Reply To: TMJ case

[lacarroll]

Sorry it took me awhile to get these answered, it’s been a long couple of days, so I’m going to do my best to go down the list and clear up all the questions/thoughts. Here goes:
– Taylor: I definitely thought she fit into the disk displacement with reduction category WITH myogenic involvement. I did not assess joint glides day 1, just because I wasn’t sure me sticking my hand in her mouth to move stuff around was the best idea.
– Helen: so this girl was great in telling me in the subjective that she no longer chews gum, has switched to a soft food diet, and noticed that her headaches tend to come on when she’s been clenching more throughout the day, so that helped me a lot in the decision between cervical vs TMD. I did not do the compression test, but that’s something I definitely want to take a closer look at in future cases. As far as irritability, she was having a really good day when she came in for the eval, so she was pretty low irritability with minimal symptoms. She has SO MUCH muscle involvement that I’ve actually considered dry needling for her. Do you have any good articles supporting dry needling in this area??
– Steven: her psychosocial components were high on my list for the eval. I asked her about her depression and it’s currently under control, but there was a point in time where she took 1-2 years off in college because of stress and depression, so it’s definitely on my radar for this one. I talked with her a lot about her day to day activities and asked her to tell me about some of her stress management techniques and that made me feel better that she had a solid grip on it, along with taking a prescription medication.
– Brandon: I was actually surprised her cervical spine didn’t seem to be involved, but I didn’t do PPIVMs/PAIVMs during the eval. The limitations I found were active with ROM at the TMJ, and again, I didn’t do more accessory testing than that. I chose cervical isometrics for posture because hers is just so bad. I also kind of picked through the Rocabado’s and Kraus’ and mixed and matched techniques for this patient. I had her perform the cervical isos and scap retraction exercises with the tongue on roof of mouth position (TROM), isometric lateral deviations & mouth opening also with TROM, and she fatigued out with these really quickly. And I’ll definitely look into the self-mobs for the HEP, I think that would be a good addition to the treatments in the clinic.