Regional effects of orthopedic manual physical therapy in the successful management of chronic jaw pain. Issue 2 (3rd March 2016)

• Record Type: Journal Article
• Authors: Sault, Josiah D.; Emerson Kavchak, Alicia J.; Tow, Nancy; Courtney, Carol A.
• Is Part Of: Cranio. Volume 34:Issue 2(2016)
• Page Start: 124
• Page End: 132
• Publication Date: 2016-03-03
• Subjects: Central sensitization -- TMD -- TMJ -- Temporomandibular -- Mobilization with movement -- Pressure pain threshold -- Hyperalgesia; Temporomandibular joint disorders -- periodicals; Temporomandibular joint -- Diseases -- Periodicals; 617.51
• DOI: 10.1179/2151090314Y.0000000039
• Languages: English
• ISSNs: 0886-9634

Abstract

Abstract : Objective and importance: Temporomandibular disorders (TMD) encompass a variety of dysfunction of the maxillofacial region. A strong relationship between TMD and cervical spine pain exists, and widespread hyperalgesia is common in TMD. This case describes the management and reduction in regional hyperalgesia in a patient with chronic TMD. Clinical presentation: A 23-year-old female with a 10-year history of tinnitus and bilateral (B) jaw pain, and 5-year history of intermittent neck pain, presented with pain, which could reach 10/10 on the numeric pain rating scale, locking, tightness and restricted eating habits. Cervical motion testing did not reproduce her jaw pain. Her mouth opening (MO) and B temporomandibular joint (TMJ) accessory glides were limited and painful. Accessory glides at the upper cervical facet joints reproduced her jaw pain. Pressure pain thresholds (PPT) at her B masseters and thenar eminences at the hand were diminished, indicating hyperalgesia. Intervention: Treatment included passive mobilizations at her TMJs and cervical spine. Home exercises included self-mobilization of her TMJs and neck. In six sessions, her MO improved from 30 to 45 mm and average pain improved from 4/10 to 0/10. The jaw pain and function questionnaire improved from 16/52 to 5/52. PPTs at her right/left masseter and thenar eminence improved from 140/106 and 221/230 kPa to 381/389 and 562/519 kPa, respectively. Conclusion: This case described the treatment and reduction of upper extremity hyperalgesia of a patient with chronic jaw and neck pain. Manual therapy may be a valuable intervention in the treatment of chronic TMD with distal hyperalgesia.