Temporomandibular disorder (TMD): A collective term embracing a number of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ) and associated structures, or both.

2.  Titled musculoskeletal Physiotherapist
 Private practitioner
 Griffith University Co-ordinator of Masters in
Musculoskeletal and Sports Physiotherapy

3.  What is physiotherapy?
 TMD from a physiotherapists perspective
 The physio role in treating TMD
 The team approach, a vital function for all
of us

5.  Definition:
› Physiotherapy provides services to develop,
maintain and restore maximum movement and
functional ability throughout life. This includes
providing services in circumstances where
movement and function are threatened by
aging, injury, disease or environmental factors.

6.  Scope of Physiotherapy:
› Musculoskeletal
 General
 Sports
 Children
 Aged
› Respiratory
› Neurological
› Miscellaneous
 Urinary function
 Psychiatric

7.  Assessment
› First line practitioner
 Posture
 Pattern of movement
 Muscle function
 Joint function
 Accept referrals in conjunction with other professionals
 Refer on to necessary professionals
› Dentist
› Prosthodontist
› Psychological
› Speech

8.  Temporomandibular disorder (TMD):
› A collective term embracing a number of
clinical problems that involve the masticatory
musculature, the temporomandibular joint (TMJ)
and associated structures, or both.
 In physiotherapy we tend to use the term
TMJ dysfunction.

9.  Establish role TMJ has in condition
 Subjective signs and symptoms
 Cervical Referral?
 Posture: Dynamic and static
 Muscle function and control
› Local and Global
 Joint function
› Cervical , thoracic, shoulder and TMJ
 Basic occlusion assessment
 Previous Dental work
 Dental work in need of doing
 Psychosocial issues

10.  Type of pain:
› Dull ache often
 Area:
› Anywhere in head
 Common connection with trigemino-cervical nucleus.
› TMJ can even affect cervical spine
 Often decreased ROM
 Ear symptoms :
› Fullness in ear
› Tinnitus

11.  Altered biting and chewing can increase loading of
contra-lateral side
 Repetitive activities:
› talking
 Pain after yawning:
› dentist - capsular
 Dysfunctional movements:
› clenching, grinding, chewing
 Mouth breathing
 Swallowing difficulty
 Noises:
› clicking, clunking, grating, grinding and popping

12.  Theoretical and
actual
 Co-ordinated
function of all
anatomical factors
 Muscles, joint
structures

13.  Static and dynamic
 Has a massive effect on
1. Breathing
2. Swallowing
3. TMJ function
 Why is it important?

15.  This one!
 ...Let’s try a little
exercise.

17.  Neck position will
affect the position of
the tongue
 This will affect the
mandibular position

19.  What about your
posture?

20.  Breathing pattern
› Scalene activity
vs.
› Diaphragmatic

21.  Teeth apart: freeway space (3mm)
› Emma
 Resting position of the tongue:
› On the ruggae of the hard palate
› R, P , T, Clucking sounds
 Lips together and relaxed

22.  Co-ordinated Muscle
functioning
 Assessment of
individual muscles
function
 Cervical muscles
 Masseter, Medial and
Lateral pterygoid,
temporalis
 Suprahyoids and
Infrahyoids

23.  Which direction does the joint move in?
 Too much or too little movement?
 Any pain with movement?
 Fit in with the functional patterns of
movement
 Does it need to be stabilised or stretched
 Feeling for joint play
 Resistance to movement

24.  Posterior anterior
movement
 Distraction
 Medial and Lateral glide
 Assessment of joint
tenderness
 Depth of force
dependant on the
condition

25.  Post fracture
› Hypomobility, poor muscle function and
weakness
 Joint problems
› OA, Ankylosis, Congenital, Inflammatory
 Partial or complete Discal dislocation with or
without reduction)
 TMJ locking
 Myofascial Pain Syndrome
 Overstretched
› Dentist visit, hungry jacks triple-decker

26.  Self management:
› Relaxed position TMJ
› Breathing control
› Posture control
› Relaxation
› Awareness of bad habits
 Joint mobilisation
 Muscle trigger points/ stretches
 Electrotherapy
 Strengthening / stretching muscles

27.  The team would typically consist of:
› Physicians
› Physiotherapists
› Dentists
› Orthodontists
› Prosthodontists
› Psychologists
› Radiology and other investigations