A very good question was asked recently by a reader, "Do you address painless clicks in the TMJ? I generally disregard them in other parts of the body but a dentist asked me yesterday about it and I doubted myself.
Also, I don't know what percentage of your readership treats TMD but I would appreciate a post about significance of clicks and possibly an exposition about the TMJ disc and how/if manual therapy can affect it. Just a thought. Thanks for all your work!"
Thanks for the question! Let me start with some background. I consider Dr. Mariano Rocabado, a mentor, and of course, a pioneer in the field of PT. He was one of the first PTs to give the TMJ any consideration for different assessment and treatment. One of his sayings regarding the TMJ was, "It's should not be, no pain, no patient." This was in regard to painless clicks, which often not only PTs disregard, but dentists do as well. He would liken it to a meniscal derangement in the knee, if there was internal clicking, an orthopaedic surgeon would probably do something about it.
It's been over a decade since I got certified in Rocabado's approach through the University of St. Augustine and I have had a lot of Pain Science courses and exposure since then. So this is not as easy as an answer as I would have given 10 years ago.
10 years ago me
- Absolutely, I would market to dentists to refer younger patients for a painless click!
- I would also tell parents who asked me about it, that it every joint should be friction free and sound free, and that reducing this click would help prevent further degeneration (based on Rocabado's research)
- At least 2-3 times/yearly, I would get a patient between 8-12 yo or younger and correct their posture, do a few TMJ distractions and then teach the parents how to do the same
- Many times it would reduce in 2-3 visits and I would discharge them, with the thought that I just prevented an early degenerative process.
- I no longer market for this, and no longer equate degeneration as a predictor of pain or future loss of function
- however, I do not see the harm in reducing a pain free clicking disc - as it still is not normal function of a joint with a meniscus in it
- I would try to reduce it, but not sweat it if it treatment is not successful
- postural correction - a must because cervical protraction causes mandible retraction - which leads to anterior disc subluxation
- TMJ distraction
- distraction and anterior glide to "capture it" then posterior glide to drag it back - this was one of Rocabado's advanced techniques
- both of these work well if the click is early in the range of depression, mid range, it is tougher but less likely, and if the click is at end range, manual therapy and postural correction are very unlikely to reduce that click
- HEP of self distractions, cervical retractions, and mandible protrusions, along with sitting with a lumbar roll
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