TMJ Lab

Closing MMT

"clench your teeth together as tightly as you can, keeping your lips relaxed. Dont let me open your mouth" F: patient closes jaw fully. completes available ROM and holds against strong resistance. therapist shouldnt break hold WF: patient closes jaw but PT can open mouth with less than maximal force NF: patient closes mouth but no resistance is tolerated 0: patient cannot completely close mouth

Lateral Deviation MMT

"move your jaw to the left and then to the right" F: pt able to laterally deviate completely and hold against strong resistance WF: patient deviates jaw only 1 tooth can only tolerate minimal force NF: minimal deviation occurs and no resistance taken 0: no motion

Protrusion MMT

"push your jaw foward, hold it, dont let me push you back" F: pt is able to complete full ROM against strong resistance WF: pt protrusion is limited and can only tolerate minimal force NF: minimal protrusion occurs and no resistance taken 0: no motion occurs

palpate TMJ during opening

-fingers slightly anterior to tragus or inside exterior auditory meatus -feel joint motion for any grinding or clicking - can also ausculate to listen for joint sounds

TMJ Distraction (joint play+ intervention)

-have pt slightly open mouth, then grab onto back molars -have pt relax jaw -gently move hand down inferiorly to put force through joint -can feel motion with other hand Intervention: same thing but 5-10 reps

rocabado 6x6 rhythmic stabilization

-hold jaw slightly open -with hand push on side of jaw for 6 seconds and hold -repeat on other side TMJ arthralgia with hypermobility

palpate medial pterygoid

-internally -thumb inside mouth -top of jaw and move posteriorly -have pt gently laterally deviate to contralateral side -gentle scooping motion to stretch out, or can just hold where you feel restriction

TMJ Anterior glide (joint play+ intervention)

-pt slightly open mouth grab onto back molars -have pt relax -gently bring hand inferior and anterior to give anterior glide TMJ (scooping) -can feel motion with other hand Intervention: same thing but 5-10 reps

Lateral deviation mobilization with movement

-sitting -lateral deviation limited away from side of restriction -therapist gives anterior glide to opposite side of motion with fingers placed just posterior to condyle ex.) for left lateral deviation, PT will give anterior glide to R TMJ

Palpate temporalis

-supine -have pt clench jaw to feel muscle, then relax - feel both sides for differences in tone, pain, etc

Palpation Masseter

-supine -have pt clench jaw to feel muscle region -feel both sides for differences in resting tone and see if any trigger points present/ replicate pain noted by patient

Open (roll) measurement

-tongue on roof of mouth and open -tip of top to tip of bottom normal: 20-25 mm

rocabado 6x6 controlled opening

-tongue on roof of mouth slowly open mouth until a deviation occurs -do in front of mirror for feedback -TMJ arthralgia with hypermobility

Rocabado scapular retraction

-with palms up squeeze shoulder blades down and back -should feel middle trap firing -make sure not to hike up using upper trap

Opening

40-45 mm (men) 45-50 mm (women) -have patient open mouth as wide as they can -measure from bottom of top tooth to top of bottom tooth

Scapular strengthening exercises

T's Y's Rows scapular clock: weight bearing on elbows and knees and reaching other arm across floor stir the pot

Rocabado cervical retraction (chin tuck)

eyes level with horizon 1 finger for chin guidance bring head straight back, should feel stretch in upper neck pretend there is a board under your head so you are sliding on that board

Diaphragmatic breathing

hand on chest or shoulder one on belly breathe deep through nose belly hand should move not shoulder one breathe in for count of 2 and out for count of 6

Lateral deviation

middle of top teeth to middle of bottom teeth -have pt move jaw as far to one side as possible -9 to 10 mm

postural awareness exercises

pec stretching in doorway or on foam roll -standing with doorway in between scapulae and retracting -lower trap on ball -taping for posture

Education

practice explaining anterior disc with reduction practice explaining myofascial practice explaining how TMJ works

Assisted opening with anterior glide

pt supine or seated -as pt is opening mouth, facilitate opening by providing a bilateral anterior glide to condyle 5 to 10 reps then have pt open mouth to reasess motion quality

Jaw Opening MMT

pt: sitting, opens mouth as wide as they can PT: one hand cupped under chin, other placed on top of head "open your mouth as wide as you can, hold it, dont let me close it" F: full range against strong resistance WF: two or fewer stacked fingers wide, with some resistance NF: minimal motion occurs, can palpate lateral pterygoid 0: no depression occurs

Rocabado 6x6 resting position of tongue

roof of mouth with tip of tongue behind teeth -have them cluck -muscles and jaw in correct position

Retrusion

tips of top teeth to tips of bottom teeth -have pt move mandible as far backward as possible -3mm

Protrusion

top tooth to bottom -have pt move mandible as far forward as possible -6 to 9 mm

Rocabado upper cervical flexion

with hands providing gentle traction on C2-C7 gently tuck chin down -postural