Functional examination and treatment of temporomandibular disorders using MWM


Appropriately trained physical therapists can significantly contribute to managing temporomandibular joint disorders (TMD). This two-day practical workshop is an advanced course for clinicians (physical therapists, osteopaths, chiropractors, medical practitioners) who have completed a basic Mulligan course.  


A health professional working in the field of orofacial pain must have a sound knowledge of temporomandibular joint (TMJ) and orofacial anatomy, relevant neurophysiology and pain neuroscience and the contribution of spinal dysfunction to TMD. They must also be able to perform a detailed clinical examination and develop an effective treatment plan within a biopsychosocial context. Physical therapists treating orofacial pain and TMD must have a sound appreciation of dental management and fit into a multi-disciplinary treatment team.


Physical therapists can expand their knowledge of anatomy, biomechanics, neurophysiology and pathology using e-learning or books. Still, the in-person course is the most effective way to grasp clinical reasoning concepts and master “hands-on” skills. This course will provide participants with the appropriate knowledge and skills to perform practical, precise TMJ evaluation and treatment. Participants will learn original TMJ MWM techniques developed by the presenter to treat: 

  • Acute malocclusion
  • Retrodiscal pain
  • Loss of mobility due to internal derangement, degenerative change, intra-articular adhesions
  • Restoration of function following orofacial surgery
  • Altered neuromotor activity.


On completion of this course, participants should:

  • Have a good understanding of the applied anatomy of the orofacial bony, ligamentous and neuromuscular systems as they relate to the TMJ
  • Have an appreciation of relevant neuroscience and pain neuroscience relating to the TMJ and orofacial region
  • Have an understanding of the etiology of TMJ neuromusculoskeletal disorders
  • Have a good understanding of how whole-body function and posture can contribute to TMJ dysfunction
  • Be aware of the current literature related to physical examination and treatment of the TMJ (up-to-date reference list provided)
  • Have a good understanding of the Mulligan concept of MWM and its clinical reasoning process 
  • Be able to confidently perform a basic evaluation of the TMJ and related orofacial musculature
  • Be able to perform basic TMJ MWW and self –MWM treatment techniques
  • Be able to design and implement individualized neuromuscular exercise and “brain game” programs for the TMJ and, when indicated, integrate them into a whole-body exercise program
  • Have an appreciation of how physical therapists should fit into a multi-disciplinary team treating TMD
  • Be aware of other relevant forms of treatment for orofacial pain and dysfunction in a biopsychosocial context.

Course Content

  • Introduction and the biopsychosocial multi-disciplinary team approach to TMD 
  • Functional anatomy of the TMJ and orofacial region 
  • Neurophysiology of the TMJ and orofacial pain
  • Etiology and pathology of TMJ disorders 
  • The influence of the spinal column on TMD (biomechanical) 
  • Identification and treatment of causative factors 
  • Examination of TMJ and related orofacial structures 
  • Treatment of specific TMJ disorders using MWM 
  • Associated orofacial pain and dysfunction treatment techniques and strategies.

Resources

Oliver M. 2011 Temporomandibular joint dysfunction. An open and shut case. 

Chapter 10 in Mobilisation with Movement: The Art and Science. Vicenzino B, Hing W, Rivett D & Hall T, Elsevier Publishing 123- 133.

This chapter demonstrates the clinical reasoning process in the application of MWM for the TMJ and describes the application of some TMJ MWM techniques. An instruction DVD is also included.

Oliver M & McDowell J 2019 Temporomandibular joint. Chapter 4 in The Mulligan Concept of Manual Therapy: textbook of techniques. Hing W, Hall T & Mulligan B, Elsevier Publishing 87-101.