Helping a TMD patient with their pain and function often changes not only their outlook on life, but also how their common facial expression.
Dr. Mariano Rocabado proved radiologically the effect of head position on mandible position. In a nutshell
- cervical protraction is a combination of
- lower cervical flexion
- upper cervical extension
- this leads to mandible retraction from the pull of the hyoid musculature, or the digastrics
Have a patient sit upright, click their teeth together a few times to get a feeling for where they meet. Then have them do the same teeth click in full cervical protraction, full cervical flexion, and extension. In many cases, the occlusion will change by a few millimeters as the head position changes. What does this have to do with facial expression? The average TMD patient has a frowning facial expression at rest.
|I'm not only frowning b/c of facial pain, it's positional!|
The pull of the inframandibular musculature imparts an inferior and posterior force on the mandible. This makes the mandible depression or open slightly. Patients subconsciously realize that it looks silly to sit there with their mouth open when they are not speaking, so instead of correcting their posture and mandible position, they bring their lower lip up and have an overactive mentalis. This makes them look like they are frowning. This also causes unwanted irradiation to the mandible elevators, the temporalis and masseter, and contributes to their increase resting tone.
Turn that frown upside down! (links to my youtube channel for demonstrations)
- tissue work to the masseter and temporalis in proximal to distal direction
- subcranial shear distraction to assist with upper cervical flexion
- light TMJ mobilization
- postural reeducation
- cervical retraction or nodding exercises
|The after education, manual therapy, and exercise shot!|
Keeping it Eclectic...