Examples of Physical Therapy

Consultations
Appendix 10
Dentists commonly refer TMD patients to physical therapists to improve TMD pain, TMJ
function, range of motion, daytime or sleeping postures, and/or neck symptoms. In addition to
improving a patient s symptoms, a goal in physical therapy is to teach the patient to maintain
this improvement, which is typically done through home exercise the patient is taught. Physical
therapy performed in conjunction with occlusal appliance therapy may attain better improve-
ment in TMD symptoms than occlusal appliance therapy alone.
Two examples are presented below: the rst is a patient whose TMD symptoms are limited
to the masticatory system, and the second is a patient who has concomitant neck pain and the
physical therapist is requested to treat just the cervical myofascial pain.
These referrals can be made on a prescription pad or ofce stationery. If you commonly refer
to a certain therapist, I recommend you ask the physical therapist for a referral pad, because it
generally just requires lling in blanks and has a map to the facility for the patient.
Many third - party payers require the requested frequency and duration of treatment be
documented; two to three times a week for a month is a reasonable request, and generally
third - party payers will allow practitioners to request as therapist recommends. Inform the
physical therapist of any precautions he or she should be aware of (e.g., previous surgery,
tumor, screws, or wires in the region) and medical disorders that could complicate therapy
(e.g., angioedema).
It is my preference to fax the physical therapist my initial evaluation ndings, so the thera-
pist benets from my referred pain observations, thoughts about the patient s contributing
factors, and my planned therapies. If the patient does not improve as anticipated, I telephone
the therapist so we can discuss our perceptions for how we can escalate therapy.
CC: Constant 6/10 Rt preauricular pain.
Dx: Rt TMJ inammation, myofascial pain, and Rt TMJ disc displacement with reduction.
Please evaluate and treat. Pt also relates she intermittently sleeps on her stomach and is
unable to change this sleep position. Would you please help Pt break this habit? Thank you.
Precautions: None.
Pt was given an occlusal appliance and TMD self - management instructions.
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