Thermal ultrasound, manipulation and exercise on pain and mouth opening in Chronic temporomandibular joint disorder

Background: A 60-year-old female patient reported with a chief complaint of pain in bilateral temporomandibular joints (TMJ) region since 1_1/2 years. The pain was initially reported to be insidious in onset, moderate in intensity, aggravated on chewing food and during excessive mouth opening. On examination her mouth opening was found to be less than 8 mm and standard head and neck examination showed grade 2 tenderness with swelling on bilateral TMJ and forward neck posture with rounded shoulders. The patient reported her pain to be 6 at rest in NPRS (with 0 being no pain and 10 being maximum) and 8 out of 10 on mouth opening. Methodology/Management: A 4-week Physiotherapy Intervention program, which consisted of Ultrasound Therapy at varying intensity, TMJ manipulation, Cervical Range of Motion Exercises and Manual Cervical traction was administered. Repeated evaluation of pain and other functional outcomes were done on a weekly basis. Results: There was significant improvement in her mouth opening (41 mm), restoration of masticatory functions, complete resolution of pain and overall improvement in quality of life after the 4 weeks intervention program. Conclusion: A structured Physiotherapy intervention program consisting of Non-thermal Ultrasound, Manipulation and exercise targeting TMJ and Upper quarter, proved to be highly effective in increasing functions and reducing signs and symptoms in Chronic TMJ Dysfunction which can be highly disabling. The recovery observed in this patient, who was not on any standard treatment for almost 18 months, hence the severe limitations she encountered, is a testament to the need of designing individualized treatment protocols addressing the many facets of impairment in TMJ Disorders.