Intra-oral myofascial therapy versus education and self-care in the treatment of chronic, myogenous temporomandibular disorder: a randomised, clinical trial

Allan Kalamir, Petra L Graham, Andrew L Vitiello, Rodney Bonello, Henry Pollard, Allan Kalamir, Petra L Graham, Andrew L Vitiello, Rodney Bonello, Henry Pollard

Abstract

Background: Myogenous temporomandibular disorders (TMD) are considered to be a common musculoskeletal condition. No studies exist comparing intra-oral myofascial therapies to education, self-care and exercise (ESC) for TMD. This study evaluated short-term differences in pain and mouth opening range between intra-oral myofascial therapy (IMT) and an ESC program.

Methods: Forty-six participants with chronic myogenous TMD (as assessed according to the Research Diagnostic Criteria Axis 1 procedure) were consecutively block randomised into either an IMT group or an ESC group. Each group received two sessions per week (for five weeks) of either IMT or short talks on the anatomy, physiology and biomechanics of the jaw plus instruction and supervision of self-care exercises. The sessions were conducted at the first author's jaw pain and chiropractic clinic in Sydney, Australia. Primary outcome measures included pain at rest, upon opening and clenching, using an eleven point ordinal self reported pain scale. A secondary outcome measure consisted of maximum voluntary opening range in millimetres. Data were analysed using linear models for means and logistic regression for responder analysis.

Results: After adjusting for baseline, the IMT group had significantly lower average pain for all primary outcomes at 6 weeks compared to the ESC group (p < 0.001). These differences were not clinically significant but the IMT group had significantly higher odds of a clinically significant change (p < 0.045). There was no significant difference in opening range between the IMT and ESC groups. Both groups achieved statistically significant decreases in all three pain measures at six weeks (p ≤ 0.05), but only the IMT group achieved clinically significant changes of 2 or more points.

Conclusion: This study showed evidence of superiority of IMT compared to ESC over the short-term but not at clinically significant levels. Positive changes over time for both IMT and ESC protocols were noted. A longer term, multi-centre study is warranted.

Trial registration: Australian and New Zealand Clinical Trials Registry ACTRN12610000508077.

Keywords: Clinical trial; Craniomandibular disorders; Education; Exercise; Musculoskeletal manipulations; Myofascial pain syndrome; Self-care; Temporomandibular joint dysfunction syndrome; Trigger points.

Figures

Figure 1
Figure 1
Intra-oral temporalis release.
Figure 2
Figure 2
Intra-oral medial and lateral (origin) technique.
Figure 3
Figure 3
Intra-oral sphenopalatine ganglion technique.
Figure 4
Figure 4
Guided and controlled jaw excursions.
Figure 5
Figure 5
Post-isometric stretches (lateral deviation).
Figure 6
Figure 6
Post-isometric stretches (opening).
Figure 7
Figure 7
Study flow-chart.

References

    1. McKinney MW, Londeen TF, Turner SP, Levitt SR. Chronic TM disorder and non-TM disorder pain: a comparison of behavioral and psychological characteristics. Cranio. 1990;8(1):40–6.
    1. Crider AB, Glaros AG. A meta-analysis of EMG biofeedback treatment of temporomandibular disorders. J Orofac Pain. 1999;13(1):29–37.
    1. Aggarwal VR, Tickle M, Javidi H, Peters S. Reviewing the evidence: can cognitive behavioral therapy improve outcomes for patients with chronic orofacial pain? J Orofac Pain. 2010;24(2):163–71.
    1. Orlando B, Manfredini D, Salvetti G, Bosco M. Evaluation of the effectiveness of biobehavioral therapy in the treatment of temporomandibular disorders: a literature review. Behav Med. 2007;33(3):101–18. doi: 10.3200/BMED.33.3.101-118.
    1. Michelotti A, Parisini F, Farella M, Cimino R, Martina R. Muscular physiotherapy in patients with temporomandibular disorders. Controlled clinical trial. Minerva Stomatol. 2000;49(11–12):541–8.
    1. Furto ES, Cleland JA, Whitman JM, Olson KA. Manual physical therapy interventions and exercise for patients with temporomandibular disorders. Cranio. 2006;24(4):283–91.
    1. Sturdivant J, Fricton JR. Physical therapy for temporomandibular disorders and orofacial pain. Curr Op Dent. 1991;1(4):485–96.
    1. Cetiner S, Kahraman SA, Yucetas S. Evaluation of low-level laser therapy in the treatment of temporomandibular disorders. Photomed Laser Surg. 2006;24(5):637–41. doi: 10.1089/pho.2006.24.637.
    1. Manfredini D, Guarda-Nardini L. Ultrasonography of the temporomandibular joint: a literature review. Int J Oral Maxillofac Surg. 2009;38(12):1229–36. doi: 10.1016/j.ijom.2009.07.014.
    1. De Vocht JW, Long CR, Zeitler DL, Schaeffer W. Chiropractic treatment of temporomandibular disorders using the activator adjusting instrument: a prospective case series. J Manipulative Physiol Ther. 2003;26(7):421–5. doi: 10.1016/S0161-4754(03)00096-4.
    1. Gregory TM. Temporomandibular disorder associated with sacroiliac sprain. J Manipulative Physiol Ther. 1993;16(4):256–65.
    1. Frymann VM. Cranial osteopathy and its role in disorders of the temporomandibular joint. Dent Clin North Am. 1983;27(3):595–611.
    1. Cuccia AM, Caradonna C, Annunziata V, Caradonna D. Osteopathic manual therapy versus conventional conservative therapy in the treatment of temporomandibular disorders: a randomized controlled trial. J Bodyw Mov Ther. 2010;14(2):179–84. doi: 10.1016/j.jbmt.2009.08.002.
    1. Albertin A, Kerppers II, Amorim CF, Costa RV, Ferrari Correa JC, Oliveira CS. The effect of manual therapy on masseter muscle pain and spasm. Electromyogr Clin Neurophysiol. 2010;50(2):107–12.
    1. Barriere P, Zink S, Riehm S, Kahn JL, Veillon F, Wilk A. Massage of the lateral pterygoid muscle in acute TMJ dysfunction syndrome. Rev Stomatol Chir Maxillofac. 2009;110(2):77–80. doi: 10.1016/j.stomax.2008.05.010.
    1. Capellini VK, de Souza GS, de Faria CR. Massage therapy in the management of myogenic TMD: a pilot study. J Appl Oral Sci. 2006;14(1):21–6. doi: 10.1590/S1678-77572006000100005.
    1. Rudrud E, Halaszyn J. Reduction of bruxism by contingent massage. Spec Care Dentist. 1981;1(3):122–4. doi: 10.1111/j.1754-4505.1981.tb01600.x.
    1. Sherman JJ, Turk DC. Nonpharmacologic approaches to the management of myofascial temporomandibular disorders. Curr Pain Headache Rep. 2001;5(5):421–31. doi: 10.1007/s11916-001-0053-7.
    1. Cho SH, Whang WW. Acupuncture for temporomandibular disorders: a systematic review. J Orofac Pain. 2010;24(2):152–62.
    1. La Touche R, Angulo-Diaz-Parreno S, De-la-Hoz JL, Fernandez-Carnero J, Ge HY, Linares MT. et al.Effectiveness of acupuncture in the treatment of temporomandibular disorders of muscular origin: a systematic review of the last decade. J Altern Complement Med. 2010;16(1):107–112. doi: 10.1089/acm.2008.0484.
    1. Bablis P, Pollard H, Bonello R. Neuro emotional technique for the treatment of trigger point sensitivity in chronic neck pain sufferers: a controlled clinical trial. Chiropr Osteopat. 2008;16:4. doi: 10.1186/1746-1340-16-4.
    1. Vuckovic NH, Gullion CM, Williams LA, Ramirez M, Schneider J. Feasibility and short-term outcomes of a shamanic treatment for temporomandibular joint disorders. Altern Ther Health Med. 2007;13(6):18–29.
    1. Hakala RV. Prolotherapy (proliferation therapy) in the treatment of TMD. Cranio. 2005;23(4):283–8.
    1. Ritenbaugh C, Hammerschlag R, Calabrese C, Mist S, Aickin M, Sutherland E. et al.A pilot whole systems clinical trial of traditional chinese medicine and naturopathic medicine for the treatment of temporomandibular disorders. J Altern Complement Med. 2008;14(5):475–87. doi: 10.1089/acm.2007.0738.
    1. Li LC, Wong RW, Rabie AB. Clinical effect of a topical herbal ointment on pain in temporomandibular disorders: a randomized placebo-controlled trial. J Altern Complement Med. 2009;15(12):1311–7. doi: 10.1089/acm.2009.0129.
    1. List T, Axelsson S. Management of TMD: evidence from systematic reviews and meta-analyses. J Oral Rehabil. 2010;37(6):430–51. doi: 10.1111/j.1365-2842.2010.02089.x.
    1. Bronfort G, Haas M, Evans R, Leininger B, Triano J. Effectiveness of manual therapies: the UK evidence report. Chiropr Osteopat. 2010;18:3. doi: 10.1186/1746-1340-18-3.
    1. Cleland J, Palmer J. Effectiveness of manual physical therapy, therapeutic exercise, and patient education on bilateral disc displacement without reduction- of the temporomandibular joint: a single-case design. J Orthop Sports Phys Ther. 2004;34(9):535–48.
    1. Kalamir A, Pollard H, Vitiello A, Bonello R. Manual therapy for temporomandibular disorders: a review of the literature. J Bodywork Mov Ther. 2007;11(1):84–90. doi: 10.1016/j.jbmt.2006.07.003.
    1. McNeely ML, Armijo Olivo S, Magee DJ. A systematic review of the effectiveness of physical therapy interventions for temporomandibular disorders. Phys Ther. 2006;86(5):710–25.
    1. Medlicott MS, Harris SR. A systematic review of the effectiveness of exercise, manual therapy, electrotherapy, relaxation training, and biofeedback in the management of temporomandibular disorder. Phys Ther. 2006;86(7):955–73.
    1. Kalamir A, Bonello R, Graham P, Vitiello AL, Pollard H. Intra-oral myofascial therapy, education and self care for chronic myogenous temporomandibular disorder: a randomized, controlled trial. J Manipulative Physiol Ther. 2012;35:26–37. doi: 10.1016/j.jmpt.2011.09.004.
    1. Kalamir A, Pollard H, Vitiello AL, Bonello R. Intra-oral myofascial therapy for chronic myogenous temporomandibular disorders: a randomized, controlled pilot study. J Man Manip Ther. 2010;18(3):139–46. doi: 10.1179/106698110X12640740712374.
    1. Dworkin SF, Huggins KH, Wilson L, Mancl L, Turner J, Massoth D. et al.A randomized clinical trial using research diagnostic criteria for temporomandibular disorders-axis II to target clinic cases for a tailored self-care TMD treatment program. J Orofac Pain. 2002;16(1):48–63.
    1. Dworkin SF, Sherman J, Mancl L, Ohrbach R, LeResche L, Truelove E. Reliability, validity, and clinical utility of the research diagnostic criteria for temporomandibular disorders axis II scales: depression, non-specific physical symptoms, and graded chronic pain. J Orofac Pain. 2002;16(3):207–20.
    1. Lobbezoo F, van Selms MK, John MT, Huggins K, Ohrbach R, Visscher CM. et al.Use of the research diagnostic criteria for temporomandibular disorders for multinational research: translation efforts and reliability assessments in the netherlands. J Orofac Pain. 2005;19(4):301–8.
    1. Lobbezoo F, Visscher CM, Naeije M. Some remarks on the RDC/TMD Validation Project: report of an IADR/Toronto-2008 workshop discussion. J Oral Rehabil. 2010;37(10):779–83. doi: 10.1111/j.1365-2842.2010.02091.x.
    1. Look JO, John MT, Tai F, Huggins KH, Lenton PA, Truelove EL. et al.The research diagnostic criteria for temporomandibular disorders. II: reliability of Axis I diagnoses and selected clinical measures. J Orofac Pain. 2010;24(1):25–34.
    1. Manfredini D, Chiappe G, Bosco M. Research diagnostic criteria for temporomandibular disorders (RDC/TMD) axis I diagnoses in an Italian patient population. J Oral Rehabil. 2006;33(8):551–8. doi: 10.1111/j.1365-2842.2006.01600.x.
    1. de Wijer A, Lobbezoo-Scholte AM, Steenks MH, Bosman F. Reliability of clinical findings in temporomandibular disorders. J Orofac Pain. 1995;9(2):181–91.
    1. Kropmans T, Dijkstra P, Stegenga B, Stewart R, de Bont L. Smallest detectable difference of maximal mouth opening in patients with painfully restricted temporomandibular joint function. Eur J Oral Sci. 2000;108(1):9–13. doi: 10.1034/j.1600-0722.2000.00747.x.
    1. Kropmans TJ, Dijkstra PU, van Veen A, Stegenga B, de Bont LG. The smallest detectable difference of mandibular function impairment in patients with a painfully restricted temporomandibular joint. J Dent Res. 1999;78(8):1445–9. doi: 10.1177/00220345990780081001.
    1. Michelotti A, Steenks MH, Farella M, Parisini F, Cimino R, Martina R. The additional value of a home physical therapy regimen versus patient education only for the treatment of myofascial pain of the jaw muscles: short-term results of a randomized clinical trial. J Orofac Pain. 2004;18(2):114–25.
    1. Nicolakis P, Erdogmus B, Kopf A, Djaber-Ansari A, Piehslinger E, Fialka-Moser V. Exercise therapy for craniomandibular disorders. Arch Phys Med Rehabil. 2000;81(9):1137–42. doi: 10.1053/apmr.2000.6282.
    1. Dworkin SF. Behavioral and educational modalities. Oral Surg Oral Med Oral Path Oral Radiol Endod. 1997;83(1):128–33. doi: 10.1016/S1079-2104(97)90103-7.
    1. Jerjes W, Madland G, Feinmann C, El Maaytah M, Kumar M, Hopper C. et al.Psycho-education programme for temporomandibular disorders: a pilot study. J Negat Results Biomed. 2007;6:4. doi: 10.1186/1477-5751-6-4.
    1. Dao TT, Lavigne GJ, Feine JS, Tanguay R, Lund JP. Power and sample size calculations for clinical trials of myofascial pain of jaw muscles. J Dent Res. 1991;70(2):118–22. doi: 10.1177/00220345910700020401.
    1. R_Development_core_team. R. A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2012.
    1. De Boever JA, Van Wormhoudt K, De Boever EH. Reasons that patients do not return for appointments in the initial phase of treatment of temporomandibular disorders. J Orofac Pain. 1996;10(1):66–72.
    1. Yatani H, Kaneshima T, Kuboki T, Yoshimoto A, Matsuka Y, Yamashita A. Long-term follow-up study on drop-out TMD patients with self-administered questionnaires. J Orofac Pain. 1997;11(3):258–69.
    1. Turk DS. In: Psychological approaches to pain management. Gatchel RJ, Turk DS, editor. New York: Guildford Press; 1996. Biospychosocial perspective on chronic pain; pp. 3–32.
    1. Hurst H, Bolton J. Assessing the clinical significance of change scores recorded on subjective outcome measures. J Manipulative Physiol Ther. 2004;27(1):26–35. doi: 10.1016/j.jmpt.2003.11.003.
    1. Flor H, Fydrich T, Turk DC. Efficacy of multidisciplinary pain treatment centers: a meta-analytic review. Pain. 1992;49(2):221–30. doi: 10.1016/0304-3959(92)90145-2.
    1. Kamper SJ, Maher CG, Mackay G. Global rating of change scales: a review of strengths and weaknesses and considerations for design. J Man Manip Ther. 2009;17(3):163–70.
    1. Dworkin RH, Turk DC, Farrar JT, Haythornthwaite JA, Jensen MP, Katz NP. et al.Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain. 2005;113(1–2):9–19. [see comment]
    1. Turk DC, Rudy TE, Sorkin BA. Neglected topics in chronic pain treatment outcome studies: determination of success. Pain. 1993;53(1):3–16. doi: 10.1016/0304-3959(93)90049-U.
    1. Simons DG, Travell JG, Simons LS, Cummings BD. Travell & Simons’ Myofascial Pain and Dysfunction: The trigger point manual. 2. Baltimore: Lippincott: Williams and Wilkins; 1998. pp. 5–44. 103–64.
    1. Dworkin SF, Turner JA, Mancl L, Wilson L, Massoth D, Huggins KH. et al.A randomized clinical trial of a tailored comprehensive care treatment program for temporomandibular disorders. J Orofac Pain. 2002;16(4):259–76.
    1. Feine JS, Lund JP. An assessment of the efficacy of physical therapy and physical modalities for the control of chronic musculoskeletal pain. Pain. 1997;71(1):5–23. doi: 10.1016/S0304-3959(96)03287-3.

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