. & Michalsen, A. (2017). Management of chronic pain using complementary and integrative medicine. BMJ.
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Di Paolo et al. (2017). Temporomandibular Disorders and Headache: A Retrospective Analysis of 1198 Patients. Pain Res Manag.
https://www.ncbi.nlm.nih.gov/pubmed/28420942

Garrigós-Pedrón et al. (2018) Effects of a Physical Therapy Protocol in Patients with Chronic Migraine and Temporomandibular Disorders: A Randomized, Single-Blinded, Clinical Trial. J Oral Facial Pain Headache.
https://www.ncbi.nlm.nih.gov/pubmed/29694464/

Gil-Martínez et al. (2018). Management of pain in patients with temporomandibular disorder (TMD): challenges and solutions. J Pain Res. (OPEN ACCESS).
https://www.ncbi.nlm.nih.gov/pubmed/29588615

Julsvol et al. (2017). Inter-tester reliability of selected clinical tests for long-lasting temporomandibular disorders. J Man Manip Ther.
https://www.ncbi.nlm.nih.gov/pubmed/28912630

La Touche et al. (2017). Evidence for Central Sensitization in Patients with Temporomandibular Disorders: A Systematic Review and Meta-analysis of Observational Studies. Pain Pract.
https://www.ncbi.nlm.nih.gov/pubmed/28557358

List, T., Jensen, R.H. (2017). Temporomandibular disorders: Old ideas and new concepts. Cephalalgia. 
https://www.ncbi.nlm.nih.gov/pubmed/28068790

Martins et al. (2016). Efficacy of musculoskeletal manual approach in the treatment of temporomandibular joint disorder: A systematic review with meta-analysis. Manual Therapy.
https://www.ncbi.nlm.nih.gov/pubmed/26144684

Mesa-Jiménez et al. (2015). Cadaveric validation of dry needle placement in the lateral pterygoid muscle. J Manipulative Physiol Ther.
https://www.ncbi.nlm.nih.gov/pubmed/25433977

Randhawa et al. (2016). The Effectiveness of Non-invasive Interventions for Temporomandibular Disorders. The Clinical Journal of Pain.
https://www.ncbi.nlm.nih.gov/pubmed/25924094

Schiffman, E. & Ohrbach, R. (2016). Executive summary of the Diagnostic Criteria for Temporomandibular Disorders for clinical and research applications. J Am Dent Assoc.
https://www.ncbi.nlm.nih.gov/pubmed/26922248

Shaffer et al. (2014). Temporomandibular disorders. Part 1: anatomy and examination/diagnosis. J Man Manip Ther.
https://www.ncbi.nlm.nih.gov/pubmed/24976743

Shaffer et al. (2014). Temporomandibular disorders. Part 2: conservative management. J Man Manip Ther.
https://www.ncbi.nlm.nih.gov/pubmed/24976744

von Piekartz, H. V. & Hall, T. (2013). Orofacial manual therapy improves cervical movement impairment associated with headache and features of temporomandibular dysfunction: A randomized controlled trial. Manual Therapy.
https://www.ncbi.nlm.nih.gov/pubmed/23415640

von Piekartz et al. (2016). Do subjects with acute/subacute Temporomandibular Disorder have associated cervical impairments: A cross-sectional study. Manual Therapy.
https://www.ncbi.nlm.nih.gov/pubmed/27744136 

Wieckiewicz et al. (2015). Reported concepts for the treatment modalities and pain management of temporomandibular disorders. J Headache Pain.
https://www.ncbi.nlm.nih.gov/pubmed/26644030

Wu et al. (2017). Acupuncture therapy in the management of the clinical outcomes for temporomandibular disorders: A PRISMA-compliant meta-analysis. Medicine (Baltimore).
https://www.ncbi.nlm.nih.gov/pubmed/28248862