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Optimizing Temporomandibular Joint Function: Mobilization Procedures

Updated: Dec 5, 2023


Temporomandibular joint (TMJ) disorders are a common source of pain and discomfort for many individuals. Jaw mobilization plays a significant role in addressing these issues, and as a musculoskeletal (MSK) practitioner, mastering these techniques is essential. This article discusses the key anatomical structures of the TMJ and some of the mobilization methods utilized to relieve symptoms associated with temporomandibular disorders (TMDs).


Article Index

 

TMJ Anatomy

A thorough understanding of TMJ anatomy is crucial for effectively performing mobilization techniques. Here, we will delve into the core components of the TMJ and their functions:


  • Mandible: The lower jawbone articulates with the temporal bone to form the TMJ. It comprises various parts, including the condylar head, the ramus (vertical portion), and the body (horizontal portion). The mandible houses the lower teeth and is responsible for jaw movement during talking and chewing.

  • Condylar head: The round, articular surface at the top of the mandible, articulating with the temporal bone's articular fossa. It is covered by a layer of hyaline cartilage to facilitate smooth movement within the joint.

  • Disc (Articular Disc): A fibrocartilaginous structure between the condylar head and the articular fossa. This biconcave disc consists of a dense central area called the intermediate zone, surrounded by thinner anterior and posterior bands. The disc distributes forces across the joint, reduces friction, and protects the joint surfaces during movement.

  • Articular fossa: A concave, shallow depression in the temporal bone that accommodates the condylar head. It is lined with fibrocartilage and is surrounded by a dense fibrous capsule that encloses the TMJ.

  • Articular eminence: A convex, anteriorly sloping bony prominence situated in front of the articular fossa. It serves as a guide for the condylar head during jaw movement, particularly during opening and closing.

  • Ligaments: The TMJ is supported by several ligaments, including the temporomandibular ligament (lateral ligament), sphenomandibular ligament, and stylomandibular ligament. These ligaments provide stability and limit excessive movements of the joint.


 

Mobilization Procedures for TMJ


With a solid understanding of TMJ anatomy, MSK practitioners can employ various mobilization techniques to improve joint function and alleviate TMD symptoms. These techniques include:




Axial Joint Decompression

This procedure is used to improve overall mobility and decompress the TMJ. To perform this technique:

  • Place your thumb on the back of the patient's mandibular molar.

  • Encourage the patient to relax and release muscle tension.

  • Gently find the point of least resistance in the joint.

  • Use graded, purposeful movements, applying gentle long-axis distraction mainly from the wrist.

  • Stretch the tissue and hold or oscillate back and forth.


Transverse Joint Space Widening

The Transverse Joint Space Widening procedure aims to facilitate transverse gapping of the condylar head and TMJ. To perform this technique:

  • Place your thumb on the inside of the patient's mandibular molars.

  • Grasp the ramus, taking care not to interfere with any dental fixtures.

  • Perform a gentle supination of your forearm, moving the condylar head laterally.

  • As you bring the condylar head laterally, you will stretch both the outer and inside of the joint capsule.


Skull Motion with Stabilized Mandibular Condyle

The procedure target adhesions between the disc and the articular fossa. To perform this technique:

  • Stabilize the patient's condyle up to the neck.

  • Apply a subtle lateral rotation of the patient's cranium.

  • Focus on moving the articular fossa on a fixed condylar head.

  • This technique primarily targets the compartment between the superior part of the disc and the articular fossa, where adhesions can occur.


Temporomandibular Joint Mobilization

In this video, Dr. Abelson, the Motion Specific Release (MSR) creator, showcases a range of efficient jaw mobilization methods. Gaining proficiency in diverse mobilization techniques is essential for managing temporomandibular disorders. It is vital to exercise caution when performing these techniques, focusing on accurate hand positioning and deliberate, gentle movements to maximize the procedures' efficacy.


 

Conclusion


In conclusion, temporomandibular joint mobilization techniques are essential to an MSK practitioner's skill set, as they help relieve pain and discomfort associated with temporomandibular disorders. By understanding the key anatomical components of the TMJ and mastering the various mobilization techniques, practitioners can effectively address these issues and improve patient outcomes. It is crucial to approach these techniques with care, ensuring proper hand placement and gentle, purposeful movements to optimize the effectiveness of the procedures.


 

DR. BRIAN ABELSON DC. - The Author


Dr. Abelson's approach in musculoskeletal health care reflects a deep commitment to evidence-based practices and continuous learning. In his work at Kinetic Health in Calgary, Alberta, he focuses on integrating the latest research with a compassionate understanding of each patient's unique needs. As the developer of the Motion Specific Release (MSR) Treatment Systems, he views his role as both a practitioner and an educator, dedicated to sharing knowledge and techniques that can benefit the wider healthcare community. His ongoing efforts in teaching and practice aim to contribute positively to the field of musculoskeletal health, with a constant emphasis on patient-centered care and the collective advancement of treatment methods.

 


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References


  1. Okeson, J.P. (2013). Management of Temporomandibular Disorders and Occlusion. St. Louis, MO: Elsevier Mosby.

  2. de Leeuw, R., & Klasser, G.D. (2018). Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management. Hanover Park, IL: Quintessence Publishing.

  3. Pertes, R.A., & Gross, S.G. (1995). Clinical Management of Temporomandibular Disorders and Orofacial Pain. Chicago, IL: Quintessence Publishing.

  4. McNeely, M.L., Armijo-Olivo, S., & Magee, D.J. (2016). A Systematic Review of the Effectiveness of Physical Therapy Interventions for Temporomandibular Disorders. Physical Therapy, 96(5), 675-688.

  5. Medlicott, M.S., & Harris, S.R. (2006). A Systematic Review of the Effectiveness of Exercise, Manual Therapy, Electrotherapy, Relaxation Training, and Biofeedback in the Management of Temporomandibular Disorder. Physical Therapy, 86(7), 955-973.

  6. Dworkin, S.F., & LeResche, L. (1992). Research Diagnostic Criteria for Temporomandibular Disorders: Review, Criteria, Examinations and Specifications, Critique. Journal of Craniomandibular Disorders: Facial & Oral Pain, 6(4), 301-355.

  7. Wright, E.F., & North, S.L. (2009). Management and Treatment of Temporomandibular Disorders: A Clinical Perspective. Journal of Manual & Manipulative Therapy, 17(4), 247-254.

  8. Calixtre, L.B., Moreira, R.F.C., Franchini, G.H., Alburquerque-Sendín, F., & Oliveira, A.B. (2015). Manual Therapy for the Management of Pain and Limited Range of Motion in Subjects with Signs and Symptoms of Temporomandibular Disorder: A Systematic Review of Randomised Controlled Trials. Journal of Oral Rehabilitation, 42(11), 847-861.

  9. Armijo-Olivo, S., Pitance, L., Singh, V., Neto, F., Thie, N., & Michelotti, A. (2016). Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis. Physical Therapy, 96(1), 9-25.

  10. Manfredini, D., & Guarda-Nardini, L. (2012). Ultrasonography of the Temporomandibular Joint: A Literature Review. International Journal of Oral and Maxillofacial Surgery, 41(12), 1481-1489.


 

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