This week we're taking a look the abstract "Treatment of temporomandibular myofascial pain with deep dry needling." As you may know, Temporomandibular dysfunction is often associated with myofascial pain and can be challenging to treat successfully. Choosing to perform dry needling on muscles of mastication surely comes with risks, i.e. increased risk of bleeding, bruising, needing to consider the anxiety that often accompanies this presentation, etc.
These authors (Gonzalez-Perez LM1, Infante-Cossio P, Granados-Nuñez M, Urresti-Lopez FJ.) selected 36 patients with six months or greater of temporomandibular pain, limited mandibular opening, and a palpable taut band within the external pterygoid. Dry needling of the external pterygoid was performed 3 total sessions over the course of 3 weeks with subsequent patient follow up at 2 weeks, 1, month, 2 months and 6, months. Follow up results demonstrated significant improvement in pain on the visual analog scale, significant improvement in mandibular opening of nearly 1.5 cm and lasting improvement of upwards of 6 months. Interestingly, the more intense the pain was at baseline, the greater improvement that was observed.
This study is important as it is one of the few that is able to demonstrate significant long improvements of upwards of 6 months utilizing dry needling as the primary intervention. Additionally, with some disagreement as to the reliability of palpating the external pterygoid intra-orally, the use of a dry needle extra-orally allows for direct treatment of an often times difficulty to treat dysfunctional muscle. Therein lies one of the beauties of dry needling in that clinicians can directly and specifically treat musculature that is often difficult to access or deep to more superficial musculature.
Why You Should Care: Temporomandibular dysfunction, particularly limited mouth opening due to internal disc derangement can a frustrating presentation to successfully manage. Often the pterygoid musculature is hypertonic and partly responsible for the anterior displacement of the intra-articular disc. There is some disagreement about whether you can directly palpate this muscle group, particularly the lateral pterygoid, with any ease. Therein lies one of the beauties of dry needling in that clinicians can directly and specifically treat musculature that is often difficult to access or deep to more superficial musculature via traditional palpation techniques. Last, and most certainly not least, this study supports longer lasting results (6 months) with dry needling.
Do you dry needle? Interested in learning? Leave your thoughts or questions below, and reserve your spot for my upcoming Dry Needling Upper Quadrant course in Dallas, TX September 19-20.
-Gary Kearns, PT, COMT, FAAOMPT
NAIOMT Guest Faculty & Clinical Fellowship Instructor