Case of the Week 11-20-13: Flying Hug = TMD! | Modern Manual Therapy Blog

Case of the Week 11-20-13: Flying Hug = TMD!


A family friend was recently given a running, jumping hug by a 7 yo. It turns out little girls are a perfect mandible striking height when an adult is crouched. For almost 1 month she had difficulty opening and eating due to TMJ and facial pain.

She finally called my wife asking if I would see her at our house. I saw her yesterday and this is what her painful and limiting opening looked like.


There was an audible early intra-articular click in the left TMJ with mandible deviation to the left until reduction. Depression was limited to about 50% with pain. She had been eating soft foods and had difficulty opening due to pain for 4 weeks with only slight improvement via time.

A quick evaluation revealed mild forward head posture, along with increased tone in the left mandible elevators compared to the right. After light IASTM to the left masseter in a proximal to distal stroke for 2 minutes then a light medial pterygoid functional release, mandible depression had much less pain, no deviation, and a very light click.

Clinical Pearl Time

I realized I had no gloves at my house! We're close, but not that close!

Using right hand to grasp left mandible and left lower molars

My adapted grasp of her right hand so I could mobilize her TMJ

Side view with left hand index on the mandible condyle palpating for light movement
I taught her to grasp her left mandible and place her thumb on her lower molars just like I would. I then grasped her hand and applied the distraction mobilization force through her hand, while I palpated her left mandible condyle for movement. To my surprise, this worked just as well and "going in." After 3 sets of 30-40 seconds of oscillations, the click was barely perceptible, and motion was now full and pain free. The last technique was a Rocabado Rollback where you capture the disc by distracting, then anteriorly translating the TMJ, and having them articulate the condyle on the inferior portion of the disc as your bring it back passively with mild compressive force.

This reduced the disc derangement completely and she now had full pain free motion with no deviation for the first time in 1 month. For HEP, I instructed her on self TMJ distractions on the left and cervical retractions to make sure the mandible does not retract excessively. I plan on following up with her next week, but she was able to go out to Panera Bread to catch up with my wife immediately after our little emergency visit!



Remember, #IASTM Technique is still on sale for the rest of the week. Join the hundreds of others who have had nothing but accolades for our affordable and immediately applicable program!

Keeping it Eclectic...

5 comments:

  1. Thanks for the article! I'm going to have to look up the Rocabado rollback. I treat TMD and work for a health system that uses outcomes measures (Oswestry, NDI, Quick Dash, etc) on all patients. Any thoughts on an approriate measure for TMD?

    ReplyDelete
  2. I'll make a video of it soon! The closest would be NDI, or maybe just use something global like SF-12, as there is not a questionnaire specifically for TMD that I am aware of.

    ReplyDelete
  3. where can I get the tool used in the roll back? I think my TMJ instructor called it a helicoidal? I've tried googling with no success. Does each pt purchase their own?

    ReplyDelete
  4. I'm not aware of any tool that is used, when I learned it from Rocabado, he just used his hands.

    ReplyDelete
  5. Preventative treatments are always the best option when possible. I have developed an online physical therapy exercise library composed entirely
    of professional quality videos. www.gopt.com offers videos that will prove helpful in treating and preventing TMJ pain.

    ReplyDelete