Top 5 Fridays! 5 Exercises for TMJ Dysfunction

"I have TMJ." My reply that no patient ever gets, "Yes I know, you have two." I guess I should stop saying it if no one but me gets it (interns laugh - do they count? They probably feel like they have to).

Thanks to my buddy Dr. Harrison Vaughn of In Touch PT Blog for suggesting this as a Friday 5 Topic! Here are 5 exercises for TMJ Dysfunction.

What smells? Just this attempt at humor

1) Cervical Retractions

Rocabado proved radiologically the mandible position is dependent on the cervico/cranial position
Explain why it is important using examples like in this video
make sure to push on the maxilla for overpressure, NOT the mandible, despite what some unknowing MDT instructors say "Only use the maxilla if it aggravates the TMJ"
versus my instruction of always use the maxilla, because you do not want to make a non TMD patient into one

90% down, 10% back

2) Scapula retractions "w's"

an easy way to reset posture and also decrease upper trap and cervical tone due to reciprocal inhibition from activating the mid and lower traps
this position should not be held, but should be back off of slightly for the neutral position
a super old video of mine, demonstrating this above

I need a haircut!

3) Masseter reciprocal inhibition

the cervical protraction adopted by many patients causes mandible retraction
prolonged mandible retraction can cause increased tone in the mandible elevators due to them compensating for the postero-inferior pull of the diagastrics
remember to instruct this in a neutral position!

4) Mandible repeated protraction

this may be needed if they are lax enough that the bite change example in the video above does not change with different head positions
if cervical retractions with or without overpressure only help cervical and cranial complaints, but not facial/ear complaints, try this exercise
the repeated mandible protraction is only edge to edge or the edge of the mandibular central incisors (inferior) to the maxillary central incisors (superior)

5) Self Distraction

No pic or video for this one
I instruct the patient how to lightly grasp their own mandible with their fingertips 2-5 on the inferior po
their thumb will be on the superior surfaces of the inferior molars of the involved or restricted side
you should practice with them using light force, teaching them to palpate for very light movement of the mandible condyle, and that's when they stop, not at end range, light oscillations into mid range distraction
then they practice trying to get the same force, and first you palpate condylar movement, and teach them to feel it when they are doing the self mobilization

Education and mode of prescription as always is key to compliance, which is what improves a patient rapidly! This along with other advice like a no chew diet, progression to soft chew, and then graded exposure to normal foods goes a long way. I will be shooting The Eclectic Approach to TMD for MedBridge soon!

Keeping it Eclectic...