The efficacy of an Osteopathic treatment protocol on pain and function in patients with TMJ disorders
Konstantinos VATHRAKOKOILIS, Torsten LIEM, Ioannis AETOPOULOS, Konstantinos ANTONIADIS, Ekaterini TRIANTAFYLLIDOU
Department of Oral and Maxillofacial Surgery, Dental School, Aristotle University of Thessaloniki (Head: Professor K. Antoniadis)
Hellenic Archives of Oral & Maxillofacial Surgery (2018) 2, 125-138
SUMMARY: Purpose: To evaluate the effect of an Osteo- pathic treatment protocol on the quality and intensity of pain, mouth opening and general joint function in patients with persistent TMD.
Methodology: 24 patients (17 women - 7 men) aged 18- 62 y.o.a. participated in the study. The patients treated with the osteopathic protocol (8 sessions - 2 times / week), suffered from the disorder for a period of 2-24 months. Data was collected at baseline of the procedure, after the 4th session and after the 8th session.
Results: The treatment protocol showed positive results for pain reduction in NPRS (Numeric Pain Rating Score) (F=213.9, p<0.001) and GROC (Global Rating of Change Score), as well as joint function using the Jaw Functional Limitation Scale (JFLS-20) (F=211.2, p<0.001). Also, for maximum mouth opening (MMO) there was a statistically significant difference between initial and final measurement in both active (F=110.01, p<0.001) and passive (F=129.05, p<0.001) MMO.
KEY WORDS: Osteopathic treatment, temporomandibular disorder, myofascial dysfunction, TMJ pain
REFERENCES
Almasan C, Hedesiu M, Baciut G, Leucuta C, Baciut M: Disk and joint morphology variations on coronal and sagittal MRI in temporo- mandibular joint disorders. Clinical Oral Investigations 17: 1243- 1250, 2013
Al-Moraissi E: Open versus arthroscopic surgery for the management of internal derangement of the temporomandibular joint: a meta- analysis of the literature. International Journal of Oral and Max- illofacial Surgery 44(6):763-770, 2015
Bartley J: Breathing and temporomandibular joint disease. Journal of Bodywork and Movement Therapies 15(3): 291-298, 2011
Carlsson E, Egermark I, Magnusson T: Predictors of signs and symptoms of temporomandibular disorders: a 20-year follow-up study from childhood to adulthood. Acta Odontologica Scandinavica 60(3): 180-185, 2002
Chase C: Educational Council on Osteopathic Principles, American As- sociation of Colleges of Osteopathic Medicine. Glossary of Os- teopathic Terminology, 2011
Ciancaglini R, Gherlone EF, Radaelli G: The relationship of bruxism with craniofacial pain and symptoms from the masticatory system in the adult population. Journal of Oral Rehabilitation 28(9): 842- 848, 2001
Cuccia M, Caradonna C, Annunziata V, Caradonna D: Osteopathic manual therapy versus conventional conservative therapy in the treatment of temporomandibular disorders: a randomized con- trolled trial. Journal of Bodywork Movement Therapy 14(2); 179- 184, 2010
Deodato F, Trusendi R, Giorgetti R, Scalese M: Predisposition for Tem- poromandibular Joint Disorders: Loose Ligaments. CRANIO 24(3): 179-183, 2006
Dodd G, Good M, Nguyen L, Grigg I, Batia M, Standley R: In vitro bio- physical strain model for understanding mechanisms of osteo- pathic manipulative treatment. Journal of American Osteopathic Association 106(3):157-166, 2006
Dommerholt J, Huijbregts P: Myofascial trigger points: pathophysiology and evidence-informed diagnosis and management: Jones & Bartlett Learning, 2010
Gonzalez-Iglesias J, Cleland A, Neto F, Hall T, Fernandez-de-las-Penas C: Mobilization with movement, thoracic spine manipulation, and dry needling for the management of temporomandibular disorder: a prospective case series. Physiotherapy Theory Practice 29(8): 586-595, 2013
Hartman L. Indirect Technique. Handbook of Osteopathic Technique: Springer; 1997. p. 31-38
Hirata FH, Guimaraes AS, Oliveira JX, Moreira CR, Ferreira ET, Caval- canti MG: Evaluation of TMJ articular eminence morphology and disc patterns in patients with disc displacement in MRI. Brazilian Oral Research 21: 265-271, 2007
Hopkins, L. (2010). Osteopathic Muscle Energy Technique to the tem- poromandibular Joint. (MOst), Unitec, Auckland, New Zealand, 2010
Jayaseelan J, Tow S: Cervicothoracic junction thrust manipulation in the multimodal management of a patient with temporomandibu- lar disorder. Journal of Manual and Manipulative Therapy 24: 90- 97, 2016
John T, Miglioretti L, LeResche L, Von Korff M, Critchlow W: Wide- spread pain as a risk factor for dysfunctional temporomandibular disorder pain. Pain 102(3): 257-263, 2003
Juca K, Galdames I,Guimarães A: Mandibular Condyle Position in Max- imum Mouth Opening. A Magnetic Resonance Imaging Evaluation. International Journal Morphology 27(3): 867-871, 2009
Kalamir A, Bonello R, Graham P, Vitiello AL, Pollard H: Intraoral My- ofascial Therapy for Chronic Myogenous Temporomandibular Disorder: A Randomized Controlled Trial. Journal of Manipulative and Physiological Therapeutics 35(1): 26- 37, 2012
Kim YK, Yun PY, Ahn MS, Kim JS: The relationship between trauma and temporomandibular joint disorder. Journal of Korean Associ- ation of Maxillofacial Plastic and Reconstructive Surgeons 31(5): 375-380, 2009
Kumar R, Pallagatti S, Sheikh S, Mittal A, Gupta D, Gupta S: Correlation between clinical findings of temporomandibular disorders and MRI characteristics of disc displacement. Open Dentistry Journal 9: 273-281, 2015
Lavelle E, Lavelle W, Smith H: Myofascial Trigger Points. Anesthesiology Clinics, 25(4): 841-851, 2007
Liu X, Liang J, Xiao P, Jiao X, Gao Y, Ahmetjiang A: The effectiveness of cognitive-behavioural therapy for temporomandibular disor- ders: a systematic review. Journal of Oral Rehabilitation 39(1): 55- 62, 2012
Mapelli A, Zanandrea Machado BC, Giglio LD, Sforza C, De Felicio CM: Reorganization of muscle activity in patients with chronic temporomandibular disorders. Archives of Oral Biology 72, 164- 171, 2016
Manfredini D, Guarda-Nardini L, Winocur E, Piccotti F, Ahlberg J, Lobbezoo F: Research diagnostic criteria for temporomandibular disorders: a systematic review of axis I epidemiologic findings. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and En- dodontology 112(4): 453-462, 2011
Meltzer KR, Standley PR: Modeled repetitive motion strain and indirect osteopathic manipulative techniques in regulation of human fi- broblast proliferation and interleukin secretion. Journal of Amer- ican Osteopathic Association 107(12):527-536, 2007
Minasny B: Understanding the process of fascial unwinding. International Journal of Therapeutic Massage and Bodywork 2(3):10-17, 2009
Mujakperuo HR, Watson M, Morrison R, Macfarlane TV: Pharmaco- logical interventions for pain in patients with temporomandibular disorders. Cochrane Database Systematic Reviews 10, 2010
Murray GM, Phanachet I, Uchida S, Whittle T: The human lateral ptery- goid muscle: a review of some experimental aspects and possible clinical relevance. Australian Dentistry Journal 49: 2-8, 2004
Nicolakis P, Erdogmus B, Kopf A, Nicolakis M, Piehslinger E, Fialka- Moser V: Effectiveness of exercise therapy in patients with my- ofascial pain dysfunction syndrome. Journal of Oral Rehabilitation 29(4): 362-368, 2002
Okeson, J. (2007). Management of temporomandibular disorders and occlusion: Elsevier Health Sciences.
Ohrbach R, Larsson P, List T: The Jaw Functional Limitation Scale: De- velopment, reliability, and validity of 8-item and 20-item versions. Journal of Orofacial Pain 22(3): 219–230, 2008
Ohrbach R, Granger C, List T, Dworkin S: Preliminary development and validation of the Jaw Functional Limitation Scale. Community Dentist Oral Epidemiology 36(3): 228–236, 2008
Pihut M, Ferendiuk E, Szewczyk M, Kasprzyk K, Wieckiewicz M: The efficiency of botulinum toxin type A for the treatment of masseter muscle pain in patients with temporomandibular joint dysfunction and tension-type headache. Journal Headache Pain 17: 29, 2016
Plesh O, Wolfe F, Lane N: The relationship between fibromyalgia and temporomandibular disorders: prevalence and symptom severity. The Journal of Rheumatology 23(11): 1948-1952, 1996
Rajadurai V: The Effcet of Muscle Energy Technique on Tempor- mandibular Joint Dysfunction: A Randomized Clinical Trail. Asian Journal of Scientific Research, 4(1), 2011
Ritchlin C: Fibroblast biology. Effector signals released by the synovial fibroblast in arthritis. Arthritis Research 2(5): 356-360, 2000 Robinson de Senna B, Marques L, França JP, Ramos-Jorge ML, Pereira
LJ: Condyle-disk-fossa position and relationship to clinical signs and symptoms of temporomandibular disorders in women. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and En- dodontology 108(3): 117-124, 2009
Saito ET, Akashi PMH, de Camargo Neves Sacco I: Global Body Pos- ture Evaluation in Patients with Temporomandibular Joint Disor- der. Clinics 64(1): 35-39,2009
Schleip R: Fascial plasticity: a new neurobiological explanation. Part 1.
Journal of Bodywork and Movement Therapy 7:11–19, 2003 Schleip R: Fascial plasticity: a new neurobiological explanation. Part 2.
Journal of Bodywork and Movement Therapy 7:104–116, 2003 Schiffman E, Ohrbach R: Executive Summary of the Diagnostic Criteria
for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications. Journal of American Dental Association 147(6): 438–445, 2016
Smith B, Maixner W, Greenspan D, Dubner R, Fillingim B, Ohrbach R, Knott C, Slade D, Bair E, Gibson G, Zaykin V, Weir S, Maixner W, Diatchenko L: Potential genetic risk factors for chronic TMD: genetic associations from the OPPERA case control study. The Journal of Pain 12(11): 92-101, 2011
Smith SB, Mir E, Bair E, Slade GD, Dubner R, Fillingim RB, Greenspan D, Ohrbach R, Knott C, Weir B, Maixner W, Diatchenko L: Ge- netic Variants Associated With Development of TMD and Its In- termediate Phenotypes: The Genetic Architecture of TMD in the OPPERA Prospective Cohort Study. The Journal of Pain 14(12): 91-101, 2013
Song F, Li Q, Wan Z, Zhao Y, Huang F, Yang Q, Zhao WF, Zhang M, Chen, Y: Lamotrigine reverses masseter overactivity caused by stress maybe via Glu suppression. Physiology & Behavior, 137(0), 25-32, 2015
Tozzi P: Selected fascial aspects of osteopathic practice. Journal of Bodywork Movement Therapy 16(4):503-519, 2012
Turner J, Mancl L, Huggins K, Sherman J, Lentz G, LeResche L: Tar- geting temporomandibular disorder pain treatment to hor- monal fluctuations: A randomized clinical trial. Pain, 152(9): 2074-2084, 2011
Walker N, Bohannon RW, Cameron D: Discriminant validity of tem- poromandibular joint range of motion measurements obtained with a ruler. Journal of Orthopaedic & Sports Physical Therapy 30(8): 484-492, 2000
Zein-Hammoud M, Standley P: Modeled Osteopathic Manipulative Treatments: A Review of Their in Vitro Effects on Fibroblast Tis- sue Preparations. Journal of American Osteopathic Association 115(8): 490-502, 2015
Department of Oral and Maxillofacial Surgery, Dental School, Aristotle University of Thessaloniki (Head: Professor K. Antoniadis)
Hellenic Archives of Oral & Maxillofacial Surgery (2018) 2, 125-138
SUMMARY: Purpose: To evaluate the effect of an Osteo- pathic treatment protocol on the quality and intensity of pain, mouth opening and general joint function in patients with persistent TMD.
Methodology: 24 patients (17 women - 7 men) aged 18- 62 y.o.a. participated in the study. The patients treated with the osteopathic protocol (8 sessions - 2 times / week), suffered from the disorder for a period of 2-24 months. Data was collected at baseline of the procedure, after the 4th session and after the 8th session.
Results: The treatment protocol showed positive results for pain reduction in NPRS (Numeric Pain Rating Score) (F=213.9, p<0.001) and GROC (Global Rating of Change Score), as well as joint function using the Jaw Functional Limitation Scale (JFLS-20) (F=211.2, p<0.001). Also, for maximum mouth opening (MMO) there was a statistically significant difference between initial and final measurement in both active (F=110.01, p<0.001) and passive (F=129.05, p<0.001) MMO.
KEY WORDS: Osteopathic treatment, temporomandibular disorder, myofascial dysfunction, TMJ pain
REFERENCES
Almasan C, Hedesiu M, Baciut G, Leucuta C, Baciut M: Disk and joint morphology variations on coronal and sagittal MRI in temporo- mandibular joint disorders. Clinical Oral Investigations 17: 1243- 1250, 2013
Al-Moraissi E: Open versus arthroscopic surgery for the management of internal derangement of the temporomandibular joint: a meta- analysis of the literature. International Journal of Oral and Max- illofacial Surgery 44(6):763-770, 2015
Bartley J: Breathing and temporomandibular joint disease. Journal of Bodywork and Movement Therapies 15(3): 291-298, 2011
Carlsson E, Egermark I, Magnusson T: Predictors of signs and symptoms of temporomandibular disorders: a 20-year follow-up study from childhood to adulthood. Acta Odontologica Scandinavica 60(3): 180-185, 2002
Chase C: Educational Council on Osteopathic Principles, American As- sociation of Colleges of Osteopathic Medicine. Glossary of Os- teopathic Terminology, 2011
Ciancaglini R, Gherlone EF, Radaelli G: The relationship of bruxism with craniofacial pain and symptoms from the masticatory system in the adult population. Journal of Oral Rehabilitation 28(9): 842- 848, 2001
Cuccia M, Caradonna C, Annunziata V, Caradonna D: Osteopathic manual therapy versus conventional conservative therapy in the treatment of temporomandibular disorders: a randomized con- trolled trial. Journal of Bodywork Movement Therapy 14(2); 179- 184, 2010
Deodato F, Trusendi R, Giorgetti R, Scalese M: Predisposition for Tem- poromandibular Joint Disorders: Loose Ligaments. CRANIO 24(3): 179-183, 2006
Dodd G, Good M, Nguyen L, Grigg I, Batia M, Standley R: In vitro bio- physical strain model for understanding mechanisms of osteo- pathic manipulative treatment. Journal of American Osteopathic Association 106(3):157-166, 2006
Dommerholt J, Huijbregts P: Myofascial trigger points: pathophysiology and evidence-informed diagnosis and management: Jones & Bartlett Learning, 2010
Gonzalez-Iglesias J, Cleland A, Neto F, Hall T, Fernandez-de-las-Penas C: Mobilization with movement, thoracic spine manipulation, and dry needling for the management of temporomandibular disorder: a prospective case series. Physiotherapy Theory Practice 29(8): 586-595, 2013
Hartman L. Indirect Technique. Handbook of Osteopathic Technique: Springer; 1997. p. 31-38
Hirata FH, Guimaraes AS, Oliveira JX, Moreira CR, Ferreira ET, Caval- canti MG: Evaluation of TMJ articular eminence morphology and disc patterns in patients with disc displacement in MRI. Brazilian Oral Research 21: 265-271, 2007
Hopkins, L. (2010). Osteopathic Muscle Energy Technique to the tem- poromandibular Joint. (MOst), Unitec, Auckland, New Zealand, 2010
Jayaseelan J, Tow S: Cervicothoracic junction thrust manipulation in the multimodal management of a patient with temporomandibu- lar disorder. Journal of Manual and Manipulative Therapy 24: 90- 97, 2016
John T, Miglioretti L, LeResche L, Von Korff M, Critchlow W: Wide- spread pain as a risk factor for dysfunctional temporomandibular disorder pain. Pain 102(3): 257-263, 2003
Juca K, Galdames I,Guimarães A: Mandibular Condyle Position in Max- imum Mouth Opening. A Magnetic Resonance Imaging Evaluation. International Journal Morphology 27(3): 867-871, 2009
Kalamir A, Bonello R, Graham P, Vitiello AL, Pollard H: Intraoral My- ofascial Therapy for Chronic Myogenous Temporomandibular Disorder: A Randomized Controlled Trial. Journal of Manipulative and Physiological Therapeutics 35(1): 26- 37, 2012
Kim YK, Yun PY, Ahn MS, Kim JS: The relationship between trauma and temporomandibular joint disorder. Journal of Korean Associ- ation of Maxillofacial Plastic and Reconstructive Surgeons 31(5): 375-380, 2009
Kumar R, Pallagatti S, Sheikh S, Mittal A, Gupta D, Gupta S: Correlation between clinical findings of temporomandibular disorders and MRI characteristics of disc displacement. Open Dentistry Journal 9: 273-281, 2015
Lavelle E, Lavelle W, Smith H: Myofascial Trigger Points. Anesthesiology Clinics, 25(4): 841-851, 2007
Liu X, Liang J, Xiao P, Jiao X, Gao Y, Ahmetjiang A: The effectiveness of cognitive-behavioural therapy for temporomandibular disor- ders: a systematic review. Journal of Oral Rehabilitation 39(1): 55- 62, 2012
Mapelli A, Zanandrea Machado BC, Giglio LD, Sforza C, De Felicio CM: Reorganization of muscle activity in patients with chronic temporomandibular disorders. Archives of Oral Biology 72, 164- 171, 2016
Manfredini D, Guarda-Nardini L, Winocur E, Piccotti F, Ahlberg J, Lobbezoo F: Research diagnostic criteria for temporomandibular disorders: a systematic review of axis I epidemiologic findings. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and En- dodontology 112(4): 453-462, 2011
Meltzer KR, Standley PR: Modeled repetitive motion strain and indirect osteopathic manipulative techniques in regulation of human fi- broblast proliferation and interleukin secretion. Journal of Amer- ican Osteopathic Association 107(12):527-536, 2007
Minasny B: Understanding the process of fascial unwinding. International Journal of Therapeutic Massage and Bodywork 2(3):10-17, 2009
Mujakperuo HR, Watson M, Morrison R, Macfarlane TV: Pharmaco- logical interventions for pain in patients with temporomandibular disorders. Cochrane Database Systematic Reviews 10, 2010
Murray GM, Phanachet I, Uchida S, Whittle T: The human lateral ptery- goid muscle: a review of some experimental aspects and possible clinical relevance. Australian Dentistry Journal 49: 2-8, 2004
Nicolakis P, Erdogmus B, Kopf A, Nicolakis M, Piehslinger E, Fialka- Moser V: Effectiveness of exercise therapy in patients with my- ofascial pain dysfunction syndrome. Journal of Oral Rehabilitation 29(4): 362-368, 2002
Okeson, J. (2007). Management of temporomandibular disorders and occlusion: Elsevier Health Sciences.
Ohrbach R, Larsson P, List T: The Jaw Functional Limitation Scale: De- velopment, reliability, and validity of 8-item and 20-item versions. Journal of Orofacial Pain 22(3): 219–230, 2008
Ohrbach R, Granger C, List T, Dworkin S: Preliminary development and validation of the Jaw Functional Limitation Scale. Community Dentist Oral Epidemiology 36(3): 228–236, 2008
Pihut M, Ferendiuk E, Szewczyk M, Kasprzyk K, Wieckiewicz M: The efficiency of botulinum toxin type A for the treatment of masseter muscle pain in patients with temporomandibular joint dysfunction and tension-type headache. Journal Headache Pain 17: 29, 2016
Plesh O, Wolfe F, Lane N: The relationship between fibromyalgia and temporomandibular disorders: prevalence and symptom severity. The Journal of Rheumatology 23(11): 1948-1952, 1996
Rajadurai V: The Effcet of Muscle Energy Technique on Tempor- mandibular Joint Dysfunction: A Randomized Clinical Trail. Asian Journal of Scientific Research, 4(1), 2011
Ritchlin C: Fibroblast biology. Effector signals released by the synovial fibroblast in arthritis. Arthritis Research 2(5): 356-360, 2000 Robinson de Senna B, Marques L, França JP, Ramos-Jorge ML, Pereira
LJ: Condyle-disk-fossa position and relationship to clinical signs and symptoms of temporomandibular disorders in women. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and En- dodontology 108(3): 117-124, 2009
Saito ET, Akashi PMH, de Camargo Neves Sacco I: Global Body Pos- ture Evaluation in Patients with Temporomandibular Joint Disor- der. Clinics 64(1): 35-39,2009
Schleip R: Fascial plasticity: a new neurobiological explanation. Part 1.
Journal of Bodywork and Movement Therapy 7:11–19, 2003 Schleip R: Fascial plasticity: a new neurobiological explanation. Part 2.
Journal of Bodywork and Movement Therapy 7:104–116, 2003 Schiffman E, Ohrbach R: Executive Summary of the Diagnostic Criteria
for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications. Journal of American Dental Association 147(6): 438–445, 2016
Smith B, Maixner W, Greenspan D, Dubner R, Fillingim B, Ohrbach R, Knott C, Slade D, Bair E, Gibson G, Zaykin V, Weir S, Maixner W, Diatchenko L: Potential genetic risk factors for chronic TMD: genetic associations from the OPPERA case control study. The Journal of Pain 12(11): 92-101, 2011
Smith SB, Mir E, Bair E, Slade GD, Dubner R, Fillingim RB, Greenspan D, Ohrbach R, Knott C, Weir B, Maixner W, Diatchenko L: Ge- netic Variants Associated With Development of TMD and Its In- termediate Phenotypes: The Genetic Architecture of TMD in the OPPERA Prospective Cohort Study. The Journal of Pain 14(12): 91-101, 2013
Song F, Li Q, Wan Z, Zhao Y, Huang F, Yang Q, Zhao WF, Zhang M, Chen, Y: Lamotrigine reverses masseter overactivity caused by stress maybe via Glu suppression. Physiology & Behavior, 137(0), 25-32, 2015
Tozzi P: Selected fascial aspects of osteopathic practice. Journal of Bodywork Movement Therapy 16(4):503-519, 2012
Turner J, Mancl L, Huggins K, Sherman J, Lentz G, LeResche L: Tar- geting temporomandibular disorder pain treatment to hor- monal fluctuations: A randomized clinical trial. Pain, 152(9): 2074-2084, 2011
Walker N, Bohannon RW, Cameron D: Discriminant validity of tem- poromandibular joint range of motion measurements obtained with a ruler. Journal of Orthopaedic & Sports Physical Therapy 30(8): 484-492, 2000
Zein-Hammoud M, Standley P: Modeled Osteopathic Manipulative Treatments: A Review of Their in Vitro Effects on Fibroblast Tis- sue Preparations. Journal of American Osteopathic Association 115(8): 490-502, 2015
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