TMJ and Physiotherapy – Training
While assessment and treatment of temporomandibular joint (TMJ) dysfunction is part of the core competency of all Canadian-trained physiotherapists, additional post-graduate training is available in advanced TMJ assessment and treatment. Physiotherapists have the option of pursuing this training through a limited number of organizations. These included the Orthopaedic Division of the Canadian Physiotherapy Association (www.orthodiv.org), the Advanced Physiotherapy Education Institute (www.aptei.com) and through Dr. Mariano Rocabardo. Dr. Rocabardo is a world-renowned physiotherapist who is a Honorary Member of the American Academy of Orofacial Pain and the American Academy of Craniofacial Pain. He is an expert on head and neck biomechanics and is Internationally published in regards to physiotherapy and TMJ function.

Our Unique Services
Our therapists have pursued Advanced TMJ training and are pleased to offer our services to your patients and their families. As causes of TMJ dysfunction are multi-faceted, treatment must be nothing short of a collaborative approach between our physiotherapists, yourself, the family doctor and maxillofacial specialist. We also routinely consult with other health care disciplines as needed, including psychologists. Jason Taddeo, PT, RCAMT, has a special interest in TMJ treatment and advanced training.

What should you expect when referring your patient to our clinic for assessment?

Patients are typically assessed for up to an hour long with the physiotherapist. This involves a thorough history taking, with specific focus on the medical and dental history. Evidence-based outcome measures and questionnaires are administered for the TMJ and often the cervical spine. The assessment includes questioning related to the current pain, past trauma (i.e. motor vehicle accidents), details about painful movements, parafunctional habits and dental appliances or interventions. Details of painful movements are gathered and compared to current evidence-based research findings to screen for signs of malocclusion, intra- or extra-articular problems. Detailed screening is also performed to identify any co-existing sources of neck pain, headaches, dizziness, vertigo, postural habits and occupational stressors. Screening for contribution from additional factors, such as sleep apnea, is also completed.

Detailed hands-on examination includes: observation of the TMJs, the cervical spine and head, TMJ muscular evaluation, cranial nerve and cervical spine neurological examination, occlusal pattern, evaluation of any orthodontic device or denture, active range of motion of the neck and TMJs, respiration patterns, passive range of motion to assess for tissue end feel and ligamentous integrity, joint play, occlusomuscular dysfunctions and local palpation.

The findings of the assessment are then discussed with the patient. Goals for therapy and a plan of care are then established in consultation with the patient. If the physiotherapist feels that additional referral, special investigation or immediate orthodontic modification is required, then this is detailed in the assessment letter to yourself and the family physician. The patient is usually seen again with 24-48 hours of the assessment to begin treatment.

What should you and your patient expect from treatment for TMJ dysfunction?

This is directly related to the type(s) of dysfunction identified by yourself from your original referral and the findings of the physiotherapy examination. We provided one-on-one physiotherapy care through every step of your patient’s recovery. This typically involves:

1. Postural modification and training;
2. Cervical spine (i.e. cranio-vertebral region) mobilization and advanced manual therapy;
3. Trigger point release, joint proprioception and bite retraining, muscle stretch and relaxation/breathing techniques, local TMJ muscle stabilization and global muscle conditioning for function;
4. Acupuncture (certified) for trigger points and myofascial pain control;
5. Electrophysiological agents (i.e. ultrasound, InterX Pain Therapy or laser therapy)

We use the best available evidence in developing our patient treatment plans and welcome additional suggestions for care at every phase in the recovery process. We are happy to consult with you even prior to your referral to determine if your patient may benefit from physiotherapy services.