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Saleh MS, Mohamed WM, Elsayed WH, Abdelatief EEM. Proprioceptive neuromuscular facilitation stretching exercises for treatment of temporomandibular dysfunction in patients with forward head posture: A double-blinded, randomized, controlled trial. J Back Musculoskelet Rehabil 2024:BMR230358. [PMID: 39058437 DOI: 10.3233/bmr-230358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
BACKGROUND Proprioceptive neuromuscular facilitation (PNF) stretching exercises have been widely advocated for the management of patients with different musculoskeletal conditions. However, its effect on the treatment of temporomandibular dysfunction (TMD) in patients with forward head posture (FHP) has not been fully investigated. OBJECTIVE To investigate the effect of PNF stretching exercises on the treatment of TMD in patients with FHP. METHODS A prospective, randomized, double-blinded clinical trial. Twenty-four patients with TMD and FHP aged from 18-40 years were randomly assigned to PNF or control group. The PNF group composed of 12 patients received PNF stretching exercises of masticatory muscles in addition to routine physical therapy treatment (FHP correction exercises and ultrasound for the temporomandibular joint); the control group composed of 12 patients received routine physical therapy treatment only. Interventions were conducted twice a week for six weeks. Craniovertebral angle, pain threshold, pain intensity, temporomandibular joint ROM, and temporomandibular joint function were assessed for all participants before and after the intervention. The outcomes were analyzed using Two-way mixed MANOVA. For further multiple comparisons, post-hoc tests with the Bonferroni correction were performed. RESULTS There was no significant difference between both groups pre-treatment (p> 0.05). Comparison between groups post-treatment revealed statistically significant differences in all outcome measures (p< 0.05) in favor of the PNF group. CONCLUSION Adding PNF stretching exercises of masticatory muscles to routine physical therapy programs is an effective method for management of TMD in patients with FHP more than routine physical therapy programs alone.
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Affiliation(s)
- Marwa Shafiek Saleh
- Department of Basic Science for Physical Therapy, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Walaa Mohsen Mohamed
- Department of Orthopedics, Faculty of Physical Therapy, Misr University for Science and Technology, 6th of October City, Egypt
| | - Walaa Hamdy Elsayed
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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van der Meer HA, Doomen A, Visscher CM, Engelbert RHH, Nijhuis-van der Sanden MWG, Speksnijder CM. The additional value of e-Health for patients with a temporomandibular disorder: a mixed methods study on the perspectives of orofacial physical therapists and patients. Disabil Rehabil Assist Technol 2024; 19:433-445. [PMID: 35960692 DOI: 10.1080/17483107.2022.2094000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 06/17/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE To assess the experience and perceived added value of an e-Health application during the physical therapy treatment of patients with temporomandibular disorders (TMD). MATERIALS AND METHODS A mixed-methods study including semi-structured interviews was performed with orofacial physical therapists (OPTs) and with TMD patients regarding their experience using an e-Health application, Physitrack. The modified telemedicine satisfaction and usefulness questionnaire and pain intensity score before and after treatment were collected from the patients. RESULTS Ten OPTs, of which nine actively used Physitrack, described that the e-Health application can help to provide personalised care to patients with TMD, due to the satisfying content, user-friendliness, accessibility, efficiency, and ability to motivate patients. Ten patients, of which nine ended up using Physitrack, felt that shared decision-making was very important. These patients were positive towards the application as it was clear, convenient, and efficient, it helped with reassurance and adherence to the exercises and overall increased self-efficacy. This was mostly built on their experience with exercise videos, as this feature was most used. None of the OPTs or patients used all features of Physitrack. The overall satisfaction of Physitrack based on the telemedicine satisfaction and usefulness questionnaire (TSUQ) was 20.5 ± 4.0 and all patients (100%) showed a clinically relevant reduction of TMD pain (more than 2 points and minimally 30% difference). CONCLUSION OPTs and patients with TMD shared the idea that exercise videos are of added value on top of usual physical therapy care for TMD complaints, which could be delivered through e-Health.Implications for RehabilitationPhysical therapists and patients with temporomandibular disorders do not use all features of the e-Health application Physitrack in a clinical setting.Exercise videos were the most often used feature and seen as most valuable by physical therapists and patients.Based on a small number of participants, e-Health applications such as Physitrack may be perceived as a valuable addition to the usual care, though this would need verification by a study designed to evaluate the therapeutic effect (e.g., a randomised clinical trial).
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Affiliation(s)
- Hedwig A van der Meer
- University Medical Center Utrecht, Department of Oral-Maxillofacial Surgery and Special Dental Care, Utrecht University, Utrecht, The Netherlands
- Department of Orofacial Pain and Disfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit (VU) University Amsterdam, Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Rehabilitation, Amsterdam, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Location Meibergdreef 9, The Netherlands
- Radboud University Medical Center, Research Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Annet Doomen
- Physiotherapy Private Practice 'De Molen', Houten, The Netherlands
- Institute of Movement Studies, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Corine M Visscher
- Department of Orofacial Pain and Disfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit (VU) University Amsterdam, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Rehabilitation, Amsterdam, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Location Meibergdreef 9, The Netherlands
| | | | - Caroline M Speksnijder
- University Medical Center Utrecht, Department of Oral-Maxillofacial Surgery and Special Dental Care, Utrecht University, Utrecht, The Netherlands
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McGrath RL, Shephard S, Parnell T, Verdon S, Pope R. Recommended approaches to assessing and managing physiotherapy clients experiencing psychological distress: a systematic mapping review. Physiother Theory Pract 2023:1-31. [PMID: 38009858 DOI: 10.1080/09593985.2023.2284823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/05/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Some physiotherapists find assessing and managing clients experiencing psychological distress challenging and are uncertain regarding the boundaries of the profession's scope. OBJECTIVE To map the approaches recommended for physiotherapists in scholarly literature, with respect to the assessment and management of clients experiencing psychological distress. METHODS A systematic mapping review was conducted. CINAHL, APA PsycINFO, Embase, and Medline ALL databases were systematically searched for secondary and tertiary literature relevant to the research objective. Recommended approaches were extracted from each article and analyzed descriptively and thematically. RESULTS 3884 records were identified with 40 articles meeting the inclusion/exclusion criteria. Most recommendations related to identifying, assessing, and managing pain-related distress, with depression screening and referral also receiving some attention. Three approaches to detecting and assessing psychological distress were identified: 1) brief depression screen; 2) integrated suicide/nonsuicidal self-harm and depression screen; and 3) multidimensional screen and health-related distress assessment. Regarding the management of psychological distress the main approaches identified were: 1) education and reassurance; 2) cognitive-behavioral approaches; 3) mindfulness; and 4) case management. CONCLUSION While assessment and management of health-related distress by physiotherapists is commonly recommended, further guidance is needed to differentiate various forms of distress.
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Affiliation(s)
- Ryan L McGrath
- Department of Rural Health, University of Melbourne, Shepparton, Australia
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, Australia
- Allied Health Education and Research Unit, Goulburn Valley Health, Shepparton, Australia
| | - Sophie Shephard
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, Australia
| | - Tracey Parnell
- Department of Rural Health, University of Melbourne, Shepparton, Australia
| | - Sarah Verdon
- Department of Rural Health, University of Melbourne, Shepparton, Australia
| | - Rodney Pope
- Department of Rural Health, University of Melbourne, Shepparton, Australia
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Shaffer SM, Naze GS. Evaluation and management of temporomandibular disorders. Part 2: an orthopaedic physical therapy update on examination and clinical reasoning. J Man Manip Ther 2023; 31:143-152. [PMID: 36171740 PMCID: PMC10288906 DOI: 10.1080/10669817.2022.2124617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Temporomandibular (TM) disorders afflict many people globally and, despite the presence of existing peer-reviewed material that assists conservative orthopedic providers, recent advances in knowledge indicate that updated resources are required for students, clinicians, and educators. This two-part series builds off previously published material to present newer supplementary information that can be useful during the evaluation and management processes. Content in Part 1 of this series includes a discussion about the factors that have been shown to contribute to TM disorders, an updated perspective of relevant pain science, a discussion of self-report outcome measures, and various different topics related to the examination of patients with TM disorders. Part 2 addresses information related to the temporomandibular joint disc, joint hypermobility, oral splints, and clinical reasoning. In combination with other available publications, this two-part series provides clinicians an opportunity to improve their delivery of effective and efficient clinical services for people diagnosed with TM disorders.
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Affiliation(s)
- Stephen M. Shaffer
- Department of Rehabilitation Sciences, College of Education, Nursing, and Health Professions, University of Hartford, West Hartford, CT, USA
| | - Garrett S. Naze
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, USA
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Shaffer SM, Naze GS. Evaluation and management of temporomandibular disorders. Part 1: an orthopedic physical therapy update on examination and clinical reasoning. J Man Manip Ther 2023; 31:133-142. [PMID: 36245265 PMCID: PMC10288910 DOI: 10.1080/10669817.2022.2123171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Temporomandibular (TM) disorders afflict many people globally and, despite the presence of existing peer-reviewed material that assists conservative orthopedic providers, recent advances in knowledge indicate that updated resources are required for students, clinicians, and educators. This two-part series builds off previously published material to present newer supplementary information that can be useful during the evaluation and management processes. Content in Part 1 of this series includes a discussion about the factors that have been shown to contribute to TM disorders, an updated perspective of relevant pain science, a discussion of self-report outcome measures, and various different topics related to the examination of patients with TM disorders. Part 2 addresses information related to the temporomandibular joint disc, joint hypermobility, oral splints, and clinical reasoning. In combination with other available publications, this two-part series provides clinicians an opportunity to improve their delivery of effective and efficient clinical services for people diagnosed with TM disorders.
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Affiliation(s)
- Stephen M. Shaffer
- College of Education, Nursing, and Health Professions, Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, USA
| | - Garrett S. Naze
- Congdon School of Health Sciences, Department of Physical Therapy, High Point University, High Point, NC, USA
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6
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López-de-Celis C, Labata-Lezaun N, Romaní-Sánchez S, Gassó-Villarejo S, Garcia-Ribell E, Rodríguez-Sanz J, Pérez-Bellmunt A. Effect of Load Distribution on Trunk Muscle Activity with Lunge Exercises in Amateur Athletes: Cross-Sectional Study. Healthcare (Basel) 2023; 11:healthcare11060916. [PMID: 36981573 PMCID: PMC10048665 DOI: 10.3390/healthcare11060916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/18/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The effect of load distribution applied to the trunk musculature with lunge exercises has yet to be determined. The aim of this study was to evaluate the effect of load placement using dumbbells on the activation of the latissimus dorsi, erector spinae, external oblique, and rectus abdominis muscles during the lunge. METHODS Forty-two amateur athletes (21 men and 21 women) were recruited. Three lunge exercises were performed with different loading arrangements (ipsilateral, contralateral, and bilateral). The principal variable recorded for muscle activity was mean "root mean square" expressed as the percentage of the maximal voluntary isometric contraction. RESULTS There are statistically significant differences in the erector spinae (p < 0.001; p < 0.003) and external oblique muscles (p < 0.009; p < 0.001) compared with the contralateral side. The muscle on the opposite side of the load achieved higher activation for these muscles. The erector spinae and latissimus dorsi muscle did not reach a statistically significant difference with the contralateral side in any exercise (p > 0.05). The higher activation of the latissimus dorsi occurred on the same side on which the load was placed. CONCLUSIONS There was higher activation of the erector spinae, external oblique, and rectus abdominis muscles contralateral to the side of load placement during lunge exercise by amateur athletes.
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Affiliation(s)
- Carlos López-de-Celis
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08195 Barcelona, Spain
- ACTIUM Functional Anatomy Group, 08195 Barcelona, Spain
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - Noé Labata-Lezaun
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08195 Barcelona, Spain
- ACTIUM Functional Anatomy Group, 08195 Barcelona, Spain
| | | | - Sergi Gassó-Villarejo
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08195 Barcelona, Spain
- ACTIUM Functional Anatomy Group, 08195 Barcelona, Spain
| | - Erik Garcia-Ribell
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08195 Barcelona, Spain
- ACTIUM Functional Anatomy Group, 08195 Barcelona, Spain
| | - Jacobo Rodríguez-Sanz
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08195 Barcelona, Spain
- ACTIUM Functional Anatomy Group, 08195 Barcelona, Spain
| | - Albert Pérez-Bellmunt
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08195 Barcelona, Spain
- ACTIUM Functional Anatomy Group, 08195 Barcelona, Spain
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7
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Göbel N. Auswirkungen manueller Therapie am Kiefergelenk und der oberen Halswirbelsäule auf die Kopfschmerzen von Patienten mit kraniomandibulärer Dysfunktion. MANUELLE MEDIZIN 2023. [DOI: 10.1007/s00337-022-00933-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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8
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Speksnijder CM, Mutsaers NEA, Walji S. Functioning of the Masticatory System in Patients with an Alloplastic Total Temporomandibular Joint Prostheses Compared with Healthy Individuals: A Pilot Study. LIFE (BASEL, SWITZERLAND) 2022; 12:life12122073. [PMID: 36556438 PMCID: PMC9784972 DOI: 10.3390/life12122073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Most patients with temporomandibular joint (TMJ) issues are successfully treated with nonsurgical methods. However, when end-stage TMJ pathologies occur, invasive management can be required, such as a total TMJ replacement. This cross-sectional pilot study aimed to provide insight into the functioning of the masticatory system, pain, and patient satisfaction in patients treated with a total joint replacement (TJR). METHODS A cross-sectional pilot study was conducted to determine the postoperative clinical results of an alloplastic TJR TMJ. Masticatory performance and also insight into maximum voluntary bite force (MVBF), active and passive maximum mouth opening (aMMO/pMMO), pain, and patient satisfaction were measured. Masticatory performance, MVBF, and aMMO of patients with a TJR TMJ were compared with healthy individuals. RESULTS Masticatory performance is equal between patients with a TJR TMJ and healthy individuals, but both MVBF and aMMO were significantly smaller in patients with a TJR TMJ. However, patients had almost no pain and were very satisfied with the TJR TMJ treatment. CONCLUSION This study revealed that most patients with an alloplastic TJR TMJ were able to function without pain, showed good masticatory performance, and were highly satisfied with their alloplastic TJR TMJ. However, MVBF and aMMO were lower than in healthy individuals.
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Affiliation(s)
- Caroline M. Speksnijder
- University Medical Center Utrecht, Department of Oral and Maxillofacial Surgery and Special Dental Care, Utrecht University, 3584 CX Utrecht, The Netherlands
- Department of Oral and Maxillofacial Surgery, Jeroen Bosch Hospital, 5223 GZ ‘s-Hertogenbosch, The Netherlands
- Correspondence:
| | - Nadiya E. A. Mutsaers
- University Medical Center Utrecht, Department of Oral and Maxillofacial Surgery and Special Dental Care, Utrecht University, 3584 CX Utrecht, The Netherlands
- Department of Oral and Maxillofacial Surgery, Jeroen Bosch Hospital, 5223 GZ ‘s-Hertogenbosch, The Netherlands
| | - Sajjad Walji
- University Medical Center Utrecht, Department of Oral and Maxillofacial Surgery and Special Dental Care, Utrecht University, 3584 CX Utrecht, The Netherlands
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Silva TB, Ortiz FR, Maracci LM, Silva GBP, Salbego RS, Liedke GS, Marquezan M. Association among headache, temporomandibular disorder, and awake bruxism: A cross‐sectional study. Headache 2022; 62:748-754. [DOI: 10.1111/head.14322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 04/04/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Tatiana B. Silva
- Department of Restorative Dentistry Universidade Federal de Santa Maria Santa Maria Brazil
| | | | - Lucas M. Maracci
- Graduate Program in Dental Sciences Universidade Federal de Santa Maria Santa Maria Brazil
| | | | - Rafaela S. Salbego
- Graduate Program in Dental Sciences Universidade de São Paulo São Paulo Brazil
| | - Gabriela S. Liedke
- Department of Stomatology Universidade Federal de Santa Maria Santa Maria Brazil
| | - Mariana Marquezan
- Department of Stomatology Universidade Federal de Santa Maria Santa Maria Brazil
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10
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Dunning J, Butts R, Bliton P, Vathrakokoilis K, Smith G, Lineberger C, Eshleman N, Fernández-de-Las-Peñas C, Young IA. Dry needling and upper cervical spinal manipulation in patients with temporomandibular disorder: A multi-center randomized clinical trial. Cranio 2022:1-14. [PMID: 35412448 DOI: 10.1080/08869634.2022.2062137] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To compare the effects of dry needling and upper cervical spinal manipulation with interocclusal splint therapy, diclofenac, and temporomandibular joint (TMJ) mobilization in patients with temporomandibular disorder (TMD). METHODS One hundred-twenty patients with TMD were randomized to receive six treatment sessions of dry needling plus upper cervical spinal manipulation (n = 62) or interocclusal splint therapy, diclofenac, and joint mobilization to the TMJ (n = 58). RESULTS Patients receiving dry needling and upper cervical spinal manipulation experienced significantly greater reductions in jaw pain intensity over the last 7 days (VAS: F = 23.696; p < 0.001) and active pain-free mouth opening (F = 29.902; p < 0.001) than those receiving interocclusal splint therapy, diclofenac, and TMJ mobilization at the 3-month follow-up. CONCLUSION Dry needling and upper cervical spinal manipulation was more effective than interocclusal splint therapy, diclofenac, and TMJ mobilization in patients with TMD.
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Affiliation(s)
- James Dunning
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA
- Montgomery Osteopractic Physical Therapy & Acupuncture Clinic, Montgomery, AL, USA
| | - Raymond Butts
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA
- Research Physical Therapy Specialists, Columbia, SC, USA
| | - Paul Bliton
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA
- Athletico Physical Therapy, Roscoe, IL, USA
| | | | - Grant Smith
- Advanced Manual Therapies, Alpharetta, GA, USA
| | | | - Noah Eshleman
- Peak Physical Therapy & Sports Rehab, Helena, MT, USA
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
- Ejercicio, Universidad Rey Juan CarlosCátedra de Clínica, Investigación y Docencia en Fisioterapia: Terapia Manual, Punción Seca y, Alcorcón, Spain
| | - Ian A Young
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA
- Tybee Wellness & Osteopractic, Tybee Island, GA, USA
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11
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Dinsdale A, Costin B, Dharamdasani S, Page R, Purs N, Treleaven J. What conservative interventions improve bite function in those with temporomandibular disorders? A systematic review using self-reported and physical measures. J Oral Rehabil 2022; 49:456-475. [PMID: 35108410 DOI: 10.1111/joor.13307] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/02/2022] [Accepted: 01/17/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bite is an important function of the human stomatognathic system. Despite this, it is commonly impaired in temporomandibular disorder (TMD) populations. The aim of this review is to evaluate the effectiveness of conservative interventions on self-reported and physical measures of bite function in individuals with TMD. METHODS This review was performed in compliance with PRISMA guidelines. An electronic search was performed on databases including Pubmed, CINAHL, Embase, and Cochrane Central. Inclusion criteria were journal articles evaluating the effect of any non-pharmacological conservative interventions on bite function in participants diagnosed with TMD. Risk of bias for individual studies was assessed using the Cochrane risk-of-bias v2 tool, and the NIH NHLBI pre-post tool. Data was synthesised based on outcome measures of bite function, and the quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Eleven studies were eligible for this review. Interventions included splinting, photobiomodulation, needling, exercise, manual therapy, and patient education; which were evaluated using mastication-related pain, self-reported chewing difficulty, and bite force/endurance outcome measures. Findings suggested manual therapy, needling, oral splinting, exercise and PBM interventions may improve bite function in TMD, although confidence in cumulative evidence ranged from moderate to very low. There was no evidence that patient education improved bite function. CONCLUSION Conservative interventions may be helpful to address bite-related impairments associated with TMD, although further research is needed to improve the quality of evidence and direct clinical guidelines.
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Affiliation(s)
- Alana Dinsdale
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, QLD, 4072, Australia
| | - Brianna Costin
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, QLD, 4072, Australia
| | - Simran Dharamdasani
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, QLD, 4072, Australia
| | - Ruth Page
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, QLD, 4072, Australia
| | - Nykeela Purs
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, QLD, 4072, Australia
| | - Julia Treleaven
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, QLD, 4072, Australia
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Ludewig PM, Saini G, Hellem A, Kahnert EK, Rezvanifar SC, Braman JP, Staker JL. Changing our Diagnostic Paradigm Part II: Movement System Diagnostic Classification. Int J Sports Phys Ther 2022; 17:7-17. [PMID: 35024204 PMCID: PMC8720248 DOI: 10.26603/001c.30177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 11/28/2021] [Indexed: 12/30/2022] Open
Abstract
Diagnostic classification is a foundational underpinning of providing care of the highest quality and value. Diagnosis is pattern recognition that can result in categories of conditions that ideally direct treatment. While pathoanatomic diagnoses are common and traditional in orthopaedic practice, they often are limited with regard to directing best practice physical therapy intervention. Replacement of pathoanatomic labels with non-specific regional pain labels has been proposed, and occurs frequently in clinical practice. For example non-specific low back pain or shoulder pain of unknown origin. These labels avoid some disadvantages of tissue specific pathoanatomic labels, but are not specific enough to direct treatment. A previously introduced movement system diagnostic framework is proposed and updated with application to shoulder conditions. This framework has potential for broad development and application across musculoskeletal physical therapist practice. Movement system diagnostic classification can advance and streamline practice if considered while recognizing the inherent movement variability across individuals.
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Affiliation(s)
- Paula M Ludewig
- Department of Rehabilitation Medicine, University of Minnesota Divisions of Physical Therapy & Rehabilitation Science
| | - Gaura Saini
- Department of Rehabilitation Medicine, University of Minnesota Division of Rehabilitation Science
| | - Aaron Hellem
- Department of Rehabilitation Medicine, University of Minnesota Divisions of Physical Therapy & Rehabilitation Science
| | - Emily K Kahnert
- Department of Rehabilitation Medicine, University of Minnesota Division of Rehabilitation Science; Orofacial Pain & Dental Sleep Medicine Clinic, University of Minnesota School of Dentistry
| | - S Cyrus Rezvanifar
- Department of Rehabilitation Medicine, University of Minnesota Divisions of Physical Therapy & Rehabilitation Science
| | | | - Justin L Staker
- Department of Rehabilitation Medicine, University of Minnesota Divisions of Physical Therapy & Rehabilitation Science
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13
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Liu GF, Gao Z, Liu ZN, Yang M, Zhang S, Tan TP. Effects of Warm Needle Acupuncture on Temporomandibular Joint Disorders: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:6868625. [PMID: 34873409 PMCID: PMC8643238 DOI: 10.1155/2021/6868625] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 10/13/2021] [Accepted: 11/05/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Temporomandibular joint disorders (TMDs) are a common and prevalent disease with main symptoms of pain, joint sounds, and mandibular movement disorders, which seriously affects the mental health and quality of life of the sufferers. In recent years, there have been an increasing number of studies utilizing warm needle acupuncture (WNA) for the treatment of TMD, and the quality of the studies has gradually improved. However, evidence from evidence-based medicine is lacking. This study aims to use a systematic review and meta-analysis method to understand the efficacy of WNA for the treatment of TMD. Methods and Analysis. We searched randomized controlled trials (RCTs) of WNA for the treatment of TMD from 9 electronic databases, including 5 English databases (PubMed, EMBASE, Cochrane Library, Web of Science, and MEDLINE) and 4 Chinese databases (Chinese National Knowledge Infrastructure (CNKI), Chinese VIP Information, Wanfang Database, and Chinese Biomedical Literature Database (CBM)) from their inception to May 2021. The included RCTs compared WNA with acupuncture, electroacupuncture, pharmacological therapy, or other therapies. And outcome indicators such as total effective rate and cure rate were assessed. All analyses were conducted using RevMan software V5.3 and Stata16. Measurement count data used the relative risk (RR) as the efficacy statistic, and each effect size was given its point estimate value and 95% confidence interval (CI). RESULTS The meta-analysis included 10 studies with a total of 670 patients, which included 340 patients in the experimental group and 330 patients in the control group. The data in this review showed that WNA is superior to treatments such as acupuncture alone, acupuncture therapy combined with TDP, drug therapy, and ultrasonic therapy in terms of effective rate (RR = 1.20; 95% CI, 1.06 to 1.35; and P = 0.003) and cure rate (RR = 1.82; 95% CI, 1.46 to 2.28; and P < 0.00001) for the treatment of TMD. CONCLUSIONS This systematic review and meta-analysis provides new evidence for the effectiveness of WNA for the treatment of TMD. However, the above conclusions need to be further verified by multicenter prospective studies of larger samples and higher-quality RCTs. Protocol registration number: INPLASY202160030.
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Affiliation(s)
- Gao-Feng Liu
- Graduate Faculty, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Zhen Gao
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu 6100752, China
| | - Zheng-Nan Liu
- The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou 510405, China
| | - Min Yang
- Dermatology Department, Qujiang District Hospital of Traditional Chinese Medicine, Quzhou 324022, China
| | - Sheng Zhang
- Neurology Department, Qujiang District Hospital of Traditional Chinese Medicine, Quzhou 324022, China
| | - Tai-Peng Tan
- Acupuncture Department, Heilongjiang Provincial Academy of Traditional Chinese Medicine Sciences, Harbin 150036, China
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14
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Anandkumar S, Manivasagam M. Physical therapist guided active intervention of chronic temporomandibular disorder presenting as ear pain: A case report. Physiother Theory Pract 2021; 38:3146-3158. [PMID: 34152897 DOI: 10.1080/09593985.2021.1938307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This case report describes the successful physical therapy management of a 40-year-old female who presented with left ear pain referred from the temporomandibular joint. Diagnosis was primarily based on clinical examination findings and ruling out of red flags. Guidance was given on active self-care approaches consisting of pain neuroscience education designed with individualized pain curriculum, exercise therapy, manual therapy, and breathing exercises for a period of sixweeks. Clinically meaningful improvements were obtained in the outcome measures of Numeric Pain Rating Scale (NPRS), Patient-Specific Functional Scale (PSFS), and Global Rating of Change (GROC) scale and progress in Pain-Self Efficacy Questionnaire (PSEQ) and Tampa Scale for Kinesiophobia (TSK) scores. Positive changes were achieved with functional activities (chewing, eating, yawing, brushing teeth and physical intimacy), and the patient was pain-free on discharge, which was maintained at a six-month follow-up.
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Affiliation(s)
- Sudarshan Anandkumar
- Synergy Rehab Clayton Heights Physiotherapy and Sports Injury Clinic, Surrey, British Columbia, Canada
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15
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Miranda LS, Graciosa MD, Puel AN, Raulino de Oliveira L, Sonza A. Masticatory muscles electrical activity, stress and posture in preadolescents and adolescents with and without temporomandibular dysfunction. Int J Pediatr Otorhinolaryngol 2021; 141:110562. [PMID: 33360408 DOI: 10.1016/j.ijporl.2020.110562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 12/11/2020] [Accepted: 12/12/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To verify the difference between the masticatory muscles' electrical activity, stress signals and the posture of preadolescents and adolescents with and without temporomandibular dysfunction (TMD). METHODS 24 preadolescents and adolescents aged between 11 and 18 years old were divided into two groups, TMD group (TMDG) and control group (CG). All subjects were submitted to anthropometric measurements, psychological stress analysis, temporomandibular joint clinical evaluation and TMD verification; postural evaluation and masseter and temporal muscles electrical activity analysis during chewing. For statistical analysis, the Student's t-test or Mann-Whitney U test were used according to data distribution. RESULTS There was a significant difference between the groups for the electrical activity of the right temporal muscles (7.43% ± 2.92 vs. 11.71% ± 5.37) and left (7.70% ± 4.04 vs.11.44% ± 4.03) in the inactive period of chewing between CG and TMDG, respectively. There was no difference in stress or posture variables between groups. CONCLUSIONS During the inactive period of chewing, there was greater activation of the temporal muscles in the TMDG. Female gender was prevalent in TMDG. The study participants showed signs of stress, regardless of the group. The posture and TMD relationship still need to be studied.
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Affiliation(s)
- Letícia Souza Miranda
- Laboratory of Development and Postural Control (LADESCOP), Center of Health Sciences and Sport, Santa Catarina State University (UDESC), Rua Pascoal Simone, 358- Coqueiros, Florianópolis, SC, 88080-350, Brazil.
| | - Maylli Daiani Graciosa
- Laboratory of Development and Postural Control (LADESCOP), Center of Health Sciences and Sport, Santa Catarina State University (UDESC), Rua Pascoal Simone, 358- Coqueiros, Florianópolis, SC, 88080-350, Brazil; Post-graduate Program in Physiotherapy, Center of Health Sciences and Sport, Santa Catarina State University, Rua Pascoal Simone, 358- Coqueiros, Florianópolis, SC, 88080-350, Brazil.
| | - Alexia Nadine Puel
- Laboratory of Development and Postural Control (LADESCOP), Center of Health Sciences and Sport, Santa Catarina State University (UDESC), Rua Pascoal Simone, 358- Coqueiros, Florianópolis, SC, 88080-350, Brazil.
| | - Luiza Raulino de Oliveira
- Laboratory of Development and Postural Control (LADESCOP), Center of Health Sciences and Sport, Santa Catarina State University (UDESC), Rua Pascoal Simone, 358- Coqueiros, Florianópolis, SC, 88080-350, Brazil; Post-graduate Program in Physiotherapy, Center of Health Sciences and Sport, Santa Catarina State University, Rua Pascoal Simone, 358- Coqueiros, Florianópolis, SC, 88080-350, Brazil.
| | - Anelise Sonza
- Laboratory of Development and Postural Control (LADESCOP), Center of Health Sciences and Sport, Santa Catarina State University (UDESC), Rua Pascoal Simone, 358- Coqueiros, Florianópolis, SC, 88080-350, Brazil; Post-graduate Program in Physiotherapy, Center of Health Sciences and Sport, Santa Catarina State University, Rua Pascoal Simone, 358- Coqueiros, Florianópolis, SC, 88080-350, Brazil; Post-graduate Program in Human Movement Sciences, Center of Health Sciences and Sport, Santa Catarina State University, Rua Pascoal Simone, 358- Coqueiros, Florianópolis, SC, 88080-350, Brazil.
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Facial Pain and Temporomandibular Joint Dysfunction Secondary to Acromegaly: Treatment with Manual Therapy, Neuromuscular Re-education - A Case Report. REHABILITATION ONCOLOGY 2021; 38:127-133. [PMID: 33447472 DOI: 10.1097/01.reo.0000000000000190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background and Purpose Acromegaly is a disorder typically caused by a benign pituitary adenoma resulting in hypersecretion of growth hormone. Common sequelae, including musculoskeletal changes and arthropathies can result in facial pain and temporomandibular disorder (TMD) that persist beyond primary treatment. Due to the unique etiology of facial pain and TMD in cases of acromegaly, the generalizability of established physical therapy (PT) literature for treatment of TMD cannot be assumed. The purpose of this case report was to illustrate an example of multimodal PT as a treatment strategy for facial pain and TMD secondary to acromegaly following treatment for benign pituitary macroadenoma. Case Description 48-year-old male patient with history significant for benign pituitary macroadenoma, presented with facial pain and TMD secondary to acromegaly. Patient-reported outcomes of pain, function, and quality of life were assessed utilizing the Gothenburg Trismus Questionnaire (GTQ) at baseline, eighth PT visit, and eight weeks following course of PT. Quantity and quality of jaw mobility were assessed at baseline and post-intervention using standard goniometric measurements and observation. A total of nine PT sessions were delivered over three months consisting of manual therapy, relaxation techniques, neuromuscular re-education, and therapeutic exercise. Outcomes After eight PT visits, patient's GTQ score improved from 81% to 67.6%, with a corresponding decrease in pain and improved symmetry of jaw mobility. Eight weeks following last PT visit, patient's GTQ score further decreased from 67.6% to 61.3%. Discussion Conservative management through multimodal PT may be effective in managing facial pain and TMD secondary to acromegaly following treatment for benign pituitary macroadenoma.
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17
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Clinical Reasoning for the Examination and Physical Therapy Treatment of Temporomandibular Disorders (TMD): A Narrative Literature Review. J Clin Med 2020; 9:jcm9113686. [PMID: 33212937 PMCID: PMC7698332 DOI: 10.3390/jcm9113686] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/11/2020] [Accepted: 11/16/2020] [Indexed: 02/07/2023] Open
Abstract
The current narrative literature review aims to discuss clinical reasoning based on nociceptive pain mechanisms for determining the most appropriate assessment and therapeutic strategy and to identify/map the most updated scientific evidence in relation to physical therapy interventions for patients with temporomandibular disorders (TMDs). We will also propose an algorithm for clinical examination and treatment decisions and a pain model integrating current knowledge of pain neuroscience. The clinical examination of patients with TMDs should be based on nociceptive mechanisms and include the potential identification of the dominant, central, or peripheral sensitization driver. Additionally, the musculoskeletal drivers of these sensitization processes should be assessed with the aim of reproducing symptoms. Therapeutic strategies applied for managing TMDs can be grouped into tissue-based impairment treatments (bottom-up interventions) and strategies targeting the central nervous system (top-down interventions). Bottom-up strategies include joint-, soft tissue-, and nerve-targeting interventions, as well as needling therapies, whereas top-down strategies include exercises, grade motor imagery, and also pain neuroscience education. Evidence shows that the effectiveness of these interventions depends on the clinical reasoning applied, since not all strategies are equally effective for the different TMD subgroups. In fact, the presence or absence of a central sensitization driver could lead to different treatment outcomes. It seems that multimodal approaches are more effective and should be applied in patients with TMDs. The current paper also proposes a clinical decision algorithm integrating clinical diagnosis with nociceptive mechanisms for the application of the most appropriate treatment approach.
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Mesa-Jiménez JA, Fernández-de-Las-Peñas C, Koppenhaver SL, Sánchez-Gutiérrez J, Arias-Buría JL. Cadaveric and in vivo validation of needle placement in the medial pterygoid muscle. Musculoskelet Sci Pract 2020; 49:102197. [PMID: 32479337 DOI: 10.1016/j.msksp.2020.102197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/10/2020] [Accepted: 05/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Evidence suggests that medial pterygoid muscle plays an important role in temporomandibular pain. Therapeutic approaches targeting this muscle are needed. OBJECTIVE To determine if a solid needle accurately penetrates the medial pterygoid muscle during the application of dry needling. DESIGN A cadaveric and human descriptive study. METHODS Needling insertion of the medial pterygoid was conducted in 5 fresh cadaver and 5 subjects with temporomandibular pain. Needling insertion was performed using a 40 mm needle inserted at the inferior angle of the mandibular bone. The needle was advanced from an inferior to superior direction into the medial pterygoid to a maximum depth of 30 mm. In cadavers, medial pterygoid placement was assessed by observation after resecting the superficial overlying tissues. In patients, medial pterygoid placement was assessed by self-reported pain referral during insertion. RESULTS Accurate needle penetration of the medial pterygoid was observed in all fresh cadavers and pain referral was reported by 4/5 patients during needling insertion. CONCLUSION Results from both cadavers and patients support the assertion that needling of the medial pterygoid can be accurately conducted.
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Affiliation(s)
- Juan A Mesa-Jiménez
- Oficial Máster in Cranio-Mandibular Disorders and Orofacial Pain, Universidad San-Pablo CEU, Madrid, Spain; Department of Physical Therapy, Universidad San-Pablo CEU, Madrid, Spain
| | - Cesar Fernández-de-Las-Peñas
- Oficial Máster in Cranio-Mandibular Disorders and Orofacial Pain, Universidad San-Pablo CEU, Madrid, Spain; Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorcón, Madrid, Spain.
| | | | - Jesús Sánchez-Gutiérrez
- Oficial Máster in Cranio-Mandibular Disorders and Orofacial Pain, Universidad San-Pablo CEU, Madrid, Spain; Department of Maxillo-Facial Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | - José L Arias-Buría
- Oficial Máster in Cranio-Mandibular Disorders and Orofacial Pain, Universidad San-Pablo CEU, Madrid, Spain; Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorcón, Madrid, Spain; Baylor University Doctoral Program in Physical Therapy, Waco, TX, USA
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19
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Effectiveness of Cervical Spine High-Velocity, Low-Amplitude Thrust Added to Behavioral Education, Soft Tissue Mobilization, and Exercise for People With Temporomandibular Disorder With Myalgia: A Randomized Clinical Trial. J Orthop Sports Phys Ther 2020; 50:455-465. [PMID: 31905097 DOI: 10.2519/jospt.2020.9175] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the immediate and short-term effects of adding cervical spine high-velocity, low-amplitude thrust (HVLAT) to behavioral education, soft tissue mobilization, and a home exercise program on pain and dysfunction for people with a primary complaint of temporomandibular disorder (TMD) with myalgia. DESIGN Randomized clinical trial. METHODS Fifty individuals with TMD were randomly assigned to receive cervical HVLAT or sham manipulation for 4 visits over 4 weeks. Participants in both groups received other treatments, including standardized behavioral education, soft tissue mobilization, and a home exercise program. Primary outcomes included maximal mouth opening, the numeric pain-rating scale, the Jaw Functional Limitation Scale (JFLS), the Tampa Scale of Kinesiophobia for TMD (TSK-TMD), and a global rating of change (GROC). Self-report and objective measurements were taken at baseline, immediately after initial treatment, and follow-ups of 1 week and 4 weeks. A 2-by-4 mixed-model analysis of variance was used, with intervention group as the between-subjects factor and time as the within-subject factor. Separate analyses of variance were performed for dependent variables, and the hypothesis of interest was the group-by-time interaction. RESULTS There was no significant interaction for maximal mouth opening, the numeric pain-rating scale, or secondary measures. There were significant 2-way interactions for the JFLS (d = 0.60) and TSK-TMD (d = 0.80). The HVLAT group had lower fear at 4 weeks and improved jaw function earlier (1 week). The GROC favored the HVLAT group, with significant differences in successful outcomes noted immediately after baseline treatment (thrust, 6/25; sham, 0/25) and at 4 weeks (thrust, 17/25; sham, 10/25). CONCLUSION Both groups improved over time; however, differences between groups were small. There were significant differences between groups for the JFLS, TSK-TMD, and GROC. The additive clinical effect of cervical HVLAT to standard care remains unclear for treating TMD. J Orthop Sports Phys Ther 2020;50(8):455-465. Epub 6 Jan 2020. doi:10.2519/jospt.2020.9175.
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20
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Blanchard L, Goostree S, Duncombe A. Graded exposure and orthopedic manual physical therapy for kinesiophobia and function in chronic temporomandibular dysfunction: A case report. Cranio 2020; 40:454-467. [PMID: 32552574 DOI: 10.1080/08869634.2020.1779483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND This case report describes the successful use of multi-modal physical therapy (PT), including orthopedic manual physical therapy (OMPT) and graded exposure, in a patient with chronic temporomandibular dysfunction (TMD). CLINICAL PRESENTATION A 41-yr old female presented with a five-year history of bilateral chronic myofascial TMD and comorbid neck/right arm pain. The patient was treated for 12 weeks with a focus on OMPT and graded exposure. The patient demonstrated clinically significant improvements on the Tampa Scale of Kinesiophobia-TMD, maximal mouth opening, Global Rating of Change, and Jaw Functional Limitation Scale. CLINICAL RELEVANCE Mechanisms underlying chronic TMD are complex. Current evidence supports PT management of physical impairments; however, neglecting central drivers or psychosocial factors may result in suboptimal outcomes. Physical therapists are able to address both peripheral and central mechanisms of pain, and future research should examine the utilization of multi-modal PT to improve kinesiophobia and function in patients with chronic TMD.
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Affiliation(s)
- Leanna Blanchard
- Department of Rehabilitation Services, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | | | - Alison Duncombe
- Department of Rehabilitation Services, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
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Plaza-Manzano G, Delgado-de-la-Serna P, Díaz-Arribas MJ, Rodrigues-de-Souza DP, Fernández-de-Las-Peñas C, Alburquerque-Sendín F. Influence of Clinical, Physical, Psychological, and Psychophysical Variables on Treatment Outcomes in Somatic Tinnitus Associated With Temporomandibular Pain: Evidence From a Randomized Clinical Trial. Pain Pract 2020; 21:8-17. [PMID: 32419303 DOI: 10.1111/papr.12919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/26/2020] [Accepted: 05/11/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess the influence of clinical, psychological, and psychophysical variables on treatment outcomes after application of exercise combined with education with/without manual therapy in people with tinnitus associated with temporomandibular disorder (TMD). METHODS A secondary analysis of a clinical trial was performed investigating the effectiveness of including cervico-mandibular manual therapy into an exercise combined with education program in 61 subjects with TMD-related tinnitus. Clinical outcomes including tinnitus severity and tinnitus-related handicap were assessed at 3 and 6 months post-intervention. Patients were assessed at baseline for clinical (tinnitus severity, tinnitus-related handicap, quality of life), physical (range of motion), psychological (depression), and psychophysical (pressure pain thresholds [PPTs]) variables that were included as predictors. RESULTS The regression models indicated that higher scores of tinnitus severity at baseline predicted better outcomes 3 and 6 months post-intervention (explaining 13% to 41% of the variance) in both groups. Higher scores of tinnitus-related handicap at baseline predicted better outcome of tinnitus-related handicap (45% variance) in the manual therapy with exercise/education group. Lower PPTs over the temporalis muscle at baseline predicted poorer clinical outcomes (10.5% to 41% of the variance) in both groups. Other predictors were sex and quality of life (6.7% variance) in the manual therapy group and PPTs over the masseter muscle (5.8% variance) in the exercise/education group. CONCLUSION This study found that baseline tinnitus severity and localized PPT over the temporalis muscle were predictive of clinical outcomes in individuals with TMD-related tinnitus following physical therapy. Other predictors (eg, sex, quality of life) were less influential.
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Affiliation(s)
- Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | | | - María J Díaz-Arribas
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain
| | | | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón Madrid, Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Spain
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22
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Thorp JN, Willson J. Thoracic spine manipulation did not improve maximal mouth opening in participants with temporomandibular dysfunction. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 25:e1824. [PMID: 31729114 DOI: 10.1002/pri.1824] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/24/2019] [Accepted: 11/01/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Temporomandibular joint disorders (TMD) have a prevalence of more than 5% in the general population. A positive correlation exists between temporomandibular joint mobility and cervical spine mobility. Similarly, a relationship exists between thoracic and cervical spine mobility. However, it is unknown if interventions to improve the mobility of the thoracic spine positively impact temporomandibular joint motion and pain. This study tested the hypothesis that a single thoracic thrust joint manipulation (TJM) would improve maximum mouth opening (MMO) compared with participants without TMD as well as decrease TMD symptoms. METHODS Forty-eight people with TMD (30.9 years old ±11.3) and 55 people without TMD (28.5 years old ±9.2) participated. Both groups received a seated upper thoracic TJM and were measured for MMO before and immediately following the TJM. The duration of TMD symptoms and pre-thrust current pain, using the 11-point Verbal Pain Rating Scale (VPRS), was recorded in the TMD group. Participants in the TMD group were contacted 2-3 days after TJM to report current VPRS and improvement utilizing the Global Rating of Change (GROC) scale. RESULTS No difference in MMO treatment response over time was observed between groups (p = .56). The MMO in the TMD group improved from 40 to 41.3 mm, and the non-TMD similarly improved from 44.5 to 45.4 mm. The VPRS decreased from 2.4 (±1.8) to 1.3 (±1.5) following thoracic TJM (p < .001), and the average GROC score was 1.8 (±2.25), which was statistically different than zero (no change; p < .001). The duration of TMD symptoms prior to TJM was not associated with GROC scores (r = .018, p = .90) or VPRS change scores (r = -.07, p = .64). CONCLUSION The observed treatment effects did not exceed previously reported standards for clinical relevance (5 mm and 2 points, respectively).
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Affiliation(s)
- Jacob N Thorp
- Department of Physical Therapy, East Carolina University, Greenville, NC, USA.,Department of Physical Therapy, Charleston Southern University, Charleston, SC, USA
| | - John Willson
- Department of Physical Therapy, East Carolina University, Greenville, NC, USA
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Delgado de la Serna P, Plaza-Manzano G, Cleland J, Fernández-de-las-Peñas C, Martín-Casas P, Díaz-Arribas MJ. Effects of Cervico-Mandibular Manual Therapy in Patients with Temporomandibular Pain Disorders and Associated Somatic Tinnitus: A Randomized Clinical Trial. PAIN MEDICINE 2019; 21:613-624. [DOI: 10.1093/pm/pnz278] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
Objective
This randomized clinical trial investigated the effects of adding cervico-mandibular manual therapies into an exercise and educational program on clinical outcomes in individuals with tinnitus associated with temporomandibular disorders (TMDs).
Methods
Sixty-one patients with tinnitus attributed to TMD were randomized into the physiotherapy and manual therapy group or physiotherapy alone group. All patients received six sessions of physiotherapy treatment including cranio-cervical and temporomandibular joint (TMJ) exercises, self-massage, and patient education for a period of one month. Patients allocated to the manual therapy group also received cervico-mandibular manual therapies targeting the TMJ and cervical and masticatory muscles. Primary outcomes included TMD pain intensity and tinnitus severity. Secondary outcomes included tinnitus-related handicap (Tinnitus Handicap Inventory [THI]), TMD-related disability (Craniofacial Pain and Disability Inventory [CF-PDI]), self-rated quality of life (12-item Short Form Health Survey [SF-12]), depressive symptoms (Beck Depression Inventory [BDI-II]), pressure pain thresholds (PPTs), and mandibular range of motion. Patients were assessed at baseline, one week, three months, and six months after intervention by a blinded assessor.
Results
The adjusted analyses showed better outcomes (all, P < 0.001) in the exercise/education plus manual therapy group (large effect sizes) for TMD pain (η 2 P = 0.153), tinnitus severity (η 2 P = 0.233), THI (η 2 P = 0.501), CF-PDI (η 2 P = 0.395), BDI-II (η 2 P = 0.194), PPTs (0.363 < η 2 P < 0.415), and range of motion (η 2 P = 0.350), but similar changes for the SF-12 (P = 0.622, η 2 P = 0.01) as the exercise/education alone group.
Conclusions
This clinical trial found that application of cervico-mandibular manual therapies in combination with exercise and education resulted in better outcomes than application of exercise/education alone in individuals with tinnitus attributed to TMD.
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Affiliation(s)
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Joshua Cleland
- Physical Therapist, Rehabilitation Services, Concord Hospital, Concord, New Hampshire
- Faculty, Manual Therapy Fellowship Program, Regis University, Denver, Colorado
- Department of Physical Therapy, Franklin Pierce University, Manchester, New Hampshire, USA
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
- Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Patricia Martín-Casas
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain
| | - María José Díaz-Arribas
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain
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Garrigós-Pedrón M, Elizagaray-García I, Domínguez-Gordillo AA, Del-Castillo-Pardo-de-Vera JL, Gil-Martínez A. Temporomandibular disorders: improving outcomes using a multidisciplinary approach. J Multidiscip Healthc 2019; 12:733-747. [PMID: 31564890 PMCID: PMC6732565 DOI: 10.2147/jmdh.s178507] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/16/2019] [Indexed: 12/19/2022] Open
Abstract
Patients with temporomandibular disorders (TMD) can become very complex. This article aims to highlight the importance of the multimodal and multidisciplinary approach in this type of patients to improve clinical outcomes. At present we have innumerable techniques and tools to approach this type of patients from a biopsychosocial model where active and adaptive type treatments are fundamental. There are various health professions that have competence in the treatment of TMD, however, although in the most complex cases should be treated simultaneously, still too many patients receive unique treatments and only from one point of view. This review exposes the treatments available from a clinical-scientific perspective and also emphasizes the importance of working in specialized units with those professionals who have competencies on the different conditions that may occur.
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Affiliation(s)
- Miriam Garrigós-Pedrón
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimeinto (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España.,CranioSPain Research Group, Instituto de Neurociencias y Ciencias del Movimeinto (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España
| | - Ignacio Elizagaray-García
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimeinto (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España.,CranioSPain Research Group, Instituto de Neurociencias y Ciencias del Movimeinto (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España
| | | | - José Luis Del-Castillo-Pardo-de-Vera
- CranioSPain Research Group, Instituto de Neurociencias y Ciencias del Movimeinto (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España.,Departamento de Cirugía Oral y Maxilofacilal, Hospital Universitario La Paz, Madrid, España
| | - Alfonso Gil-Martínez
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimeinto (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España.,CranioSPain Research Group, Instituto de Neurociencias y Ciencias del Movimeinto (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España.,Departamento de Cirugía Oral y Maxilofacilal, Hospital Universitario La Paz, Madrid, España.,Departamento de Fisioterapia, Hospital Universitario La Paz, IdiPAZ, Madrid, España
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Barbosa MA, Tahara AK, Ferreira IC, Intelangelo L, Barbosa AC. Effects of 8 weeks of masticatory muscles focused endurance exercises on women with oro‐facial pain and temporomandibular disorders: A placebo randomised controlled trial. J Oral Rehabil 2019; 46:885-894. [DOI: 10.1111/joor.12823] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/09/2019] [Accepted: 05/13/2019] [Indexed: 01/06/2023]
Affiliation(s)
- Michelle Almeida Barbosa
- Musculoskeletal Research Group—NIME, Department of Physical Therapy Federal University of Juiz de Fora Governador Valadares Brazil
- Master Degree Program in Rehabilitation and Physical Performance Federal University of Juiz de Fora Juiz de Fora Brazil
| | - Ariany Klein Tahara
- Musculoskeletal Research Group—NIME, Department of Physical Therapy Federal University of Juiz de Fora Governador Valadares Brazil
- Master Degree Program in Rehabilitation and Physical Performance Federal University of Juiz de Fora Juiz de Fora Brazil
| | - Isabella Christina Ferreira
- Musculoskeletal Research Group—NIME, Department of Physical Therapy Federal University of Juiz de Fora Governador Valadares Brazil
| | | | - Alexandre Carvalho Barbosa
- Musculoskeletal Research Group—NIME, Department of Physical Therapy Federal University of Juiz de Fora Governador Valadares Brazil
- Master Degree Program in Rehabilitation and Physical Performance Federal University of Juiz de Fora Juiz de Fora Brazil
- Master Degree Program in Applied Health Sciences Federal University of Juiz de Fora Governador Valadares Brazil
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26
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Arbex G, Teixeira VP, Moriyama CM, Andrade de Paula E, Santos EM, Bussadori SK. Temporomandibular disorder and headache in university professors. J Phys Ther Sci 2019; 31:217-222. [PMID: 30936634 PMCID: PMC6428655 DOI: 10.1589/jpts.31.217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 12/10/2018] [Indexed: 11/29/2022] Open
Abstract
[Purpose] Temporomandibular disorder is a condition with a multifactor etiology that
involves the temporomandibular joint, bones, surrounding muscles and facial pain is the
most common symptom. This study evaluated the possible association between headache and
temporomandibular disorder in university professors. [Participants and Methods]
Twenty-seven professors were recruited and answered the Axis II of the Research Diagnostic
Criteria for Temporomandibular Disorders for the evaluation and diagnosis of
temporomandibular disorder and filled out a “Headache Diary” proposed by the American
Headache Society. [Results] The university professors showed headache and
temporomandibular disorder, but no association was found between the two conditions.
Comparing the gender, the males were most frequently affected, but females had more
intensity of signs and symptoms. There is a lack of data on the population addressed in
the present study. [Conclusion] Indeed, this was the first such study developed with
university professors. It is of considerable importance to develop further studies to
investigate the possible association between headache and temporomandibular disorder.
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Affiliation(s)
- Gabriella Arbex
- School of Dentistry, Metropolitana de Santos University, São Paulo, Brazil
| | | | | | | | | | - Sandra Kalil Bussadori
- School of Dentistry, Metropolitana de Santos University, São Paulo, Brazil.,Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho: Vergueiro Street, 235/249 Liberdade, 01504000, São Paulo, SP, Brazil
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27
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Prodoehl J, Kraus S, Klasser GD, Hall KD. Temporomandibular disorder content in the curricula of physical therapist professional programs in the United States. Cranio 2019; 38:376-388. [DOI: 10.1080/08869634.2018.1560983] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Janey Prodoehl
- Physical Therapy Program, Midwestern University, Downers Grove, IL, USA
| | - Steven Kraus
- Horizon Physical Therapy LLC, Atlanta, GA, USA
- Division of Physical Therapy Department of Rehabilitation Medicine, Emory University of Medicine, Atlanta, GA, USA
| | - Gary D. Klasser
- School of Dentistry, Department of Diagnostic Sciences, Louisiana State University Health Sciences Center School of Dentistry, New Orleans, LA, USA
| | - Kathy D. Hall
- Physical Therapy Program, Midwestern University, Downers Grove, IL, USA
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Özden MC, Atalay B, Özden AV, Çankaya A, Kolay E, Yıldırım S. Efficacy of dry needling in patients with myofascial temporomandibular disorders related to the masseter muscle. Cranio 2018; 38:305-311. [PMID: 30296920 DOI: 10.1080/08869634.2018.1526848] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE This randomized, single-center clinical trial aimed to compare the efficacy of superficial dry needling (SDN) and deep dry needling (DDN) in patients with myofascial temporomandibular disorder (MTMD) related to the masseter muscle.Methods: Forty patients showing MTMD with trigger points in the masseter muscle were randomly assigned to groups. Dry needling of the masseter muscle was performed once per week for three weeks. Pressure pain threshold (PPT) measurements, visual analog scale scores, and maximal jaw opening were assessed.Results: Both patient groups showed significant pain reduction, but the SDN group showed significantly better pain reduction. The PPT measurements obtained in the follow-up examinations at three and six weeks were significantly better than the values in SDN and DDN groups.Discussion: SDN showed better pain-reduction efficacy in patients with MTMD. Further research with a larger size sample and a longer follow-up period will help elucidate the benefits of SDN.
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Affiliation(s)
- Mehmet Cem Özden
- Department of Oral Surgery, Faculty of Dentistry, Istanbul University , Istanbul, Turkey
| | - Berkem Atalay
- Department of Oral Surgery, Faculty of Dentistry, Istanbul University , Istanbul, Turkey
| | - Ali Veysel Özden
- Department of Physiotherapy, Rehabilitation, Health Sciences Institute, Bahçeşehir University , İstanbul, Turkey
| | - Abdülkadir Çankaya
- Department of Oral Surgery, Faculty of Dentistry, Istanbul University , Istanbul, Turkey
| | - Erdinç Kolay
- Department of Statistics, Faculty of Science, Sinop University , Sinop, Turkey
| | - Sami Yıldırım
- Department of Oral Surgery, Faculty of Dentistry, Istanbul University , Istanbul, Turkey
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29
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Maulén-Yáñez M, Meeder-Bella W, Videla-Jiménez PJ, González-Arriagada WA. Assessment of association between muscular diagnosis in temporomandibular disorders with mandibular kinematics. Cranio 2018; 37:365-373. [PMID: 29734882 DOI: 10.1080/08869634.2018.1465513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective: To study the association between mandibular kinematics and muscular diagnoses in temporomandibular disorders (TMD). Method: Retrospective, descriptive clinical study based on an analysis of 370 clinical records of muscle diagnoses in TMD. Statistical analysis was performed with the SPSS program. Results: Five different muscle diagnoses were considered. Myospasm and centrally mediated myalgia were discarded from the statistical analysis because of their low incidences. The diagnoses included in the analysis were protective co-contraction, myofascial pain, and myalgia. Decreased mandibular kinematics in the frontal and horizontal planes were related to myofascial pain. Mandibular kinematics with deflection in opening values decreased in the frontal plane, but intermediate or increased values in the horizontal plane were related to the protective co-contraction. Muscle pain with normal or increased mandibular kinematics was associated with a diagnosis of myalgia. Conclusion: Values of mandibular kinematics are correlated with the muscular diagnoses in TMD and are useful for diagnosis.
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Affiliation(s)
- Miguel Maulén-Yáñez
- Facultad de Odontología, Universidad de Valparaíso , Valparaíso , Chile.,Clinic of Temporomandibular Disorders and Orofacial Pain, Department of Dentistry, Gustavo Fricke Hospital , Viña del Mar , Chile
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30
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Butts R, Dunning J, Perreault T, Mettille J, Escaloni J. Pathoanatomical characteristics of temporomandibular dysfunction: Where do we stand? (Narrative review part 1). J Bodyw Mov Ther 2017; 21:534-540. [DOI: 10.1016/j.jbmt.2017.05.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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31
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Dickerson SM, Weaver JM, Boyson AN, Thacker JA, Junak AA, Ritzline PD, Donaldson MB. The effectiveness of exercise therapy for temporomandibular dysfunction: a systematic review and meta-analysis. Clin Rehabil 2016; 31:1039-1048. [DOI: 10.1177/0269215516672275] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To investigate the effectiveness of exercise therapy on pain, function, and mobility outcomes in patients with temporomandibular joint dysfunction. Study design: Systematic review with meta-analysis. Methods: A systematic review and meta-analysis undertaken following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies that met the inclusion criteria: (1) randomized controlled trials; (2) a population with the diagnosis of temporomandibular joint dysfunction; and (3) interventions that included exercise therapy were considered for review. When studies demonstrated homogeneity on outcome measures, the mean differences or standardized mean differences with 95% confidence interval were calculated and pooled in a meta-analysis for pooled synthesis. Results: Six articles with a total of 419 participants were included in the review and only four studies were included in the meta-analysis. Mobility and mixed exercise therapy approaches appear to be the most common exercise approaches utilized for management of temporomandibular joint dysfunction. Exercise therapy and the associated dosage provide moderate short-term and varying long-term benefits in reduction of pain and improvement of range of motion of the in patients with temporomandibular joint dysfunction. Conclusion: Included studies suggest a mobility or a mixed approach to exercise therapies have impact on reducing pain, significant impact for increasing range of motion, but lack a significant impact for functional improvement. Level of evidence: Therapy, level 1a-.
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Affiliation(s)
| | - Jarod M Weaver
- Department of Physical Therapy, Walsh University, North Canton, OH, USA
| | - Ashley N Boyson
- Department of Physical Therapy, Walsh University, North Canton, OH, USA
| | - Jared A Thacker
- Department of Physical Therapy, Walsh University, North Canton, OH, USA
| | - Andrew A Junak
- Department of Physical Therapy, Walsh University, North Canton, OH, USA
| | - Pamela D Ritzline
- Department of Physical Therapy, Walsh University, North Canton, OH, USA
| | - Megan B Donaldson
- Department of Physical Therapy, Walsh University, North Canton, OH, USA
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Julsvoll EH, Vøllestad NK, Robinson HS. Validation of clinical tests for patients with long-lasting painful temporomandibular disorders with anterior disc displacement without reduction. ACTA ACUST UNITED AC 2016; 21:109-19. [DOI: 10.1016/j.math.2015.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 06/01/2015] [Accepted: 06/12/2015] [Indexed: 12/27/2022]
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