GAPE

Myofunktional Exercise  Collect ion

Application:

click picture to enlarge

The exercise should not be mixed up with the term “joint lock” which describes the situation where the mouth  (mandible) can not be closed as the conyles accidentally got in a position from where the back slide and thus the jaw occlusion is not possible ( this will be further discussed in the paragraph “Discussin” from chapter  ,TAP-TAP’-EXERCISE).

The exercise discussed here rather will be prescribed in case of a limited oral aperture of the mandible in its joint respectively through the musculature – presumably the adductors – to help the jaw into a mobilization.

Contents:

Hetero or self manipulated stretching (mobilization) exercise to get into a physiological movement scale.

Materials:

Not required

Procedure:

It should be minded the procedure being divided into two phases. he emphasis should be put on the first one (a).

- Previous exercises: Facultative. The exercise PEA should be explained.

-Starting position: The patient is at best with the head leaned against the chair back rest or against the wall and tries to avoid a strained posture (BASIC-POSITION)

- Step-by-step-description:

a

-1 The mouth opens slightly. the therapist lays his finger pad of the middle finger of the one hand on  the incisal edges of the lower, that of the thumb on that of the upper front teeth. The other hand is resting with its finger pads of  index and middle finger  against the skin of the cheek in the tragus region (PEA ).

-2 The fingers of the first hand , now, will start spreading the lower from the upper incisors. The fingers of the other hand start watching the movement to be carried out in the joint presumably in a rotating manner: The forward gliding of the joint capitulum will not be sensed.

-3 The posture is kept; the distance between the incisal edges should be tried to be enlarged by and by.

-4 In a subsequent brake, filled with the ,L-M’-POSITION, the thumb softly pushes in the “drawer” i.e the mandible by exerting pressure to the chin in a retral direction.

b

Starting from the above described step 3 consequently

-4 an additional spreading pressure by thumb and middle finger a further opening of the mouth is caused by  a forward gliding of the joint head, controlled by the groping finger of the other hand at the tragus-point.

The opening width should measure 4 to 5 centimetres

-5 A break follows as described under a4.

The patient may be instructed to execute the same procedure by himself later on.

-Timing: The length of one sequence should comply with the movability and perhaps the soreness.

It is advisable to extend the exercise over several minutes and to repeat in a series of five.

With self-manipulation the patient is instructed to count to about fifty holding the maximum opening width.

Characteristics:

Stretching, Stretch help, Manipulation, Mobility.

Remarks:

After a traumatisation the exercise should be carried out with sensitive caution so that only a faint dragging sensation within joint or musculature arises,

The training goal will not be reached by force but by stamina.

Discussion:

This exercise is mainly prescribed in cases of convalescence following TMJ diseases but as well for stiffness or cramps in the adductor musculature.

To protect the articular cartilage of the discus articularis it should be ensured that the patient does not stress the adductor muscles when practicing.

For this purpose the TAP-TAP’-EXERCISE is advantageous.

Instructions:

The mouth should be able to open so wide as to take a bite from an apple. Because it can not manage it by itself the thumb and middle finger will assist it in the way we have rehearsed.

To do this the thumb finds support against the incisal edges of the upper incisors. The middle finger is rested against the lower incisors. Now each finger starts pushing against its incisors to push the two rows apart from each other. With this the fingers are pushing as strongly as to cause a pulling type of feeling in the cheek region. This position will be kept while counting to 50 or as long as agreed upon. Then the mouth is shut and with the flat of the hand the chin slight pressure is adapted to the chin like in the exercise ,DRAWER-IN’.

This is repeated from the beginning after a short break. The point is to get the mouth a bit more open each time. If we want to do it carefully we, in the beginning, practice it with monitoring using the “PEA” meaning that in front of the ear the joint – the pea – must not become palpable.

Five turns in a row if not agreed otherwise.