In the past few years there has been increasing communication between the professions of physical therapy and dentistry. This communication began as these practitioners gradually realized the multiple complaints of the adult patient with head, neck, and facial pain were all parts of the syndrome.
Physical therapists and dentists working as a team observed that with their joint efforts, results were more complete and longer lasting, and the length of time necessary for treatment was reduced considerably. Physical therapy can help reduce the length of time necessary for treatment with patients who have abnormal head posture contributing to their TMJ problem.
The correlation between Class II occlusion and forward head posture is as high as 70% and is probably the strongest evidence in the relationship between head posture and malocclusion. The typical adult symptomatic TMJ patient has a deep overbite or Class II occlusion and a forward head posture. He or she may develop facial pain, abnormal mechanics at the level of the temporomandibular joints inducing excessive anterior translatoric glides of the condyles, or fatigue and spasm of the facial musculature. The patient may also develop headaches as referred pain from the muscles of the temporomandibular joint, since the forward head posture causes over-work of all the suboccipial musculature.
In addition to these problems, abnormal head posture also creates fatigue of the neck muscles and compression of the facet joints of the cervical spine, which may cause neck pain and referred pain into the arm and to the interscapular area. In advanced cases, neck posture may also create degenerative changes that gradually encroach upon the intervertebral joints and produce cervical nerve root compression, neurogenic pain in the arm, and paresthia and weakness of the upper extremities.
If the reciprocal relationship between head posture and occlusion is understood, it becomes clear that physical therapists may not be able to stabilize head posture in a patient with malocclusion. In addition, the dentist may not be able to restore a definite occlusion or correct craniomandibular relationships in patients with obvious postural problems.
Often once the original malocclusion and posture are solved, there remain other secondary problems such as abnormal shoulder girdle conditions or low back problems. These will need to be treated for full structural posture and normal body mechanics.
There are approximately four treatment phases a therapist will bring a patient through:
- Phase I: decrease pain, apprehension and muscle spasms.
- Phase II: continue with pain relief and increase soft tissue and joint function.
- Phase III: instruct the patient in a specific exercise program for the care of their head, neck, TMJ and back, including correct postural mechanics, and incorporating muscle strengthening exercises.
- Phase IV: increase the patient’s total body function (cardiovascular conditioning, and overall fitness)
A patient is discharged from physical therapy when he or she can demonstrate correct spinal posture, exercises, functional and pain-free jaw and neck mobility, and if applicable, correct splint applications.
When a doctor suspects muscles, joints, ligaments or posture may be a factor in the patient’s pain or dysfunction, he should refer the patient to physical therapy. Examples include trismus, limited opening, referred pain from muscles and referred pain from cervical spine involvement.
The most important approach is the evaluation. This identifies many soft tissue and postural components of the patient’s problem. Additionally, therapeutic exercise, mobilization, various modalities and a home exercise program are utilized as needed.
