JOINT STRETCH (MANIPULATED)

Myofunktional Exercise  Collection

Application:

This exercise is prescribed for temporomanibulary joint problems as painfulness, noises or restriction in mobility. If diagnostic findings hint towards a dysfunctional joint compression or a rostra position  this exercise at one hand will, by manipulation of the joint (Mandibula), lead to a normalization of the positioning of the interarticulary disc, at the other hand the joint will experience a manipulated ad hoc relief. Furthermore the feeling can be conveyed to the patient how a not tensed up retral posture should feel like. At the same time the training aims at the relaxing of the adductor muscles. (Anatomy, Adductormuscles: 1.6, Area VII, Page 31).

Contents:

Manipulated guidance of the Mandibula to open up the reorientation pathway for the joint disc respectively the Mandibula.

Materials:

For the procedure no devices are needed.

Procedure:

- Previous exercises: The patient should master or simultaneously practice the exercises ,L-M’-POSITION, ,DRAWER-IN’-EXERCISE (CHIN-IN), ,TAP-TAP’-EXERCISE, and THE  PEA.

-Starting position: ,DRAWER-IN’-EXERCISE.

- Step-by-step-Description:

-1 The mouth opens as in the exercise THE  PEA, i.e. maintaining the retral position of the mandible respectively the joint condyle. The musculature is kept in a maximum relaxed state as in the ,TAP-TAP’-EXERCISE. The patient “lets hang his jaw” as much as possible.

-2 The therapist is standing in front of the patient gripping the Mandibula with both hands. The thumbs are resting on both sides upon the dental arch, the fingers taking hold of the mandibular bone outwardly as if leading a wheelbarrow or handlebars of a bike.

-3 The patient is repeatedly admonished to let go his jaw. Now with his hands the therapist applies some pressure to the retral teeth mainly stressing the thumb tips guiding the Mandibula in a retral-caudal direction. This position is retained for a defined time (from half a minute upwards).

-Timing: One exercise round represents one sequence which will be lasting for one or two minutes by holding the position. The sequence may be repeated to add up to a series or interchange with the TAPP - TAPP as an ALTERNATIVE EXERCISE.

Characteristics:

Manipulation, mobility, stretch aid.

Remarks:

As already mentioned, the manipulation should rather be carried out by a trained therapist. With muscle spasms a simultaneous massaging might be beneficial. Special significance lies in the sensitation of the patient regarding the state of tone and posture of Mandibula and adductors (also see RELAXATION EXERCISES). An incorrect manipulation may harm the frail perygoid muscles, the joint capsule or the intercondylar disc. In special situations the treatment with a gnathologic splint  - meaning: no locking splint or bite or positioning device – might be helpful only leading to a reasonable success if accompanied by a simultaneous Myofunctional therapy.

Discussion:

This exercise does not belong to the Myofunctional exercise in the words original meaning. Nevertheless it is a constructive help in acute cases leading to the self control by the patient in combination with the collateral treatment mentioned

Instructions: