Efficacy of Manual Therapy Techniques in the Management of Temporomandibular Joint Locking

Introduction

Temporomandibular joint (TMJ) locking, characterized by limited mouth opening due to structural or functional reasons, poses significant challenges in both diagnosis and management. Manual therapy techniques have emerged as promising interventions for addressing TMJ locking, offering non-invasive alternatives to surgery or pharmacotherapy. This article aims to explore the efficacy of manual therapy techniques in managing TMJ locking through a comprehensive review of relevant scientific literature.(1)

Pathophysiology of TMJ Locking

 TMJ locking is often associated with various factors such as disc displacement, muscle spasm, joint inflammation, and structural abnormalities. These factors contribute to the mechanical obstruction or dysfunction within the TMJ, leading to restricted mouth opening and discomfort.(2)

Disc Displacement

A small disc within the TMJ acts like a smooth-operating guide for jaw movement. When this disc gets displaced due to excessive jaw movement, injury, or muscle strain, it disrupts the gliding motion of the jaw bone (condyle). This misalignment can lead to restricted movement and potentially locking.

Muscle Spasm

 Stress, anxiety, or teeth grinding can cause tightness and spasms in the muscles surrounding the TMJ. This compression restricts jaw movement and, in severe cases, can even contribute to disc displacement and locking.

Joint Inflammation

 Inflammation of the joint lining or surrounding tissues due to factors like autoimmune diseases, infections, or overuse can cause swelling and pain. This restricts jaw movement and potentially leads to locking if the inflamed tissues hinder the condyle's movement.

Structural Abnormalities

 Conditions like arthritis or congenital jaw malformations can also contribute. Arthritis degenerates the joint cartilage, limiting movement and potentially causing locking episodes. Malformations can alter the joint's mechanics, further restricting movement.

Manual Therapy Techniques

Manipulative Therapy

Manipulative techniques involve skilled passive movements to mobilize joints and soft tissues. Specific techniques may include mobilization with movement (MWM), high-velocity low-amplitude (HVLA) thrust techniques, and muscle energy techniques (METs). These techniques aim to restore normal joint mechanics, reduce muscle tension, and improve range of motion.(3)

Soft Tissue Mobilization

Soft tissue techniques target the muscles and fascia surrounding the TMJ. Methods such as massage, myofascial release, and trigger point therapy are utilized to alleviate muscle tightness, reduce pain, and enhance tissue flexibility.(4)

Stretching and Exercise

Therapeutic exercises and stretching routines are essential components of manual therapy for TMJ locking. These exercises aim to strengthen the muscles around the TMJ, improve joint stability, and promote optimal function.(5)

Discussion

 The findings from various studies suggest that manual therapy techniques hold considerable promise in the management of TMJ locking. By targeting both the joint and surrounding soft tissues, these interventions address the underlying mechanical dysfunction and associated symptoms effectively. Furthermore, manual therapy offers a conservative approach with minimal risks compared to surgical interventions or pharmacotherapy.

However, it's essential to acknowledge the variability in treatment outcomes among individuals and the need for personalized approaches in manual therapy. Factors such as the duration and severity of TMJ locking, underlying etiology, patient compliance, and therapist expertise may influence treatment efficacy.(6)

Conclusion

In conclusion, manual therapy techniques represent valuable interventions in the management of TMJ locking, offering non-invasive and effective approaches to improve joint function and alleviate symptoms. While further research is warranted to elucidate optimal treatment protocols and long-term outcomes, existing evidence supports the integration of manual therapy into comprehensive management strategies for TMJ locking.

References

1.         Herrera-Valencia, A., Ruiz-Muñoz, M., Martin-Martin, J., Cuesta-Vargas, A., & González-Sánchez, M. (2020). Effcacy of Manual Therapy in TemporomandibularJoint Disorders and Its Medium-and Long-TermEffects on Pain and Maximum Mouth Opening:A Systematic Review and Meta-Analysis. Journal of clinical medicine, 9(11), 3404. https://doi.org/10.3390/jcm9113404.

2.         Vieira, L. S., Pestana, P. R. M., Miranda, J. P., Soares, L. A., Silva, F., Alcantara, M. A., & Oliveira, V. C. (2023). The Efficacy of Manual Therapy Approaches on Pain, Maximum Mouth Opening and Disability in Temporomandibular Disorders: A Systematic Review of Randomised Controlled Trials. Life (Basel, Switzerland), 13(2), 292. https://doi.org/10.3390/life13020292.

3.         Lucas C., Branco I., Silva M., Alves P., Pereira Â.M. 2nd International Congress of CiiEM-Translational Research and Innovation in Human and Health Science. Campus Egas Moniz; Monte de Caparica, Portugal: 2017. Benefits of manual therapy in temporomandibular joint dysfunction treatment.

4.         Armijo-Olivo S., Pitance L., Singh V., Neto F., Thie N., Michelotti A. Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis. Phys. Ther. 2016;96:9–25. doi: 10.2522/ptj.20140548.

5.         Wood G.D., A Branco J. A comparison of three methods of measuring maximal opening of the mouth. J. Oral Surg. (Am. Dent. Assoc. 1965) 1979;37:175–177.

6.         Gębska, M., Dalewski, B., Pałka, Ł. et al. Evaluation of the efficacy of manual soft tissue therapy and therapeutic exercises in patients with pain and limited mobility TMJ: a randomized control trial (RCT). Head Face Med 19, 42 (2023). https://doi.org/10.1186/s13005-023-00385-y.