Physiotherapy in Temporomandibular Disorders

Temporomandibular disorders (TMD) are those in which the jaw joint is affected, which allows the correct movement of the mouth when opening and closing, or the musculature in charge of giving movement to the joint is affected. In a very large proportion, both structures are affected, both the joint and the muscular system. But we can also find cases in which we only have a muscular problem, or only an intrinsic deterioration of the joint. This is the case of a pure joint disease, such as rheumatoid arthritis. In the evolution of the treatment of these conditions, physiotherapy plays a very important role, both in the treatment of an acute overload, and in the maintenance of an optimal state of the entire cranio-cervical muscular system, which is essential to be in balance.

The most frequent symptom, and the most common reason for consultation, is pain. This pain is most often caused by some kind of problem associated with a muscle that opens the mouth, or those that close it, or those that give stability to the neck. It can be a pain when yawning, a pain when chewing, a pain in the upper part of the neck when swallowing, a headache or cephalalgia, an earache, etc.

Where do these muscle contractions come from?

The muscle inflammation that can cause this wide variety of symptoms is caused by bruxism.

What is the definition of bruxism?

It is the involuntary and unconscious contraction of the musculature, especially of the masticatory, whose effect when these muscles contract when approaching a jaw against another and contact the teeth. During mastication, these contractions are combined in order to grind the food and then swallow it.

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What causes bruxism?

There are very few situations in which it is known with scientific evidence that they are the cause of muscular activity; and that, therefore, eliminating these situations will eradicate this muscular activity. However, we observe that almost 75% of the population is bruxist, and only one out of every three ends up in the consultation room to eliminate the pain.

What are these causes?

They are few:

  • Direct trauma to the jaw joint.
  • Malocclusion or abnormal bite.
  • Absence of teeth, especially in the back region.

Most patients do not have any of the situations mentioned above, and bruxism is then associated with a very strong relationship to stress, anxiety, to our socio-labor environment, to a very strong emotional component, in which we cannot act. We can only act against the symptoms it produces.

It is for all these reasons that the treatment of TMD is based on lowering the muscle tone, on keeping the masticatory system in a balanced situation, which counteracts the unconscious and involuntary activity of bruxism, since the functional overload that our joints will receive if we do not remedy it, is what will initiate a possible joint deterioration.

It is here where physiotherapy forms one of the fundamental pillars both to treat the muscular symptoms and to protect the joints secondarily.

The treatment that we call conservative, focused on the treatment of the joints is based on 5 pillars, and one of them is physiotherapy. In my opinion, I think it is the most important pillar, together with ferulotherapy.

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Physiotherapy consists of eliminating those points of tension, which usually cause pain on pressure, until muscular relaxation is achieved, which, together with the rest of the treatment, makes the patient forget about his ailment and live with it, because unfortunately bruxism does not disappear, and therefore there will be relapses and fluctuations in the symptomatology. The most important thing is that there is correct information about what is happening, and that the patient himself knows what to do and who to go to systematically when he has a flare-up of the pain, without the anxiety component produced by the uncertainty of knowing what is happening to the patient, adding more intensity to the pain, or which can make the pain chronic.