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 Hypothesis
Massage Therapy will reduce symptoms of
TMJ dysfunction such as pain and
clicking/popping of the joint and it will
improve range of motion by cutting down
the frequency of lateral deviation/tracking
of the mandible as well as improving the
amount of pain-free jaw depression, the
byproduct being an improvement in quality
of everyday life.
 TMJ Dysfunction Causes
‡ Physical and/or emotional trauma
‡ Articular disc displacement or
dysfunction
‡ Muscular hypertonicity as a result of
teeth clenching and/or bruxism
(grinding)
‡ STRESS
‡ Chronic pain in other areas of the body
causing the above
TMJ Dysfunction Causes
TMJ Dysfunction Causes
TMJ Dysfunction Symptoms
 Client History
‡ 31 yr. old female, Certified massage therapist
‡ TMJ issues (primarily j
 side) for 15 years .
‡ Musculoskeletal and emotional trauma are contributing factors.
‡ Smoker for ~ 15 years.
‡ Dental history ± chipped front tooth accidentally on a foosball table 0
steel rod put in as a result. Years later got a root canal.
‡ Stress a big factor in the cyclical nature of her symptoms.
‡ Clenching and possible bruxism.
‡ General constant jaw pain, common headaches in temporalis & occular
areas on righ side, all of which affect quality of life.
‡ Favors chewing on right side as a result of pain. Can¶t eat hard cereal
& favors chicken & fish over red meat.
 Treatment Protocol
0 Eight 65-minute sessions over a period of one month

‡ 5 min. Bi-lateral Trapezius (petrissage, MFR & TPT)

‡ 5 min. Right SCM (petrissage, MFR & TPT)
‡ 5 min. Right Sub-Occipitals (petrissage, MFR)
‡ 5 min. Left SCM (petrissage, MFR & TPT)
‡ 5 min. Left Sub-Occipitals (petrissage, MFR)
‡ 5 min. face massage + Digastric/hyoid muscles (petrissage, friction)
‡ 7.5 min. Bi-lateral Massaters (petrissage, TPT, linear friction, pin/stretch)
‡ 7.5 min. Bi-lateral Temporalis (petrissage, scrubbing/light XFF)
‡ 10 min. Right-side Intra-oral work (very progressive TPT)
‡ 10 min. Left-side Intra-oral work (very progressive TPT)
Treatment Protocol
 Methods of Assessment
‡ Qualitative information regarding quality of life (via a profile before the
first session and after the last)
‡ Subjective Pain Level (via a pain scale from 1-10)
‡ Magee¶s Orthopedic Assessment µKnuckle test¶ (client should ideally be
able to comfortably fit 3 knuckles inside mouth when jaw is in depression)
‡ Objective µclick¶ quality observation (before and after each session, both
TMJ¶s are palpated during full jaw depression)
‡ µClick/Pop¶ waveform is recorded (via a microphone, before first session
and after last)
‡ Lateral Deviation/Tracking observation (before and after each session,
full, slow jaw depression is observed)
 (Qualitative) Pain Scale
[


  r

  r

[
 
r
    
Click/Pop
Waveform
Aug 11th

(Before
Any
Treatment)
Click/Pop
Waveform
Sept 11th

(After
Treatment)
 Other Assessment
‡ Magee¶s µKnuckle test¶ varied from being able to fit 2
knuckles in between bottom and top teeth comfortably to
once or twice being able to fit 3 almost comfortably.
‡ Bi-lateral palpation of TMJ during full depression
discovered a transference of force from left TMJ to the
right side when the µclick¶ occurred (making it feel as if the
µclick¶ was on the right side)
‡ Lateral deviation/tracking progressed from 6 or 7 varying
small to large deviations, alternating right to left (in the
first session) to 3 larger, more generalized deviations, right
to left (after all 8 sessions).
 Limitations & Challenges
‡ Dropped Assessments ± blood pressure assessment was dropped early
on, as it is not relevant to this case study. Also, videotape of pre &
post lateral tracking assessment was dropped due to time constraints. A
TENS unit was available and could have been used. Also a dietary
journal would have been a good assessment.
‡ Inconsistency ± protocol wasn¶t followed rigidly enough & treatment
sessions were not evenly spaced out. 8 sessions didn¶t seem like it was
enough to see drastic change. Level of menken made me question my
abilities and had an effect on my morale.
‡ Unattainable Assessments ± such as sophisticated neuromuscular
dentistry equipment that measures lateral deviation, malocclusion and
TMJ noise.
Dentist¶s Gadjets
 Conclusion
0 Client¶s pain level decreased as a result of therapy.
0 Some positive change (a decrease) in number of lateral deviations was
achieved. Working the medial pterygoid and digastric seemed to have
the biggest effect on lateral deviation, whereas focusing more on
lateral pterygoid seemed to have more of a positive effect on pain.
0 One aspect of quality of life improved, being that the client was able to
eat things such as trail mix, tougher breads and chew gum with less
pain/irritation.
0 Minimal change in µclicks/pops¶.
0 There was little change in quality of life in terms of stress level.
0 Treatment could have been less aggressive & protocol could maybe
use some modification.
0 Case study could have been taken with a more scientific approach &
more experience with this work would be beneficial in future research.
 References & Resources
‡ Magee, David J. Magee Orthopedic Physical Assessment,
3rd Edition Philadelphia, PA: W.B. Saunders Company,
1997. pp. 152-173
‡ Rattray, Fiona and Ludwig, Linda Clinical Massage
Therapy Toronto, ON: Talus Incorporated, 2000. pp. 597-
616
‡ McGill-Melzack Pain Questionnaire (online resource)
‡ Google Images Search Function (online resource)
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