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Physiotherapy of a displaced disc with reposition of a temporomandibular joint
BROŽKOVÁ, Aya
The topic of my bachelor thesis is physiotherapy of a displaced disc with reposition of a temporomandibular joint. It is a functional disorder, when the mandible disc is not in a physiological position and creates an obstacle for a condyle movement. When mouth is fully opened the disc does not return to its original position. This moment is characteristic with a clicking sound. Another symptom is inclining of the chin to the disordered site when the mouth is being opened. Main cause of TMD is stress, bad occlusion and a long-term micro trauma of TMJ. It is a topical issue, because an increase of stress in daily life causes also more TMD. Almost 70 % of the population has the TMD, in most of the cases the TMJ disc is in a wrong position. The therapy of this kind of disorder should be done by physiotherapist. Unfortunately knowledge of diagnosis and healing of the TMD is not sufficient. The disorder is recognized usually by dentists, who send a patient to a specialized clinic. The goal of my work was examining of mastication and neck muscle spasms. In the work there are also described physiotherapeutic possibilities of healing including postural strategy. I have created informational booklet for patients, in which saving method for TMJ healing, exercises, ergonomic principles and correct posture both when sitting and standing are presented. The research was done by 14 case analysis, analytic-inductive method and experimental work. Patients were randomly divided into three groups. As a first step TMJ and cervical spine of each patient and their posture were examined. The examination of TMJ consisted of diagnosis, extent and symmetry of an opening movement and palpation examination of the cervical spine. Therapy was six weeks long. Each patient was introduced to TMJ saving method, which is based on limitation of a TMJ movement, eating soft food and elimination of stress. In the first group (5 patients) the therapy was focused only on mastication muscles. Patients were supposed to be exercising to loosen the muscles of mastication. Exercises were chosen after palpation examination. Third group (4 patients) did neck muscle exercises and self massage. Second group (5 patients) did the therapy of both first and third group. Results of the therapy show, that there is a possible connection between TMD and cervical spine dysfunction. There were positive (evaluated subjectively) changes in both TMJ and in all groups. The condition of TMJ is influenced by neck muscle therapy and the condition of cervical spine is influenced by mastication muscle therapy. Best results had the second group. All patients but one improved (one lady had a TMJ inflammation). There were no deterioration of TMJ and cervical spine condition either. There were some worsening in group one and three. The best therapy is a combination of exercises of both mastication and neck muscles. I would like to point out a fact that TMJ is one of the most complicated and busy joints in human body. Both TMJ are connected to mandible so dysfunction of one joint can lead to problems with the other one. Physiotherapy is needed most in cases of functional disorder.
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