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BACKGROUND

THE TEMPOROMANDIBULAR JOINT (TMJ) IS ONE of the most used joints in the body and, therefore, susceptible to injury. Temporomandibular disorder (TMD) is the broad term used to describe many different diagnoses that cause TMJ pain and potentially limit mouth opening. TMD can be subdivided into three physical diagnostic categories: muscle disorders, disc displacements, or joint disorders. The physical therapy examination must consist of a thorough patient history, systems screen, pain and postural assessment, palpation of joint structures and related muscles, AROM and PROM testing, resisted isometrics, functional and dynamic loading tests, as well as a cervical spine screen. The specific examination findings will assist the physical therapist in identifying the physical therapy diagnosis and the patient's body structure and function impairments, activity limitations, and participation restrictions as part of the International Classification of Functioning, Disability and Health (ICF) classification system. A comprehensive examination and assessment will help identify the most appropriate physical therapy management for the patient and will determine the need for referral to other health care providers.

The physical therapy management of a patient with TMD must consider all of the contributing factors that are causing the patient's symptoms, including their parafunctional habits, posture, and psychosocial characteristics to name a few. Many research studies on specific research interventions for TMJ do not have rigorous methodology and, therefore, their recommendations for the best interventions must be considered cautiously. Research has shown some cautiously positive improvement in symptoms for patients with TMD when the physical therapist utilizes active exercises, manual therapy, postural re-education, relaxation techniques, biofeedback, or mid-laser therapy, as well as combinations of these treatment interventions.

The temporomandibular joint (TMJ) opens and closes approximately 2,000 times per day as it accommodates a full day worth of chewing, talking, swallowing, yawning, and snoring. This makes the TMJ the most active joint in the body and susceptible to injury.1 Temporomandibular disorder (TMD) is the term used to describe pathology associated with pain in the jaw, muscles of mastication, and other related structures.2 There is a close association between alignment of the cervical spine, jaw, and teeth. Any dysfunction, or aberrant movement patterns, of one or more of these components may, therefore, lead to TMD. There are many potential causes of TMD, and its etiology is often multifactorial. Posture, jaw, or dental malocclusion, and parafunctional habitual activities, including bruxism and chewing gum, may all play a role in the development of TMD. Additionally, inflammatory or degenerative conditions, trauma, and stress also contribute to its development. Psychological stress is not only a potential cause for TMD, but it may prolong and amplify its symptoms in individuals.3

EPIDEMIOLOGY OF TMD

Upwards of 50% to 75% of the population may present with at least one symptom of TMD within their lifetime; however, only a small percentage of those individuals seek medical treatment.4,5 Although TMD can affect people ...

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