Manipulation for TMJ Pain

This study documents the effectiveness of manipulation of the jaw in the treatment of TMJ pain. The authors state that, “In 1500 treated cases, documented on videotape, only five cases required surgical intervention. The success of the therapy was confirmed by 13 MRI images of the TMJ of patients with acute and chronic locking before and after therapy. In all cases the anteriorly dislocated disk in closing and opening position was recaptured and repositioned in a normal position in the tempormandibular fossa.”

The Martini’s manipulative reduction technique is described as such: “The patient is instructed to relax and slightly open the mouth as much as possible before pain occurs. The clinician is positioned behind the patient. The patient’s head is turned away from the locking side (in cases with bilateral locking, to the most recent locked side). The clinician places his thumb right on the lower dental arch of the locking side, left or right. The other hand is placed on the temporale of the same side in order to stabilize the patient’s head during the manipulative maneuver. The distal phalange of the thumb is flexed and the joint of the second phalange contacts the upper arch at the molar level, functioning as a fulcrum. The power of the lever is expressed by the third, fourth and fifth finger positioned on the lower border of the mandibular body.”

“Light pressure is applied on the lower second molar. The pressure is applied in a back and down direction and is increased inward as the condyle is freed of interference with the disk. The hand stabilizing the head applies a progressive pressure in the opposite direction to the hand on the teeth and inclines the head forward. At the same time, the clinician moves the mandible in an antero-medial direction.”

“The index finger of the stabilizing hand, pushes the condyle out of the fossa and compresses the empty fossa when the mandible is opened. The manipulative reduction maneuver must be painless (with no clicking).”

The authors also detail physiotherapeutic exercises that the patient does after the manipulation to assist in healing the TMJ. “This mandibular manipulation is dependent upon the clinician’s technical ability. It requires adequate training (1-2 months) before a health care provider becomes sufficiently clinically skilled.”

For more details about this technique we suggest getting a copy of this article.

Martini G, Martini M, Carano A. MRI study of a physiotherapeutic protocol in anterior disk displacement without reduction. The Journal of Craniomandibular Practice 1996;14(3):216-224.

 

 

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