Are your TMD patients leaving feeling better, but not keeping the improvements between visits? Here are some modifications to their ADLs and HEP that may be necessary.
1) The Nod
- the cervical retraction often feels strange and is difficult to perform for someone who has had forward head posture for the last bajillion years
- sitting upright, sternum elevated, have their hand behind their neck
- lightly push the back of the neck into your hand
- nod slightly without rolling your neck off of your hand
- for more unilateral Sx, they may rotate their head 5 degrees or so to the side of pain and nod in that direction
- this can easily be done against a car seat headrest (at every stoplight/stop sign)
2) diet
- if eating is bothering them, sometimes we have to eliminate threats systematically in order for the peripheral and central sensitization to return to normal levels
- have them go on a no chew diet for 1 week, followed by a soft chew diet for 2-3 weeks, and then gradually go back to a normal diet, one meal a day for smaller bites
- try not to instruct unilateral loading on the non painful side unless absolutely necessary
3) mandible protraction
- the reason why cervical retractions/nods work well for this population is not only the incidence of cervical/upper cervical dysfunction, but because it repositions the mandible to a more neutral state
- because this population is often very lax, occasionally just a nod/retraction won't do it
- if changing their head/neck position does not change their occlusal contact position, have them slightly protract their mandible at end range nod/retraction
- the directional preference for the TMJ is mandible protraction, because forward head places a retraction force on it, often sensitizing posterior structures
4) how they're eating
- if the variability they need is posture correction and nods, which help, but eating is still bothering them, it may be how they're doing it
- most people bring the food halfway to their face and then go to an end range cervical protraction position to eat or drink
- instruct them on either being more upright when they eat, or to break up eating every once in a while with some nods/retractions and mandible protrusions
5) self masseter STM
- the masseter is often hypertonic due to guarding from facial pain perception
- if they feel/move better after your STM/IASTM technique, tell them they can do the same thing
- they can lightly release with slow, proximal to distal stroke for 1-2 minutes on the painful side, or bilaterally if having Sx on both sides
- this can be done as their own type of reset several times daily or as needed
If you found these helpful, check out my course on MedBridge Education, The Eclectic Approach to TMD Parts A and B! Sign up here - last chance for the over $100 discount!
Keeping it Eclectic....
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