Q&A Time! How Well Did My Original MTC Training Prepare Me for Treating TMD? | Modern Manual Therapy Blog

Q&A Time! How Well Did My Original MTC Training Prepare Me for Treating TMD?

This week's Q&A asks about my original OMPT training from the University of St. Augustine and how well it prepared me to treat a TMD caseload.

This is kind of a tough question as it's hard for me to go back 13 years and remember exactly what I learned.  I certainly remember pulling on a very restricted TMJ capsule like it was a shoulder; this was before I learned Rocabado's "finesse..." That patient eventually responded to the "less is more" in regard to force and manual treatments.

The story between Drs. Stanley Paris and Mariano Rocabado goes like this. Stanley just finished about an hour or so on the TMJ during one of his 10 day courses. Someone stands up and says, "I know a bit about the TMJ" - and that participant was Mariano Rocabado! Stanley invited him to teach and he went on to present the rest of the day. (that is more or less how it went) This is why Rocabado comes in to teach the more advanced courses, he's the MAN when it comes to this topic!

I think any OMPT trained clinician will do better than your typical ultrasound slinging one with cervical treatment, education, postural correction and basic TMJ distraction. This will help many of the simpler cases that have slipped through the cracks. However, I would not go through the MTC series of courses and expect to be very proficient treating more difficult TMD cases without additional tools in your bag.

Any knowledge of MDT and soft tissue treatments would greatly help. The current Craniofacial courses through the University of St. Augustine make you a better clinician for the entire cervical spine. You are exposed to hundreds of different types of scans of the cervical spine and TMJ, which helps the understanding of the craniomandicular relationship.

Another point to mention, many FAAOMPT credentialed programs are lacking in exposure to TMD and this is a point of contention when getting re-credentialed. So even fellows (or at least fellow mentors) generally have a lack of these patients in their practice. I'm not sure if it's lack of training, comfort, or marketing, because they are certainly out there!

If you have finished another OMPT certification like Maitland, NAIOMPT, CFMT etc... can you chime in? I am not sure how much is covered in other programs in respect to treating TMD.


  1. Erson, We certainly cover current published evidence related to TMD, and we have ample material in the curriculum covering techniques addressing the TMJs. Further, the DASP requirements for all credentialed programs essentially mandate a certain amount of exposure. The difficulty comes in getting direct "exposure" as a lead therapist since so few PTs see a large TMD population in their practices. Therefore, fellows-in-training: 1) travel to spend time with folks like yourself to get exposure, 2) they actively recruit in their region, 3) they network in their communities to find dentists who are treating patients to supplement their exposure from sources #1 and 2 above. It is not optimal, and you are right that the patients are out there in every city in the US. For those willing to push and develop this niche, the patients should ideally show up. This is one of many areas where PTs could do a better job in marketing and recruitment. Thanks for highlighting this topic, and for standing up some more courses to teach people to treat these patients. Julie Whitman

  2. Np Julie! I will be rolling out a TMD basics course next year in several areas around the nation. Also, I'll start shooting TMD cases for indirect hours for fellows in training soon.

  3. I am playing catch up on your blog. I got my COMT through NAIOMT, and they did cover cover TMD in some detail. I also went to Steve Kraus' course on it, but it is hard to get confident in treating it when we see so few of them. The issue seems be at least in part in insurance coverage, since some pointedly leave that syndrome out of coverage, I guess assuming it is a money pit. Fortuitously, some of these folks have had neck pain and head aches as well, the diagnosis was put in as that

  4. I can tell you're playing catch up! I can tell you that the patients are there, but many of them are misdiagnosed as migraines, trigeminal neuralgia, etc... Also asymptomatic clicks are also patients!