By SHEILA YONEMOTO, P.T.
Communication between physical therapists and dentists began as these practitioners realized that multiple complaints of the adult patient with head, neck and facial pain were all connected in a syndrome called TMJ, or temporomandibular joint disorder.
When working as a team, they discovered that the results of their joint efforts were more complete and longer-lasting and had a shorter treatment time. Physical therapy helps reduce the length of time necessary for treatment with patients who have abnormal head posture contributing to their TMJ problem.
The typical adult symptomatic TMJ patient has a deep overbite or Class II occlusion and a forward head posture. He or she may develop facial pain, abnormal mechanics and fatigue and/or spasm of the facial musculature. The patient may also develop headaches as referred pain from the TMJ muscles.
In addition, abnormal head posture creates fatigue of the neck muscles and compression of the facet joints of the cervical spine, which may cause neck pain and referred pain into the arm and to the inter-scapular area. In advanced cases, neck posture may also create degenerative changes that gradually encroach upon the intervertebral joints and produce cervical nerve root compression, neurogenic pain in the arm, and paresthesia and weakness of the upper extremities.
If the reciprocal relationship between head posture and occlusion is understood, it becomes clear that physical therapists may not be able to stabilize head posture in a patient with malocclusion. In addition, the dentist may not be able to restore a definite occlusion or correct craniomandibular relationships in patients with obvious postural problems.
Often once the original malocclusion and posture are solved, there remain other secondary problems such as abnormal shoulder girdle conditions or low back problems. These will need to be treated for full structural posture and normal body mechanics.
There are approximately four treatment phases. The first is to decrease pain, apprehension and muscle spasms. Next is to continue with pain relief and increase soft tissue and joint function. Phase 3 is to instruct the patient in a specific exercise program for the care of their head, neck, TMJ and back, including correct postural mechanics and incorporating muscle strengthening exercises. The fourth and last phase is to increase the patient’s total body function, cardiovascular conditioning and overall fitness.
A patient is discharged from physical therapy when he or she can demonstrate correct spinal posture, exercises, functional and pain-free jaw and neck mobility and, if applicable, correct splint applications.
Whenever a doctor suspects muscles, joints, ligaments or posture may be a factor in the patient’s pain or dysfunction, he or she should refer the patient to physical therapy. Examples include trismus, limited opening, referred pain from muscles and referred pain from cervical spine involvement.
The most important approach is the evaluation. This identifies many soft tissue and postural components of the problem. Additionally, therapeutic exercise, mobilization, various modalities and a home exercise program are utilized as needed.
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Sheila Yonemoto, P.T., has been a physical therapist for more than 30 years, specializing in integrative manual therapy, utilizing a holistic approach. She can be reached at Yonemoto Physical Therapy, 55 S. Raymond Ave., Suite 100, Alhambra, CA 91801. Sheila offers a qigong “Chinese energy” exercise class. Your first class is free. Call (626) 576-0591 for more information or visit www.yonemoto.com.