Abstract
Objective
Studies investigating the efficacy of intraoral myofascial therapies (IMTs) for chronic
temporomandibular disorder (TMD) are rare. The present study was an expansion of a
previously published pilot study that investigated whether chiropractic IMT and the
addition of education and self-care were superior to no-treatment or IMT alone for
5 outcome measures—interincisal opening range, jaw pain at rest, jaw pain upon opening,
jaw pain upon clenching, and global reporting of change—over the course of 1 year.
Methods
Ninety-three participants with myogenous TMD between the ages of 18 and 50 years experiencing
chronic jaw pain of longer than 3 months in duration were recruited for the study.
Successful applicants were randomized into 1 of 3 groups: (1) IMT consisting of 2
treatment interventions per week for 5 weeks, (2) IMT plus education and “self-care”
exercises (IMTESC), and (3) wait-list control. The main outcome measures were used.
Range of motion findings were measured by vernier callipers in millimeters, and pain
scores were quantified using an 11-point self-reported graded chronic pain scale.
Global reporting of change was a 7-point self-reported scale, balanced positively
and negatively around a zero midpoint.
Results
There were statistically significant differences in resting, opening and clenching
pain, opening scores, and global reporting of change (P < .05) in both treatment groups compared with the controls at 6 months and 1 year.
There were also significant differences between the 2 treatment groups at 1 year.
Conclusions
The study suggests that both chiropractic IMT and IMTESC were superior to no-treatment
of chronic myogenous TMD over the course of 1 year, with IMTESC also being superior
to IMT at 1 year.
Key Indexing Terms
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References
- Occlusion and functional disorders of the masticatory system.Dent Clin North Am. Apr 1995; 39: 285-300
- The president's conference on the examination, diagnosis and management of temporomandibular disorders. ADA Special Publication, Chicago1983
- Guidelines for the treatment of temporomandibular disorders.J Craniomandib Disord. 1990; 4: 80-88
- Manual physical therapy interventions and exercise for patients with temporomandibular disorders.Cranio. 2006; 24: 283-291
- Physiotherapy in the treatment of temporomandibular joint disorders: a comparative study of four treatment methods.Br Dent J. 1994; 176: 257-261
- Physical Therapy treatment results for 178 patients with temporomandibular syndrome.Am J Otol. 1984; 5: 183-193
- Short-term efficacy of physical therapy compared to splint therapy in treatment of arthrogenous TMD.J Oral Rehabil. 2007; 34: 807-813
- A systematic review of the effectiveness of exercise, manual therapy, electrotherapy, relaxation training, and biofeedback in the management of temporomandibular disorder.Phys Ther. 2006; 86: 955-973
- Physical medicine modalities and trigger point injections in the management of temporomandibular disorders and assessing treatment outcome.Oral Surg Oral Med Oral Rad Endod. 1997; 83: 118-122
- Physical therapy for temporomandibular disorders and orofacial pain.Curr Op Dent. 1991; 1: 485-496
- The effect of grade IV distraction mobilisation on patients with temporomandibular pain-dysfunction disorder.Physiother Theory Prac. 1994; 10: 129-136
- Global postural reeducation and static stretching exercises in the treatment of myogenic temporomandibular disorders: a randomized study.J Manipulative Physiol Ther. 2010; 33: 500-507
- Comparison of the efficacy of electromyographic biofeedback, cognitive-behavioral therapy, and conservative medical interventions in the treatment of chronic musculoskeletal pain.J Consult Clin Psychol. 1993; 61: 653-658
- Efficacy of biofeedback-based treatments for temporomandibular disorders.Appl Psychophysiol Biofeedback. 2005; 30: 333-345
- Behavioral and educational modalities.Oral Surg Oral Med Oral Path Oral Radiol Endod. 1997; 83: 128-133
- Long-term efficacy of biobehavioral treatment of temporomandibular disorders.J Behav Med. 2001; 24: 341-359
- The relative efficacy of three cognitive-behavioral treatment approaches to temporomandibular disorders.J Behav Med. 2000; 23: 293-309
- Short- and long-term efficacy of brief cognitive-behavioral therapy for patients with chronic temporomandibular disorder pain: a randomized, controlled trial.Pain. 2006; 121: 181-194
- Isokinetic exercise management of temporomandibular joint clicking in young adults.J Prosthet Dent. 1993; 70: 33-39
- Physical self-regulation training for the management of temporomandibular disorders.J Orofac Pain. 2001; 15: 47-55
- Therapeutic jaw exercises and interocclusal appliance therapy. A comparison between two common treatments of temporomandibular disorders.Swed Dent J. 1999; 23: 27-37
- Home-exercise regimes for the management of non-specific temporomandibular disorders.J Oral Rehabil. 2005; 32: 779-785
- The additional value of a home physical therapy regimen versus patient education only for the treatment of myofascial pain of the jaw muscles: short-term results of a randomized clinical trial.J Orofac Pain. Spring. 2004; 18: 114-125
- Effectiveness of exercise therapy in patients with internal derangement of the temporomandibular joint.J Oral Rehabil. 2001; 28: 1158-1164
- A systematic review of the effectiveness of physical therapy interventions for temporomandibular disorders.Phys Ther. 2006; 86: 710-725
- Is there a superiority of multimodal as opposed to simple therapy in patients with temporomandibular disorders? A qualitative systematic review of the literature.Clin Oral Implants Res. 2007; 18: 138-150
- Illness behavior and dysfunction: review of concepts and application to chronic pain.Can J Physiol Pharmacol. 1991; 69: 662-671
- Behavioral dentistry: a renewed paradigm for the future.J Indiana Dent Assoc. 2000; 79: 11-15
- Temporomandibular disorders and chronic pain: disease or illness?.J Prosthet Dent. 1994; 72: 29-38
- Analysis of occlusal variables, dental attrition, and age for distinguishing healthy controls from female patients with intracapsular temporomandibular disorders.J Prosthet Dent. 2000; 83: 76-82
- Relationship between occlusal factors and signs and symptoms of mandibular dysfunction. A clinical study of 48 dental students.Acta Odontol Scand. 1984; 42: 277-283
- Mandibular dysfunction and periodontitis. A comparative study of patients with periodontal disease and occlusal parafunctions.Acta Odontol Scand. 1987; 45: 239-246
- The degree to which attrition characterizes differentiated patient groups of temporomandibular disorders.J Orofac Pain. Spring. 1993; 7: 196-208
- Predictors of signs and symptoms of temporomandibular disorders: a 20-year follow-up study from childhood to adulthood.Acta Odontol Scand. 2002; 60: 180-185
- study of the influence of occlusal factors and parafunctional habits on the prevalence of signs and symptoms of TMD.Int J Prosthodont. 2002; 15: 43-48
- A 20-year longitudinal study of subjective symptoms of temporomandibular disorders from childhood to adulthood.Acta Odontol Scand. 2001; 59: 40-48
- Association of malocclusion and functional occlusion with subjective symptoms of TMD in adults: results of the Study of Health in Pomerania (SHIP).Angle Orthod. 2005; 75: 183-190
- TMD and the problem of bruxism: a review.J Bodywork Mov Ther. 2007; 11: 183-193
- Symptoms of functional disturbances of the masticatory system. A comparison of frequencies in a population sample and in a group of patients.Acta Odontol Scand. 1975; 33: 183-190
- Reported bruxism and biopsychosocial symptoms: a longitudinal study.Community Dent Oral Epidemiol. 2004; 32: 307-311
- Temporomandibular disorder treatment outcomes: second report of a large-scale prospective clinical study.Cranio. 2002; 20: 244-253
- The longevity of temporomandibular disorder improvements after active treatment modalities.Cranio. 2004; 22: 110-114
- Influence of the temporomandibular joint on range of motion of the hip joint in patients with complex regional pain syndrome.J Manipulative Physiol Ther. 2009; 32: 364-371
- A cross-sectional study of prevalence and etiology of signs and symptoms of temporomandibular disorders in high school and university students.J Orofac Pain. 1996; 10: 254-262
- Prevalence in the Dutch adult population and a meta-analysis of signs and symptoms of temporomandibular disorder.J Dent Res. 1993; 72: 1509-1518
- Prevalence of signs and symptoms of temporomandibular disorders in an urban and rural German population: results of a population-based Study of Health in Pomerania.Quintessence Int. 2004; 35: 143-150
- Prevalence of symptoms and signs indicative of temporomandibular disorders in children and adolescents. A cross-sectional epidemiological investigation covering two decades.Eur Arch Paediatr Dent. 2009; 10: 16-25
- Association between symptoms of temporomandibular disorders and gender, morphological occlusion, and psychological factors in a group of university students. Indian.J Dent Res. 2009; 20: 190-194
- Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia, and temporomandibular disorder.Arch Intern Med. 2000; 160: 221-227
- The relationship of temporomandibular disorders and fibromyalgia: implications for diagnosis and treatment.Curr Pain Headache Rep. 2004; 8: 355-363
- Temporomandibular disorders and fibromyalgia: comorbid conditions?.Gen Dent. 2003; 51 ([quiz 188-9]): 184-187
- The impact of orofacial pain on the quality of life of patients with temporomandibular disorder.J Orofac Pain. 2009; 23: 28-37
- Manual of peripheral technique.Department Health & Chiropractic Macquarie University, 2004
- 2nd ed. Myofascial pain and dysfunction: trigger point manual. Vol 1. Williams & Wilkins, Baltimore1999
- Chiropractic treatment of temporomandibular disorders using the activator adjusting instrument: a prospective case series.J Manipulative Physiol Ther. 2003; 26: 421-425
- Osteopathic manipulative treatment (OMT) effects on mandibular kinetics: kinesiographic study.Eur J Paediatr Dent. 2008; 9: 37-42
- Complementary and alternative therapy use by patients with myofascial temporomandibular disorders.J Orofac Pain. Winter. 2003; 17: 36-41
Cunali PA, Almeida FR, Santos CD, et al. Mandibular exercises improve mandibular advancement device therapy for obstructive sleep apnea. Sleep Breath 2010 Oct 22 (Epub ahead of print).
- The use of an oral exercise device in the treatment of muscular TMD.Cranio. Jul 2002; 20: 204-208
- The effects of manual therapy and exercise directed at the cervical spine on pain and pressure pain sensitivity in patients with myofascial temporomandibular disorders.J Oral Rehabil. 2009; 36: 644-652
- The efficacy of traditional, low-cost and nonsplint therapies for temporomandibular disorder: a randomized controlled trial.J Am Dent Assoc. 2006; 137 ([quiz 1169]): 1099-1107
- The effects of a home exercise program on pain and perceived dysfunction in a woman with TMD: a case study.Cranio. 2001; 19: 279-288
- Short-term effects of dry needling of active myofascial trigger points in the masseter muscle in patients with temporomandibular disorders.J Orofac Pain. 2010; 24: 106-112
- Developing a massage protocol for temporomandibular joint disorders.Massage Ther J. 2004; 43: 108-115
- Referred craniofacial pain patterns in patients with temporomandibular disorder.J Am Dent Assoc. 2000; 131: 1307-1315
- Manual therapy for temporomandibular disorders: a review of the literature.J Bodywork Mov Ther. 2007; 11: 84-90
- The lateral pterygoid release to restore normal jaw motion: a case report.Clinical Chiropractic. 2005; 8: 27-32
- Epidemiologic study of patients with craniomandibular disorders. Report of data and clinical findings.Minerva Stomatol. 2001; 50: 9-14
- Psycho-education programme for temporomandibular disorders: a pilot study.J Negat Results Biomed. 2007; 6: 4
- Treatment of temporomandibular disorders among adolescents: a comparison between occlusal appliance, relaxation training, and brief information.Acta Odontol Scand. 2003; 61: 203-211
- TMJ teacher: simplified TMD patient education.Cranio. 1994; 12: 134-137
- Intra-oral myofascial therapy for chronic myogenous temporomandibular disorders: a randomized, controlled pilot study.J Man Manip Ther. 2010; 18: 139-146
- Research diagnostic criteria for temporomandibular disorders: current status & future relevance.J Oral Rehabil. 2010; 37: 734-743
- Reliability, validity, and clinical utility of the research diagnostic criteria for Temporomandibular Disorders Axis II Scales: depression, non-specific physical symptoms, and graded chronic pain.J Orofac Pain. 2002; 16: 207-220
- IMMPACT recommendations for clinical trials: opportunities for the RDC/TMD.J Oral Rehabil. 2010; 37: 799-806
- The RDC/TMD Validation Project: an important or a final step towards a revised version of the RDc/TMD?.J Orofac Pain. 2010; 24: 234-235
- Power and sample size calculations for clinical trials of myofascial pain of jaw muscles.J Dent Res. 1991; 70: 118-122
- Assessment of pain.Br J Anaesth. 2008; 101: 17-24
- Sensitivity and specificity of outcome measures in patients with neck pain: detecting clinically significant improvement.Spine. 2004; 29 ([discussion 2418]): 2410-2417
- Smallest detectable difference of maximal mouth opening in patients with painfully restricted temporomandibular joint function.Eur J Oral Sci. 2000; 108: 9-13
- Repeated assessment of temporomandibular joint pain: reasoned decision-making with use of unidimensional and multidimensional pain scales.Clin J Pain. 2002; 18: 107-115
- Core outcome domains for chronic pain clinical trials: IMMPACT recommendations.Pain. 2003; 106: 337-345
- Global rating of change scales: a review of strengths and weaknesses and considerations for design.J Man Manip Ther. 2009; 17: 163-170
- Exercises for mechanical neck disorders.Cochrane Database Syst Rev. 2005; : CD004250
- Temporalis and masseter muscle activity in patients with anterior open bite and craniomandibular disorders.Scand J Dent Res. 1991; 99: 219-228
- Reaction strains on the condylar neck during mastication and maximum muscle stimulation in different condylar positions: an experimental study in the miniature pig.J Dent Res. 1997; 76: 1412-1420
- Variation of heads of lateral pterygoid muscle and morphology of articular disc of human temporomandibular joint—anatomical and histological analysis.J Oral Rehabil. 2001; 28: 560-571
- TMJ symptoms and referred pain patterns.J Prosthet Dent. 1982; 47: 430-433
- Superior and inferior bellies of the lateral pterygoid muscle EMG activity at basic jaw positions.J Prosthet Dent. 1983; 50: 710-718
- The role of the human lateral pterygoid muscle in the control of horizontal jaw movements.J Orofac Pain. 2001; 15 ([discussion 292-305]): 279-292
- MRI findings concerning the lateral pterygoid muscle in patients with symptomatic TMJ hypermobility.Cranio. 2001; 19: 260-268
- MR abnormalities of the lateral pterygoid muscle in patients with nonreducing disk displacement of the TMJ.Cranio. 2002; 20: 209-221
- The distribution of the auriculotemporal nerve around the temporomandibular joint.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998; 86: 165-168
Simons DG, Travell JG, Simons LS, Cummings BD. Travell & Simons' myofascial pain and dysfunction: the trigger point manual. Vol 1. 2nd ed. Baltimore: Lippincott Williams and Wilkins; 1998:5-44, 103-64.
- Atlas of manipulative techniques for the cranium and face.Eastland Press, Seattle1985
- The immediate effect of soleus trigger point pressure release on restricted ankle joint dorsiflexion: a pilot randomised controlled trial.J Bodywork Mov Ther. 2011; 15: 42-49
- Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: a randomized controlled trial.J Orthop Sports Phys Ther. 2011; 41: 43-50
- The International Classification of Headache Disorders: accurate diagnosis of orofacial pain?.Cephalalgia. 2008; 28: 752-762
- Treatment of myofascial trigger points in patients with chronic shoulder pain: a randomized, controlled trial.BMC Med. 2011; 9: 8
- Benefits of massage-myofascial release therapy on pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia.Evid Based Complement Alternat Med. 2011; : 561753
- 6-Day intensive treatment protocol for refractory chronic prostatitis/chronic pelvic pain syndrome using myofascial release and paradoxical relaxation training.J Urol. 2011; 185: 1294-1299
- 2nd ed. Clinical application of neuromuscular techniques. Vol 1.. Edinborough, Churchill Livingston2008
- Trigger points: diagnosis and management.Am Fam Physician. 2002; 65: 653-660
- Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome.Curr Opin Rheumatol. 2000; 12: 113-123
- Myofascial trigger mechanisms and temporomandibular joint disturbances in head and neck pain; differential diagnosis.N Y State J Med. 1959; 59: 2554-2558
- Myofascial pain syndrome.Neurol Clin. 1989; 7: 413-427
- The myofascial pain dysfunction syndrome. II. Treatment.N Z Dent J. 1975; 71: 23-27
- The myofascial pain dysfunction syndrome. I. Aetiology and diagnosis.N Z Dent J. 1974; 70: 192-198
- The myofascial syndrome.N C Med J. 1979; 40: 562-565
Hutchins MO, Feine JS. Neuromuscular dysfunction: the role of nutrition. Compend Contin Educ Dent 1985;6:38-9, 42-35.
- Myofascial referred pain patterns: the role of trigger points.CDA J. 1985; 13: 27-32
- Fourth World Congress on Myofascial Pain. Silvi Marina, Italy, August 24-27, 1998.J Orofac Pain. 1998; 12: 312-314
- New views of myofascial trigger points: etiology and diagnosis.Arch Phys Med Rehabil. 2008; 89: 157-159
- Reduced high-energy phosphate levels in the painful muscles of patients with primary fibromyalgia.Arthritis Rheum. 1986; 29: 817-821
- Endplate potentials are common to midfiber myofascial trigger points.Am J Phys Med Rehabil. 2002; 81: 212-222
- Short-term effect of two therapeutic methods on myofascial pain and dysfunction of the masticatory system.J Prosthet Dent. 1988; 60: 606-610
- Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points.Phys Ther. Oct 2000; 80: 997-1003
- Clinical massage and modified proprioceptive neuromuscular facilitation stretching in males with latent myofascial trigger points.Phys Ther Sport. 2010; 11: 91-98
- Effect of manual therapy and stretching on neck muscle strength and mobility in chronic neck pain.J Rehabil Med. 2007; 39: 575-579
- Personal characteristics influencing patients' adherence to home exercise during chronic pain: a qualitative study.J Rehabil Med. 2009; 41: 347-352
Article info
Publication history
Published online: November 14, 2011
Accepted:
June 2,
2011
Received in revised form:
June 2,
2011
Received:
April 22,
2011
Identification
Copyright
© 2012 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.
