Strapping for temporomandibular joint dysfunction.
ABSTRACT Temporomandibular joint dysfunction (TMJD) is a common problem seen in many of the dental clinics. Management of this depends on an accurate diagnosis of the cause for the TMJD. Physical therapy and rehabilitation play a vital role in the management of these dysfunctions. Physical therapy is useful in treating post-traumatic stiffness of the TMJ while strapping of the TMJ for a dysfunction along with conventional physical therapy is of benefit in terms of reduction in click, decrease in pain, and an improvement in function.
278Indian J Dent Res, 19(3), 2008
Strapping for temporomandibular joint dysfunction
Abraham Samuel Babu, Sandhya Mary John1, Amith Unni1
Temporomandibular joint dysfunction (TMJD) is a common problem seen in many of the dental clinics.
Management of this depends on an accurate diagnosis of the cause for the TMJD. Physical therapy and
rehabilitation play a vital role in the management of these dysfunctions. Physical therapy is useful in
treating post-traumatic stiffness of the TMJ while strapping of the TMJ for a dysfunction along with
conventional physical therapy is of benefit in terms of reduction in click, decrease in pain, and an
improvement in function.
Key words: Strapping, TMJ dysfunctions, physical therapy, rehabilitation
Temporomandibular joint dysfunction (TMJD) is a term
used to describe a common disorder characterized by pain
and derangement of the TMJ. This is a common sight in
most dental clinics and is the most common cause of pain
in the jaw.
A 38-year-old male presented with pain in the left TMJ
after he sustained a traumatic injury which resulted in a
subcondylar fracture of the left mandible. The fracture was
manually reduced and immobilized with intermaxillary
Þ xation using Erich’s arch bar for 6 weeks. After 6 weeks, he
presented with pain in the left TMJ, limited mouth opening
and difÞ culty in eating and speaking. He had no signiÞ cant
medical history. He was referred to physical therapy with a
diagnosis of post-traumatic stiffness of the TMJ for further
evaluation and management.
The initial physical therapy assessment was done on the day
of referral from the dental surgeon. He is a healthy male
with normal vital signs. On examination, he had decreased
mouth opening (1.5 cm) with grade 2 tenderness over the
left TMJ. Mouth opening was measured by measuring the
distance between the incisal edges of the upper and lower
central incisors. Functional mouth opening was assessed
by having the patient try and insert two or three ß exed
proximal interphalangeal joints within the mouth. At this
time, he was able to put in only one Þ nger. An audible click
from the left TMJ was appreciated during mouth opening.
This was accompanied by a lateral deviation of the mandible
to the right. Pain was recorded using the Visual Analog Scale
(VAS). The patient reported a VAS of eight.
He was started on intensive physical therapy for improving
joint mobility that comprised of ultrasound in the continuous
mode at 1 W/cm2 using a 3 MHz head for 5 min to each joint.
Grade two mobilization of the joint for antero-posterior and
lateral glides were done. Active exercises consisting of mouth
opening, mandibular protraction and lateral deviations, neck
ß exion-extension, protraction-retraction, and shoulder
shrugging were taught. Hold-relax techniques for the TMJ
were also incorporated into the treatment to help bring
about relaxation. Therapy was done on a daily basis with
each session lasting 45-60 min. The patient was instructed
to carry out active exercises and relaxation at home three
times a day, consisting of three sets of 10 repetitions each.
However, he continued to have a persisting click despite
the physical therapy. An excessive lateral movement of
the mandible was observed during mouth opening and
hence strapping was considered in the management to help
prevent the lateral deviation of the jaw and thereby reduce
Strapping of the left TMJ to prevent lateral movement of the
joint to the right was done with the mouth in the relaxed
position. The strap was applied directly onto the skin midway
on the body of the mandible on the right side. The strap was
then pulled across the symphysis menti with a force directed
to the left in the transverse plane [Figure 1]. The strap was
then secured directly onto the skin just below the opposite
mastoid process [Figure 2]. Appropriate precautions were
taken to check for any skin reactions to the tape used for
strapping. No adverse reactions to the tape used for strapping
was observed. Repeated mouth opening revealed no click
following the strapping. The strap was applied by the
physical therapist everyday for 2 weeks and was kept for at
least 6 h everyday. Gentle isometric strengthening exercises
Dr. Abraham Samuel Babu,
Departments of Rehabilitation
and 1Oral and Dental Surgery,
CSI Mission Hospital, Codacal
PO, Tirur - 676 108, Kerala,
Review completed : 20-04-08
S HORT C OMMUNICATION
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Indian J Dent Res, 19(3), 2008279
for the masseter and pterygoids were also started with the
strap on. He continued his regular routine of exercises and
relaxation for another 2 weeks.
At the end of 2 weeks, a marked improvement in mouth
opening to 3.5 cm was seen. Functional mouth opening
also had improved and he was able to insert three ß exed
proximal interphalangeal joints into his mouth. Resolution
of the dysfunction was noted by a decrease in pain to a
VAS of 0 and also the absence of lateral deviation of the
mandible on mouth opening. A home program consisting
of regular range of movement exercises, relaxation and
strengthening was taught to the patient. He was advised
not to bite hard food and to gradually progress to hard and
tough foods. At 3 months follow-up, the patient revealed
no symptoms other than the occasional click on extreme
mouth opening. The patient continued the exercises, and
at 6 months follow up was found to have no dysfunction
with a normal mouth opening both functionally and as by
insical distance measurement (4 cm). He was also able to
tolerate a normal diet and had no difÞ culty in eating hard
and tough food.
TMJ dysfunction is a common problem present in 20% of
the population.[2,3] Physical therapy involving combinations
of active exercises, manual therapy, postural correction,
and relaxation techniques has been described as the main
stay of management for TMJ dysfunction according to the
American Academy of Craniomandibular Disorders and the
Minnesota Dental Association.[4,5]
In this case report, it is seen that conventional physical
therapy alone did not bring about much change in the TMJD.
However, the addition of strapping did bring about both
short- and long-term beneÞ ts in regard to pain, tenderness,
click, mouth opening and function for this patient. Strapping
for the TMJ lacks scientiÞ c evidence for advocating it as
part of a treatment option and hence, randomized control
trials on a larger population would be needed to verify this
The authors would like to thank Ms. Manjula Sukumari Noone,
Dr. Ann Johns and Dr. Sunderlal Babu for their help and
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Co; 1983. p. 216-23.
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Figure 1: Demonstration of the strapping technique for the
temporomandibular joint (TMJ)
Figure 2: The completed application of the strap for the TMJ
How to cite this article: Babu AS, John SM, Unni A. Strapping for
temporomandibular joint dysfunction. Indian J Dent Res 2008;19:278-9
Source of Support: Nil, Confl ict of Interest: None declared.
Strapping for TMJ Babu, et al.
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