Chronic Jaw Pain

Case Description: Pt. is a 35 y/o female with a 5+ year hx of bilateral TMJ region pain as well as persistent headaches.  She notes that her jaw has popped since high school, but in the past 5 years her jaw popping has become more painful and she has noticed her ability to open becoming less and less. This is limiting her ability to eat, open for dental procedures/hygiene, and talk during her work as a speech therapist.  She states she has worn a bite splint at night for years, but feels it is only worsening her issues as she feels her bite is “off” each morning on waking.    

Objective Measures: The patient was seen for 10 visits over a 7 wk period.

Initial Evaluation (IE)	Findings: 29 mm opening (pain at L TMJ region). Palpable click with pain on opening and just prior to occlusion on closing. TMD Disability Index = 23% impairment
2 weeks after IE (5 visits)	Findings: 46 mm opening without pain (click still present) and beginning to incorporate previously avoided crunchy and chewy foods.  Discontinued use of night splint without increased pain (with permission of dentist)
7 weeks after IE (10 visits)	Findings: 46 mm opening maintained without pain (click slight and non-painful).  Headache symptoms minimal and less frequent.  Able to bite forcefully without pain. No longer limited in her diet or in her occupation. TMD Disability Index = 3% impairment

Patient Comments:  She reports 90% improvement in her problem, stating, “I am able to open my mouth without pain or fear of tightness and popping.” 

Case Summary: This patient had a 5+ year hx of jaw region pain which she had brought up with her dentist on multiple occasions, yet still had only been treated with a bite splint or anti-inflammatories. These interventions were obviously not helping and she was ultimately referred to an oral surgeon.  When deemed a non-surgical candidate, she was finally referred to physical therapy. As focused dental issues are ruled out, physical therapy can and should be considered early in the course of treatment for TMJ related pain.  

Luke Vander Zouwen, DPT
Full Potential Physical Therapy