Effectiveness of Manual Physical Therapy, Therapeutic Exercise, and Patient Education on Bilateral Disc Displacement Without Reduction of the Temporomandibular Joint: A Single-Case Design

Abstract

Study Design: Single-case A1-B-A2 design. Objective: To determine if manual physical therapy, therapeutic exercise, and patient education would be an effective management strategy for a patient with a disc displacement without reduction of both temporomandibular joints. Background: A number of conservative management strategies have been proposed for the treatment of temporomandibular disorders. However, little evidence exists to indicate the effectiveness of physical therapy interventions in patients with bilateral disc displacement without reduction. Methods and Measures: Phase A1 of the study consisted of a baseline condition in which no intervention was initiated. Phase B included manual physical therapy, therapeutic exercise, and patient education focusing on the temporomandibular joint and cervical spine. Phase A2 consisted of withdrawal of the intervention. The Steigerwald/Maher disability questionnaire was used to collect data relative to function. A visual analog scale was used to collect pain data and maximal mouth opening measurements were obtained as an indicator of range of motion. Visual analysis and the 2 standard deviation band method of statistical analysis were used to compare data. Results: Following the implementation of the intervention phase, the patient demonstrated significant reductions in pain and improvements in maximal mouth opening and function as measured by the Steigerwald/Maher disability questionnaire. These observed improvements were maintained at the time of a 3-month follow-up. Conclusions:The results of our study suggest that manual physical therapy, therapeutic exercise, and patient education may have been an effective management strategy for a patient with bilateral disc displacement without reduction of the temporomandibular joints. Further outcome studies in the form of randomized controlled trials are needed to determine the clinical utility of this treatment approach in a larger population.

Low Back Pain

“…62, 64, 116, 179, 289 Diagnoses utilized in these reports included hamstring strain and complex regional pain syndrome.…”

Automobilization intervention and exercise for temporomandibular joint open lock

“…29,30,32,33 Reports of post-reduction treatment of TMJ-AD are minimal and limited to two case series which utilized intraoral occlusal splinting. 9,16 Although exercise has been reported as beneficial for persons with non-specific TMD or TMD with ADD, 3,13,23,24,34 no reports were found describing exercise following joint reduction for TMJ-AD, PDD, or open lock. The purpose of this case report is to describe a novel joint mobilization technique using the patient's muscular force that was effective in reduction of open lock of the TMJs due to an apparent PDDWR or TMJ-AD.…”

Use of orthopedic manual physical therapy to manage chronic orofacial pain and tension-type headache in an adolescent

“…6,7,15,16,23 Descriptions and pictures of technique choice, dosage, and patient response by visit are summarized in Table 2.…”

“…10,14 Numerous studies have investigated the role of orthopedic manual physical therapy (OMPT) in the treatment of cervicogenic and TMD-type headaches. 1,11,[15][16][17][18] In light of the significant overlap in symptom prevalence between TMD and primary headache types, it seems reasonable that OMPT may be similarly beneficial in the treatment of TMD and primary headache types. Recent research in pain neurophysiology has suggested that hyperexcitable central pain mechanisms, known to be a component of primary headaches and TMD, [19][20][21] may be inhibited by manual therapy in conjunction with a pain education program.…”