correcting asymmetry & joint compression in tmj ...€¦ · craniomandibular complex tmj...
TRANSCRIPT
Correcting Asymmetry & Joint Compression
in TMJ Dysfunction
John W. Corry, RMT
� Mastery is a lifelong process in which focus is given to
a specific subject in order to cultivate expertise.
� Ironically, the process is often humbling as each
revelation leads to many more inquiries.
� Introduction; Why address TMJ Dysfunction?
� A review of the Craniomandibular Complex� Cranial bones
� Muscles of Mastication – our domain
� The role of occlusion
� Voice, breath and expression
� Assessing Symmetry; The foundations of proper function.
� Providing effective intra-oral access.
� Practice building and networking with other health care
providers; Dentists, Speech-Language Pathologists, Physiotherapists, Chiropractors, MD’s, etc
� TMJ hypertonicity is extremely prevalent!�72% of surveyed in March 2007 people clenched their teeth.
� Trauma, assault, MVC, and sport clients often have TMJ
issues overlooked by many different practitioners.
� TMJ dysfunction is often a silent contributor in cases of
headache, scoliosis, and MVC.
� TMJ dysfunction is frequently found in clients where stress and “busy mindedness” is present.
� TMJ work will open networking possibilities with Dentists, Speech-Language Pathologist, Chiropractors, voice coaches, etc.
� It is easy on therapists, and will therefore offset other techniques that are taxing.
� Dovetails well with other modalities; Myofascial Release, CranioSacral Therapy, etc.
� It is unique in the profession of Massage Therapy! Therefore it provides an edge to networking and building a clientele.
Three Main Components:1. Cranial bones – remember
they move!
2. TMJ’s, Articular Disc & the
muscles of mastication
3. Occlusion (how the teeth fit
together)
Stages of opening showing
condylar hinge and then glide
forward
� The mandibular fossa of the Temporal bone
� Craniosacral Therapy informs us that their symmetrical position and movement is integral to proper TMJ function
Asymmetrical hypertonicity of the Medial Pterygoid muscles will influence the Sphenoid’s balance along
the mid-sagittal plane.
Temporalis Muscle; “has been almost completely
overlooked.” J. Upledger
Masseter muscle;
The Power Chewer
Medial Pterygoid:
The Function chewer
Lateral Pterygoid; Conjoined twins with opposing function
Muscle Action Insertion
Inferior Lateral Pterygoid Opens; condyle forward &
down
Neck of condyle
Superior Lateral Pterygoid During Closing (chewing
or “Power Stroke”)
(anterior pull on Articular
Disc matching Retrodiscal
Lamina) 1
30% to 40% to Articular
Disc, remaining 70% to
neck of condyle
1: Okeson, Jeffrey P: Management of Temporomandibular Disorders and
Occlusion, 5th Edition: Lexington, Kentucky,2003
To order 6th edition:
http://www.us.elsevierhealth.com/product.jsp?isbn=9780323046145
Anterior & Posterior bellies
� Along with the Inferior Lateral Pterygoid the Digastric muscles open the mouth.
� Fulcrum around the hyoid bone, which connects it to voice issues!
� Attachment to mastoid process makes it another influence on the temporal bone symmetry!
� Shown as #2; the articular
disc sits on “top” of the
condyle providing important
guidance during opening
and closing
� Like vertebral discs, its job
is to take up a prescribed
amount of space – forces of
clenching and grinding lead
to diminished space and
contributes to anterior disc
displacement.
� The hypertonic Medial Pterygoid m. lying over the inferior alveolar nerve can be a site of soft tissue nerve compression – mimicking tooth ache where the nerve is employed.
� Caution; cases of Trigeminal Neuralgia show up as TMJ Dysfunction –refer to MD for meds!
A relaxed jaw:
“lips closed – teeth open”
� A complex subject in the
domain of Dentistry
� Malocclusion often sited as
a primary contributor to
TMJ Dysfunction and
related headaches
� Until recently, many years
of Orthodontic applications
negated the awareness that
the cranial bones move!
Treating the mandibular sling;
� decrease/resolve hypertonicity
� restore joint space
Great view from beneath!
� Mandibular Sling; the
Masseter m. and the Medial
Pterygoid m. wrap around
the ramus of the mandible
with fascial continuity.
� Like the humerus, the
mandible is suspended by
soft tissue and is therefore
primarily affected by soft
tissue injury or dysfunction.
� While palpating active opening and closing ask,
“Which side is delayed?”
� No more tracking the mandibular wobbles!!
� The condyle that is delayed has accumulated more
compressive joint forces – clenching, grinding, trauma,
etc.
◦ The delayed side has been under-employed
◦ The other side has been over-employed – pain, tenderness, etc
◦ Similar to SI
Knowing which side is delayed
creates a treatment plan;
informs MT which muscles need work to
restore symmetry and joint space!
Motion Palpation of TMJ’s opening
and closing , “Which side is delayed?”.
“How To” . . . provide treatment for TMJ Dysfunction could never be taught effectively without live
instruction!
Proceed to a few visual
demonstrations.
Masseter muscle & Medial Pterygoid muscle
Wearing Nitrile glove
� Reaching across to contra-
lateral masseter m. allows
pad of thumb to explore
intra-orally.
� Outside fingers complete a
myofascial approach
� Incremental; 20 to 40
second intervals of access,
repeat right and left
� Effectiveness is achieved
by repetition – not
duration!
� First, find the ridge at the front of the mandible; Pterygomandibular Raphe
� Have the client rest their teeth on your finger –un-employ the muscle.
� Wait – 3 to 5 seconds!
� Gag reflex lives there, allow client to become familiar with contact.
Reaching the red line is full
access – then treatment begins.
� Proceed medially from hard
bone to soft tissue – YOUR
THERE!
� Flex your DIP joint to find
and engage superficial
resistance in the tissue –
count aloud for client,
“5,4,3,2, 1 and I’m out”
� Repeat left and right to
accumulate release.
� Effectiveness is achieved by
repetition, not duration!
Proceed to de-compress the joint
space – “invites” the articular disc to
return to rightful position.
� By pushing downwards on
the rear lower molar, with a
slight lift to the chin, the
condyle can be gently
tractioned .
� N.B. The client must rest
their teeth on your thumb as
any employment of
masticating muscles will
sabotage the line of traction.
Downwards on the molar, slight lift to the chin.
� The outside hand palpates
the TMJ to feel the joint
space opening.
� This determines the amount
of decompression force
needed from client to client.
� Engage decompression
force, stop a moment, then
re-engage.
� Our goals are to decrease hypertonicity in the
masticatory muscles, and restore joint space.
� Accessing the Masseter m. is easy, but mastering the
access of the Medial Pterygoid m. is the Gold Star!
� Treating both is addressing the Mandibular Sling – this
is unique to the profession of Massage Therapy!
� Remember – The Mandibular Sling is only a
component in the whole operation of the
Craniomandibular Complex
TMJ MasteryPrinciples, Applications and
Disc Displacement
A 2-day workshop focusing on
intra-oral techniques exploring masticatory dysfunction.
(7 CEU’s - CMTO)
John W. Corry, RMT
(519) 433-6156
“Feel free to contact me for further
discussion on this intriguing subject”.
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