Q&A Time! How Do I Market for TMD | Modern Manual Therapy Blog

Q&A Time! How Do I Market for TMD

This week's Q&A asks How Do I Market for TMD?

First of all you have to choose your market. Many of the patients with TMD issues are being told they have migraines or trigeminal neuralgia just because of their Sx.

I target the following in order for my TMD referrals
  • dentists - duh! 
    • It's not no pain no problem, the asymptomatic click or asymmetry in mandible movement is an indication they should refer out
  • neurologists
    • patients with HA and/or neck pain
  • ENTs
    • earache, sinus pain 
    • when the testing is negative, time to refer out
I find by teaching other health care professionals or fitness professionals some simple tests that can be implemented into their screens, they are more likely to refer to you. Here is that screen.

There is absolutely a market for these patients who are just being medicated or improperly treated by other passive health care professionals. Find the right docs and get out there and help these people!

Next up in referral screens is what I teach running store salespeople, runners in general, and fitness professionals on what to look for in lower quarter movement asymmetry before referring out.

I have set up a new service to help integrate EMR, marketing, website, social media, etc at EDGE Health and Tech Solutions!

Keeping it Eclectic....


  1. I just want to clarify a point from the video. You said that patients with a click should be referred to PT even if the click is not painful. Are you talking about symptomatic patients who have a non-painful click or are you including asymptomatic patients with a click?

  2. One my favorite Rocabado's quotes, is "It's not no pain, no patient." So I don't get a lot of asymptomatic clicks, but it's still important to address. Since every joint should be friction free and sound free, you may be able to prevent a painful TMD in a few visits of postural re-ed and manual therapy by seeing this patients in their forming years/teens rather than the typical TMD demo of mid-late 20s to 50s.

  3. +1 this - Infinitely easier to get those good habits and some degree of control in an early click, than 30yrs later when they've a not reducing and locked. Not to mention all the other issues (neck and headaches) and are considering botox, surgery etc (even LVI/NMD eek).

    While the click may not completely go, getting everything else right will do a great deal in preventing progression.

  4. Thanks for the responses Erson and Jack. I think this idea that patients with clicks should be treated may be true but it seems that you are making some assumptions.

    1) You are assuming that a painless click indicates future TMJ pain. I don't think this is supported by the literature.

    2) That PT treatment has a long lasting positive effect on painless clicking which then results in a reduced incidence of future TMJ pain.

    From what I have seen in the literature TMJ clicking is often transient and there is no clear relationship to future pain. I am hesitant to suggest that the 30 some percent of the population who have painless jaw clicking need to see a PT (although it would be good for business). With the large psychosocial component of TMD we may also run the risk of increasing fear (setting them up for pain) in patients if we suggest to them that their painless click is a threat.
    I am not an expert in this area of research but have looked at it some. If my understanding of the literature is incorrect please let me know.

    I understand that expertise has its place in decision making. However, I don't see how experience in the clinic could ever help you figure out if painless clicking leads to future TMJ pain or if PT treatment of painless clicking reduces the chances of future TMJ pain. I think the only way to get insight into these questions is through research.



  5. Adam,

    Agreed with what you say about prevention. We have no way of proving this other than long term research. Not sure if Dr. Rocobado has proven this already as he tends to collect large amounts of data for his courses, but not publish it.

    You know I have moved away from a purely pathoanatomical model for the most point, except in the cases of running and the TMJ. I still like Rocabado's point about if a knee was painlessly clicking, that would most likely either get them surgery if they're unlucky, or PT if they are more fortunate to have conservative measures.

    Much like how all the slouching individuals out there may not develop, head, neck, lower back, shoulder pain etc.. I see no harm in correcting for movement efficiency and posture as a starting point. I see this as a risk factor, like how an obese patient may not have a CVA, but does not mean you should not try to prevent one.

    I rarely see patients who have asymptomatic clicks, but when I do, it's usually 2-3 visits at most, I'm not taking these people for a ride and only seeing them as much as I have to. I'll be sure to link up your new blog on my sidebar and feature you in my future Quick Links! Keep up the great work, it can be difficult blogging regularly!

  6. Thanks for the response! I agree that we need to find a balance between the pathoanatomical model and the bio-psychosocial model. Some disorders like ACL tears seem to need a pathoanatomical/biomechanical approach.

    I disagree that patients with a painless clicking knee get told they need treatment. I may have a skewed impression but I don't know of any practitioners who feel painless clicking is an important finding in the knee (but I am sure there are some out there).

    I also think the relationship between obesity and CVA is different than say posture and shoulder pain. You are correct that every patient who is obese will not have CVA however studies ( I assume, I don't really know this research) have found a correlation between the two. So obesity is a risk factor for a CVA. In contrast, no such correlation has been found with posture and shoulder pain despite it being studied several times. So I conclude that "poor" posture is not a risk factor for developing shoulder pain.

    Thanks for the encouragement on the new blog. My goal is to get students and colleagues involved to help with the posting (we will see how that goes). I am always impressed with how active you keep your blog. It is not an easy task!