Q&A Time! | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Q&A Time!

It's Q&A Time! This week's questions are 1) Is tongue numbness common with TMD? and 2) What percentage of TMD patients have cervical involvement?

1) Is tongue numbness common with TMD?

While I do not hear this complaint often clinically, it is a common symptom in patients with TMD. The hypoglossal nerve is very closely related to the trigeminal nerve. Cases that are diagnosed as trigeminal neuralgia are often just simple TMD cases that can be treated well with OMPT, postural correction, and patient education. I do not ask about it in particular during my history, so it may be more common than my clinical experience suggests. However, like tinnitus, and particularly ear fullness, the treatments are the same and should mainly focus on restoration of function, ROM, and craniovertebral relationship which leads us to...

2) What percentage of TMD patients have cervical involvement?

Sit upright and click your teeth together, slouch, protract your head/neck, then click your teeth together. Fully flex and extend your cervical spine and click your teeth together in both positions. In most cases, you (or the patient) will notice that there is a slight difference in your occlusion. Cervical protraction, where most of these patients live, causes mandible retraction, often leading to irritation of the bilaminar zone behind the mandible condyle and intra-articular disc anterior subluxation.

Dr. Rocabado proved a long time ago that the mandible is closely related to head and neck position, so unless your TMJ patient's mandible is not attached to a temporal bone and a cervical spine by bones and muscles, I'd say 100% of TMD patients have cervical involvement. One of Rocabado's sayings, "It's not no pain, no patient." This is in regard to

  • non-painful intra-articular clicking
  • no cervical complaints
The cervical spine may not hurt, but often has upper cervical dysfunction possibly causing referred cranial pain in the superior, temporal, and frontal aspects, headaches, and dizziness. That's a problem and can be again addressed with OMPT and MDT. So 100% of TMD patients are cervical patients, but not all cervical patients are TMD patients.

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