There is a common motion dysfunction that many TMD and cervicogenic headache patients have. I am dating myself as a gamer, but if your patient looks like this guy....
They are using their capital extensors, instead of gravity and diagastrics to help open their mouth. We should not have to use capital extensors to promote end range mandible depression. This also leads to overuse of cervical protracted posture, which may place stress on the mandible elevators and TM joint.
As a review, the mandible should depress (open) with a rolling phase first, and then an anterior translation phase. The cranium should not go into extension (at least during the rolling phase, or roughly the first half of depression).
So a quick thing I look for is what i call "pac-manning." When asking the patient to open their mouth as wide as possible, do they
- have an initial rolling phase (or do the mandible condyles translate anteriorly immediately)
- are they simultaneously extending the cranium and cervical spine during mandible depression
Want to learn more about The Eclectic Approach to TMD? Take parts A and B on MedBridge, and get some CEUs in the process. Follow this link for $225 off a yearly subscription for all you can eat CEUs! Just don't open too wide consuming them!
Keeping it Eclectic...
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