Technique Highlight: TMJ Manual Techniques | Modern Manual Therapy Blog

Technique Highlight: TMJ Manual Techniques

Here are my basic go-to techniques for the TMJ.

This goes well with this case.

TMJ Distraction

  • Pt: Supine
  • PT: sitting superior to pt's cranium
  • Tech: 
    • rotate pt's head away from the side you are mobilizing
    • use ipsilateral 2nd digit pad on the mandible condyle to palpate for movement
    • use contralateral thumb on the top of the pt's lower molars with pad on rearmost molar
    • have pt lightly close on your thumb - important to emphasize the light part!
    • light wrist extension for the TMJ distraction, palpate for condyle distraction
    • perform 6-10 reps (the 6 is a nod to the man Dr. Rocabado!)
  • Improves all mandible ROM, intracapsular space
TMJ Lateral Glide

  • Pt: Supine
  • PT: sitting superior to pt's cranium
  • Tech: 
    • rotate pt's head away from the side you are mobilizing
    • use ipsilateral 2nd digit pad on the mandible condyle to palpate for movement
    • use contralateral thumb on the medial side of the pt's lower molars with pad on rearmost molar
    • have pt lightly close on your thumb 
    • light wrist extension to promote TMJ lateral glide, palpate condyle for lateral translation
    • 6-10 reps
  • Improves mandidble contralateral lateral excursion (mob left side, improves lat excursion right)
TMJ Medial Glide
  • Pt: Supine
  • PT: sitting superior to pt's cranium
  • Tech: 
    • rotate pt's head away from the side you are mobilizing
    • ipsilateral hand on the apex of the cranium with fingers on the temporal side
    • use contralateral thumb on the medial side of the pt's lower molars with pad on rearmost molar
    • have pt lightly close 
    • stabilize the mandible with one hand, the other hand 
    • mobilize cranium over the mandible condyle laterally, which is a relative medial glide
  • improves mandible ipsilateral lateral exucrsion (mob left side, improves lat excursion left)
Masseter Release
  • Pt: supine
  • PT: sitting slightly to the treating side above pt's cranium
  • Tech
    • mob hand assesses for tone, TrP, restriction in proximal to distal direction from zygomatic arch to angle of mandible
    • assist hand may drag tissues in the opposite direction to promote further stretch
    • slow progressive depth of treatment to reduce tone, proximal to distal to promote mandible depression
    • perform 3-5 minutes or until released
  • improves all mandible motion, HA
Temporalis Release
  • Pt: supine
  • PT: sitting slightly to the treating side above pt's cranium
  • Tech
    • mob hand assesses for tone in anterior temporalis (hard to release the rest under hairline unless they have a shaved head
    • assist hand may drag tissues in opposite direction to promote further stretch
    • light slow treatment from proximal to distal to promote mandible depression
    • perform 3-5 minutes or until released
  • improves all mandible motion, HA


4 comments:

  1. How often do you see true TMJ dysfunction vs. referred cervical pain to the area?

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  2. Every day, but I'm a TMD specialist. Over half of my caseload. Most of them have cervical dysfunction as the mandible position is affected by the cervicocranial position.

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  3. Why do you stabilize the mandible and move the temporal bone laterally in order to get a medial glide.(rather than moving the mandible medially)?

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  4. Dr. Rocabado states lateral glide moves the condyle on the disc, and mobilizes the inferior TMJ; moving the temporal bone laterally for medial glide (relatively) moves the disc on condyle and emphasizes the superior TMJ. It has two capsules, superiorly and inferiorly. You can certainly just do medial glides of the mandible, but this seems more comprehensive to address both synovium.

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