This week's abstract of the week is from the Journal of Oral Rehabilitation is called Manual therapy for the management of pain and limited range of motion in subjects with signs and symptoms of temporomandibular disorder: a systematic review of randomised controlled trials. (Calixtre LB1, Moreira RF1, Franchini GH1, Alburquerque-Sendín F2, Oliveira AB1.)
In this preliminary systematic review of RCT regarding manual therapy effectiveness in the treatment of TMD disorders, it found 8 studies that warranted comparison and review. While the manual therapy treatment varied between studies, several manual therapy interventions demonstrated significant improvements in Maximum Mouth Opening (MMO), pain (VAS used) and pressure pain threshold (PPT). The interventions that demonstrated significant effect included myofascial or intra-oral soft tissue and graded jt mobilization techniques to upper three cervical spine joints and C0-C1 thrust techniques. Three studies included confidence interval assessments (CI) of their statistical significance.
I believe this is a great example of how NAIOMT's Quadrant scanning exam can be very helpful in both determining the 'drivers' of the patient's symptoms and functional limitations, and it assists in selecting manual therapy techniques to address a patient's TMD symptoms. Assessment of the TMD should include at minimum the upper quarter to screen for contributing dysfunctions (not just the TM joint complex and controlling muscles) and consider the influence of the lower quarter if it is relevant for a particular patient case. Future studies need further standardization of assessment and treatment protocols. Additional investigation of the whole 'spectrum' of TMD neuromuscular function could consider including adjunct interventions like breathing or swallowing retraining that many Physical Therapists incorporate in their comprehensive care of TMD.
-Karen Walz, PT, DPT, OCS, COMT, FAAOMPT
Clinical Fellowship Instructor and Examiner