Make sure the patient is sitting relaxed, but in an upright position with sternum elevated to start all of these exercises. Tongue should be at the roof of the mouth in the "N" sound position and teeth should be apart.
Have them perform them 10x hourly to start, more if their window of improvement closes faster than that.
1) Cervical Retraction
- a commonly held prolonged position of cervical protraction may cause mandible retraction
- this often sensitizes the posterior bilaminar zone of the TMJ
- it also may contribute to hypertonicity in the masseters and temporalis
- the +1 for the -1 of prolonged cervical protraction is the simple and effective cervical retraction
- make sure the patient is able to perform this simple movement correctly and as a low threshold exercise
- bonus visualization, if the patient knows who "Atlas" is, tell them this exercise also gives Atlas a rest
2) Mandible protraction
- TMD patients are often ectomorphic hypermobile females
- if their occlusion does not change with end range cervical protraction, extension, flexion, cervical retraction alone may not be enough to give the bilaminar zone a break
- this does not have to be to end range, just have them move forward 3-4 mm
3) Isometric mandible protraction
- isometrics are a great way to inhibit muscles that are held in tonic and tender states
- have the patient lightly protract the mandible and hold it forward into their fist for 3-4 seconds
- repeat often throughout the day and particular if they start to have posterior TMJ tenderness or referred ear symptoms
- repeat 6 times
4) Isometric mandible depression
- the digastrics are often in a passively insufficient state due to prolonged forward head positions
- if the patient is sitting upright, have them do a light retraction to get into a bit past neutral
- have the patient open just 1 finger width or less and isometrically hold the mandible depression movement - not cervical flexion into the fist for 3-4 seconds
- repeat 6 times
5) Functional TMJ Mobilization - example deviation to the right
- have the patient hold their right hand on the right inferior mandible and along the angle of the mandible
- with tongue at the roof of the mouth, have them open, their hand can actively assist the initial rolling phase of mandible depression
- overpressure using the right hand with light pressure to the left, guiding the mandible into left lateral excursion during depression
- repeat 6 times
Want to learn more? Check out my two part course on Medbridge or Modern Manual Therapy below! Better yet, register for Nxt Gen PT's Certificate in Temporomandibular Management - seats still available for our next seminar!