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TMJ Dysfunction Case Study

Temporomandibular Joint Dysfunction Case Study

14 year old male baseball player presented to Vertex with a chief complaint of left sided jaw pain that occurred after being hit on the chin by a ground ball at practice.  Additionally, he complains of his jaw “locking” and “clicking” with end range mouth opening, specifically while eating.

Clinical Exam:

Palpable Click with opening and 25mm left mandibular deviation (ipsilateral)

Apical breathing pattern

Decreased left upper cervical rotation (+ left cervical flexion rotation test)

Tenderness to palpation left masseter and left medial pterygoid with patient reported familiar pain

 

Treatment:

HVLAT directed to bilateral C1/C2 with + cavitations.

Upper and mid thoracic HVLAT

DN with electrical stimulation to left masseter, medial pterygoid, and joint capsule.

Manual TMJ distraction

Home Exercise Program:

Cervical SNAGs, cervical retraction with over-pressure applied to maxilla, postural resets, diaphragmatic breathing

Patient Education:

Postural considerations; specifically with school and smart phone use consisting of spending less time in forward head posture in order to minimize mandibular retraction.

Result:

Chief complaint of “click” and “locking” resolved within session. 25mm deviation reduced to <5mm.  Patient followed up 6 weeks later and maintained treatment effect.

Four Exercises to Improve Dance Technique and Strength

 

1. Hip Flexor Pulse
a. Purpose: Improves strength in hip flexors, especially Iliopsoas, to increase leg height. This exercise works best in combination with stretching the hamstrings to allow greater mobility and active range of motion.
b. How to do: start sitting with legs extended and leaning back on hands. Perform a posterior pelvic tilt and lift one leg with the knee bent. Pulse the leg closer to your body for about 4 reps while concentrating on using the Iliopsoas. Repeat 4-6 times.

2. Attitude Raises
a. Purpose: To increase turn out (external rotation of hips) and leg height in second position (to the side).
b. How to do: Start lying on one side. Raise top leg (both knees facing forward and knee bent). Turn out the leg into attitude al second (to the side with knee facing ceiling). Repeat this while bringing the leg closer to the trunk with each rep. Repeat 4 reps 4-6 times.

3. Hip Flexor Stretch
a. Purpose: To stretch hip flexors more efficiently
b. How to do: Start in lunge with both knees at 90 degrees. Perform strong posterior pelvic tilt. Add more of a stretch by bending the trunk to the same side as the front leg. Hold for at least 30 seconds.

4. Calf Raises with ball
a. Purpose: To improve strength and control of plantar flexion in heel raises without inverting at the ankles.
b. How to do: Place small ball in between the ankles. Raise heels off the ground while squeezing the ball. The goal is to not let the ball fall to the ground. This helps train the muscles to not invert, but to remain neutral in plantar flexion.

 

-Lauren Rowell