THE RHEUMATOID TMJ

(TEMPOROMANDIBULAR JOINT)

Myofunktional Exercise  Collect ion

Application:

click for illustration

This chapter does not describe the carry-out of one single exercise but it gives a listing-up of a group of exercises being well suited to support in co-therapy the treatment or rheumatic temporomandibular joint diseases.

Contents:

The exercises will become necessary to keep or regain the physiological movability of the joints during or after the chemotherapy has crowded out the symptoms of this autoimmune disease like inflammation and destructive processes.

Materials:

Exercise specific.

Procedure:

The sequence of steps of the single  exercise should be looked up under the respective special exercise description.

For the treatment of the patients – and in our special case in the Myofunctional Treatment it will be mostly children – the safeguarding of the special diagnosis should always have priority .

In the follow there will have to be carried out as top priority the disease control of the autoimmune disorder. The Myofunctional Therapy should rather not be applied as an independent treatment for  consultation with the co-therapist is very important.

Characteristics:

The second most important problem is the preservation of the joint movability. This will firstly be worked out passively, i.e. by physiotherapeutic training of the Mobility (width of movement). Later on there should be a prescription concept for the patient containing the training plan and its weekly monitoring.

Remarks:

It is of  some importance to proceed gently and sensitively during an acute stage in any case avoiding suspending  the training.

Discussion:

The movement training is dispensable neither in the acute stadium nor in the relatively unstressed remission stage of JIA. The tissue defects are healing; if joints do not get moved this process will lead to deviation or heavy constriction of the movability frame.

As mentioned above multifaceted target lines are persued:

The closest aim , of course, will be the easing of the masticatory muscles (Anatomy Page 31) to decrease the active muscular stress generated ( possibly in a protective reflex) by hyper-tensed muscles.

The second component is the physiotherapeutic manipulation at the patient through passive stretching, guiding and sensing the posture of the mandible.

The third possibility of effecting lies in activating the ‘trampoline’. As the mandible strives to sink down by gravitation and as it is only held retrally through the masticatory musculature and, thus, tends to the OMP, the Open Mouth Posture’, leading to the tipping forward of the capitulum temporomandibulare towards the slant of the articular slideway  the rostral  suspension represented by the extrinsic tongue muscles (M. Styloglossus, Anatomy page 21), cheek muscles, lip muscles has to lift the manible  actively into its balanced floating position.

Here, furthermore, a third force has a significant bearing which we may entitle the ‘pneumatic power’. In a fully functional system the Manibula is kept in suspension by negative air pressure (to avoid the expression ‘Vacuum’).

Within the joints there are the two-chambered Disci Intercondylares; in their chambers that elastic negative pressure is created through the downward traction. In the rostral region it is created directly in the Cavum Oris when a regular closure of lips and Velum Palatinum is granted.

For all three of these components, in case of need, the respective muscle exercises will have to be executed.

The following list collates exercises being of some therapeutic use; in the conclusive list each exercise shows a short explanation about the effective mechanism of it.

List of manipulated Exercises:

028 ,DRAWER-IN’-EXERCISE

029 THE  PEA

049 OPEN AND CLOSE          

096 JOINT STRETCH (MANIPULATED

099 GAPE

118 MASSETER EXERCISE

031BALLOON

106 HOLD A MATCH

013 ,L-M’-POSITION

List of other beneficial exercises with a short explanatiomn:

OPEN AND CLOSE

Monitoring and coordinating the application of mandible adductors and deflectors.

BALLOON

Essential cheek tonicity and perioral musculature.

CHUBBY LIP

Hindering Mentalis pressing, lower lip biting –  Perioral musculature

THE  PEA

Empathizing the retral position of the TMJ-head

PODGY TONGUE- SLIM TONGUE

Adjustment of the tongue tone

JOINT STRETCH(MANIPULATED)

Physiotherapy, demonstration of joint balancing and muscle limbering

BASIC-POSITION

Common posture of the upper body

COLLUM EXERCISES

Common exercises for  the cervical region

NECK SIDE STRETCH

Exercises for the lateral cervical region

POSITION EXERCISES

Exercises suitable as associated physiotherapeutic measures for the collum musculatureLip closure

JIG-EXERCISE

Selfmanipulated assistance for the backward motion of the Mandibula

MASTICATORY MUSCLE STRETCH (LATERAL)

Manipulated stretching of presumably the Pterygoidei

ROLLING HEADS

Exercises for the cervical region, vertebral joints

TURN YOUR HEAD

Head turner mm.

EASY NODDING

Fine motor skills of the neck vertebra

CLOWNY

Lip closure as a potential trigger problem

,L-M’-POSITION

Obligatory stand-by posture of the Orofacial System

,M’-POSITION

Obligatory stand-by posture of the Stomatognathic System also known as the physiological rest position

MASSETER EXERCISE

Monitoring the adductor muscle tone

GAPE

Selfmanipulated masricatory muscle stretch

MENTAL TRAINING

Important basic condition for the night-time self-monitoring

, M-O-I ‘

adjusting the “aged face” (accompanying sign of the “derailed” muscle tracks)

TIRE OUT CHEWING

Mainly mental exercise to correct an adductor hyperactivity

NAPE-DIALTOR

Exercises suitable as an associated physiotherapeutic measure for the neck musculature

PLATELET-HOLDER

 Flanking Measure for the oral fissure closure

DRAW-BACK

Flanking the tongue retroversion in  coincidence with the mandible

RESTPOSITION

Especially for night-time habituation of a correct mandible posture

TUBECHEWER

Adductor relaxation

HOSECLAMP

Adductor relaxation

,CHIN-IN’

Teaching the basic principle Jaw position

SLENDER TONGUE

Associated measure for a  tongue retroversion

SIDE THRUST

Self-manipulated stretching of the Pterygoidei

SITTING-POSITION

General associated measure for the body posture

,TAP-TAP’-EXERCISE

Teaching self-manipulation  for the

CHATTERING TEETH

Autogenous adductor relaxation

TEETHCLICKING

Night-time mental monitoring for an adductor hyperactivity