Evidence for physical therapy in temporomandibular disorders - a prospective clinical study

Biomechanical or muscular disorders are often the cause of temporomandibular disorders (TMDs) and may be treated with physiotherapy (PT). This study was part of a PhD thesis1 investigating whether PT shows therapeutic success in TMD patients and whether it is an economic means of treatment. PT treatments were selected and adjusted to last for 15 to 20 min (German statutory health insurance). Questionnaires for pain localization (SL-NRS)2 before and after PT were completed by 807 TMD patients (P-Practice group), blinded to the examiners. These questionnaires were compared with those of control groups (N = 450) at the end of the study. Also investigated was whether TMD patients only suffer from symptoms of the chewing system or are also affected by complaints of the cervical spine region (CSR) and the sacroiliac joint (SIJ), and whether this pain can be reduced by PT. Patients in the P-Practice group (N = 807; average age 43 years) experienced an improvement of 65.8% in the pain indication from the first to the final treatment dates of a treatment series. To find out whether TMD patients with a pain indication of ≥ 5 experience a comparable change through PT, 319 of the 807 P-Practice group patients were observed separately. Of this P-Practice group ≥ 5 (N = 319), 85.58% indicated an improvement - 2 points from 10 could be realized in the median of the general pain indication - from the time before and after one therapy unit. As additional values, the median in the head and jaw area on both sides showed an even clearer improvement of 3 points in the SL-NRS, compared to the total P-Practice group (N = 807). The same result was obtained for the CSR (P 0.001). This shows that the CSR and TMD should not be viewed in an isolated manner. With TMD patients, good to very good results were achieved with PT and/or manual therapy of 15 to 20 min per prescription. With TMD pain patients (N = 319), in particular, PT/manual therapy was highly effective, economical, and useful. Keywords: pain, pain localization, pain intensity, pain scale, numerical rating scale, physical therapy, manual therapy, temporomandibular joint disorder, TMJ