Manual Therapy for TMJ Disorders: Proven Relief for Pain | Podcast Ep. 279

Foreign. Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. On this week's episode, we're talking all about TMJ and TMD disorders. There's a new study that just came out that I think is pretty cool and it showcases the effectiveness of manual therapy with at home physical therapy. But for patients with TMJ disorders, this was a randomized controlled trial. Lots of take home messages, lots of practical application. This study came out in the Journal of Bodywork in Movement Therapies a few years back and it's titled Effectiveness of Manual Therapy and Home Physical Therapy in Patients with Temporomandibular Disorders. And this again was a randomized controlled trial. Now I have a buddy, Alex Vinnan, he does a lot with TMJ disorders. Teaches it around the country. Does a fantastic, fantastic job. My clinical practice was, it was never something that I focused on and it really wasn't something that I felt truly adept at taking care of. But I know for a lot of docs out there, this is an important part of their practice. And highlighting the research is very key. Now, the second piece of it is I almost feel remiss to have not taken care of more TMJ and TMD disorders, especially in light of the research that we'll go through here. For many people there's just no great sort of solution or treatment. But I'm gonna tell you, as if you're listening to this right now, as a chiropractor, your hands are what they need and that's what we're seeing in the research. So understanding the research, then getting those clinical application skills, super, super important. We'll talk it all down on today's episode and we'll start with what the heck is a temporomandibular disorder? Well, basically, it's a collective term for the structural and functional disorders that involve the temporomandibular joint and, or the muscles of the head and neck that support and surround it. Basically, I'm gonna say TMJ is the joint, TMD is the disorder. Well, I'm not gonna say it, the researchers are gonna say it and I'm gonna agree with it. So we could use those nearly interchangeably, but that's the difference between the two. So there are biological, anatomical, biomechanical, behavioral, environmental, emotional factors that affect this system and that can contribute to the development, signs and symptoms and perpetuation of a TMJ and a TMD disorder. So it's multifactoral by nature. And yes, that was a laundry List basically what they're saying. There's biological components, there's anatomical, this makes sense, Behavioral, environmental, emotional factors. All, all of these things play a role. Now I'm gonna say in most instances that are neuromusculoskeletal, most of these things play a role. If we bring it way, way back, machine to the start of chiropractic and we're talking about physical, chemical, emotional stress, there's just a lot of truth in that. You know, how we move our bodies, what we're thinking about, what we're putting in it dramatically affects the core of what we experience and what we deal with. Pain or not pain. So very important to keep in mind. Now what is a TMJ or TMD disorder characterized by. Normally it's pain and restricted jaw movement with the pain being the most common symptom and the reason for seeking treatment. So if somebody has restricted jaw movement, if they have pain, basically have a T, not overly complex to be able to diagnose something like that. So now we take a look and say, how has this been treated historically? And the answers are not going to be pretty, I will tell you that. So treatments available historically, historically are medication, pharmacological, oral appliances, physical therapy, surgery, biobehavioral treatments, and maybe a little patient education. So none of that sounds very attractive to me. Right. Taking medication, largely ineffective for it, Appliances while they have their place are probably not a go to for most people with a light issue. It's just their obstructive, I guess you could say surgery, I mean, gosh, in an extreme case maybe, but certainly not a first line treatment. And biobehavioral treatments, this is where manual therapy as you can clearly see, is gonna come into play because there's just, is a huge gaping hole with how this situation is normally taken care of. So home physical therapy, that's sort of a, that is one of these items and it's probably the best one. So typically that includes things like self care, patient education, lifestyle modification and awareness of what's aggravating it to be able to avoid things. So what does that mean? You kind of, you're watching out for jaw movements that cause the pain using some stretching exercises and head postural exercises. It's very, very basic. And a lot of it is, what I'm gonna say is, you know, a lot of it has to be done by the patient. Right. We're talking about what they can do in many cases, whereas manual therapy is a little more getting in there. Right. So what is manual therapy? This could Include things like TMJ mobilization, ding ding ding, chiropractic. Right. Soft tissue mobilization of the painful muscles, active and passive stretching of those muscles, isometric exercises against resistance, and guided opening and closing of the jaw. So this is very, very important because the goals of things in the manual therapy realm is include such things as decreasing muscle spasms. Makes sense. Altering the jaw opening and closing patterns, which that tracking, I think of it like a knee. Right? The tracking is important. You can get away with not being quote unquote perfect because there is no perfect. Everybody's a little bit different. But over time, imbalances can lead to challenges and that's what we see. So these patterns are important in improving the coordination of the muscles of mastication. So you want to make sure that you have good coordination of those muscles. So various reports previously suggest that therapy might be viable and useful. But this study is really going to take a look deeper at that and make a official determination and that's where we'll kind of go from. So they basically broke people into two groups. This is a randomized controlled trial. So they basically broke all of the subjects into two groups. Group one received home physical therapy only. Group two received manual therapy in conjunction with home physical therapy. So home physical therapy was kind of the baseline. One group added on the manual therapy and then it was thrown out to the wolves to see what happened and which set of individuals received better results. So there's about 40 total subjects in this study and there were no statistically significant differences between the groups. So they were adjusted for stuff like age, height, weight, complaint duration, diagnosis, the affected side, VAs at rest, VAs stress, all of those things were accounted for and there were no statistical differences between the groups. So it was an apples to apples comparison. How long did this go on for? 4 week intervention. So all subjects went through the 4 week intervention. And here's two interesting points. No adverse effects. So was this safe? Absolutely yes. No adverse effects. And no subject in this study required drug therapy during. So everybody hint towards the results here. People were getting results. So nobody in this study required pharmacological care. Let me repeat that. Nobody in this study worsened and required taking medications and drugs. That is ridiculously powerful and should not be overlooked. And there were no adverse effects. Safe and effective. So let's take a look at some of these results. Pain intensity, VAS scores at both rest and with stress significantly decreased for both groups over time. Powerful effectiveness. How about pain free, Maximum mouth opening. Open that mouth as wide as you can and see if it hurts. Pain Free max MMO as they call it, pain free MMO significantly increased in both groups over time, meaning their ability to open their mouth without pain increased significantly over the course of care. Again, safe and effective. Now when we break this down kind of in the subgroups, what did they find? The decrease in VAS and improvement in pain free MMO were significantly higher in the manual therapy plus home physical therapy group than in the home physical therapy group alone, indicating the clinical effectiveness of the manual therapy and physical therapy treatment combined. So how did they assess the difference? Let's go right there. In addition, it may be speculated this quote from the study in addition, it may be speculated that manual therapy had positive contributions of nearly 25% and 55% on VAs at rest and VAS with stress respectively in the manual therapy physical therapy group. So it was a 25% bump in results up to over a 50%, 55% to be exact bump in results, positive contribution when you added in manual therapy to the physical therapy group, that's really significant. A 25 to 55% bump in results is really significant and cannot be overstated as being really, really important. Now these researchers also found, quote in our study, pain free MMO significantly increased over time in both groups. However, the effect of treatment over time was significantly greater in terms of an increase in pain free MMO in the in the manual therapy physical therapy group in comparison to the physical therapy group alone. Important. We're just stacking on the evidence here. They also found, quote, factors in this study that justify the improvements observed in the manual therapy and physical therapy group. Manual therapy may influence pain modulation through neurophysiological effects and may influence mobility through a neuromuscular mechanism. This is almost tying back in many ways to what we see in the spine. I mean joints of the spine are different than joints of the extremities are different than joints of the TMJ joint, for instance. There are significant differences. However, a lot of what we see when a joint is manipulated, mobilized, adjusted, hold true across different joint types. Biomechanical improvement, neurophysiological effects, these are things that we continue to see time and time again in the research and the literature. And, and it's important because it continues to develop our knowledge of how an adjustment works. What's going on when you deliver that high velocity, low amplitude care, when you're delivering hands on care into with your patients with the goal of improving quality of life and reducing pain, how does that take hold? And I'm just fascinated because I just continually, I like to think back, my great grandfather was a chiropractor in the 1920s. Graduated. We have things that are signed by BJ Palmer who was still at the school at the time. And man, he didn't have access to any of this stuff. Docs 25 years ago they had access to none of this research, none of this literature, which is two things. Number one, an absolute testament to those docs who pushed through between 1925 and 1985. Man, that is, I hate to say a leap of faith. But their ability to persevere, their ability to deliver care, to communicate, chiropractic is, is something that none of us today should take for granted. Because our ability to have even the opportunity to have this research and have a profession starts with their ability to communicate. So I love seeing this, I love seeing what's new, what we can continue to learn as an adjustment is delivered. I think it's impactful, I think it's important it helps continue integrate us into the healthcare system. And I don't mean integrate meaning taking away what we do in terms of an adjustment. What I mean is integrating in terms of showcasing the benefits we as chiropractors can provide. The conclusion of this study, they found in the short term manual therapy in conjunction with home physical therapy is more effective than home physical therapy alone for the treatment of tmd, particularly with regard to decreasing pain and increasing pain free, maximum mouth opening. Well as they say, particularly in regard to, I'd say those are the two most important things. Decreasing pain and increasing maximum mouth opening. That's what you're after. Uh, that's what drives people to get care. So if you are improving those two things, you're taking care of business. And when we see that adding manual therapy on improves home physical therapy and there are no adverse events and none of these individuals needed medication, now is the time to get out there, start conversations. Is there a possible reason why on anybody in your community should be getting home physical therapy care for TMJ disorders and not receiving manual therapy in addition to it? I would say no. Based upon this study, there's always the exception to the rule. However, in general, no. These individuals need that care. So get out there and have conversations because conversations are what start the process. That's what we do at the evidence based chiropractor, bridge the gap with other healthcare providers. If you want to check that out, check out the evidence basedchiropractor.com Additionally, if you want more marketing materials and we've been mixing in some really cool clinical stuff as well, check out the Smart Chiropractor blog. We now have over 50 blog posts that give insight into email marketing, insight into clinical application of skills, insight into social media marketing, insight into strategy. I even put up, and I was editing today, a video guide. So if you are an aspiring content creator out there, man, I know I spent hundreds of hours checking out camera gear and I don't know if I. That's a rabbit hole and you don't need to go down that rabbit hole. I'll make it super easy for you. I broke things down into good, better and best video gear. Content creator, cameras, microphones, lights. Also listed out my personal gear closet so you can check that out as well. But all of that's available at the blog. At the Smart Chiropractor last month I think we reached four and a half million people through our social posts, which is absolutely Incredible. Reached over 500,000 people through email. All thanks to our doctors around the world who enable us to automate their marketing. You do not, you should not do this alone. If you're relying on a staff member, a teenager to put up your social posts and or to send your emails and it's not happening daily with social posts at least once a day, by the way, and we at least weekly with emails, you're missing out. You're hurting your business, you're hurting your practice and you are not doing, I'm going to say it, you're not doing what's best for your community. Who need to know, based upon the research that we talk about this every single week on this podcast, need to know who you are and what you do. So how do you get out there and spread your message? You do it by being efficient, you do it by automating and you do it by delegating when you can. We're happy to do that for you at the Smart Chiropractor. I'll drop that link down below. Any questions whatsoever, hit me up. Jeff the Evidence Based Chiropractor. Make it a fantastic week in practice and I will talk to you soon.

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