Clinical Reasoning for the Examination and Physical Therapy Treatment of Temporomandibular Disorders (TMD): A Narrative Literature Review

César Fernández-de-las-Peñas; Harry Von Piekartz

doi:10.3390/jcm9113686

journal article Open Access Nov 17, 2020

Clinical Reasoning for the Examination and Physical Therapy Treatment of Temporomandibular Disorders (TMD): A Narrative Literature Review

César Fernández-de-las-Peñas

Harry Von Piekartz

Journal of Clinical Medicine Vol. 9 No. 11 pp. 3686 · MDPI AG

View at Publisher Save 10.3390/jcm9113686

Abstract

The current narrative literature review aims to discuss clinical reasoning based on nociceptive pain mechanisms for determining the most appropriate assessment and therapeutic strategy and to identify/map the most updated scientific evidence in relation to physical therapy interventions for patients with temporomandibular disorders (TMDs). We will also propose an algorithm for clinical examination and treatment decisions and a pain model integrating current knowledge of pain neuroscience. The clinical examination of patients with TMDs should be based on nociceptive mechanisms and include the potential identification of the dominant, central, or peripheral sensitization driver. Additionally, the musculoskeletal drivers of these sensitization processes should be assessed with the aim of reproducing symptoms. Therapeutic strategies applied for managing TMDs can be grouped into tissue-based impairment treatments (bottom-up interventions) and strategies targeting the central nervous system (top-down interventions). Bottom-up strategies include joint-, soft tissue-, and nerve-targeting interventions, as well as needling therapies, whereas top-down strategies include exercises, grade motor imagery, and also pain neuroscience education. Evidence shows that the effectiveness of these interventions depends on the clinical reasoning applied, since not all strategies are equally effective for the different TMD subgroups. In fact, the presence or absence of a central sensitization driver could lead to different treatment outcomes. It seems that multimodal approaches are more effective and should be applied in patients with TMDs. The current paper also proposes a clinical decision algorithm integrating clinical diagnosis with nociceptive mechanisms for the application of the most appropriate treatment approach.

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Details

Published: Nov 17, 2020
Vol/Issue: 9(11)
Pages: 3686
License: View

Authors

C

César Fernández-de-las-Peñas

Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorcón, 28922 Madrid, Spain; Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, 28922 Madrid, Spain

H

Harry Von Piekartz

Department of Physical Therapy and Movement and Rehabilitation Science, Faculty of Business, Management and Social Science, University of Applied Science Osnabruck, 49076 Osnabruck, Germany; Cranial Facial Therapy Academy (CRAFTA), 29097 Hamburg, Germany

Cite This Article

César Fernández-de-las-Peñas, Harry Von Piekartz (2020). Clinical Reasoning for the Examination and Physical Therapy Treatment of Temporomandibular Disorders (TMD): A Narrative Literature Review. Journal of Clinical Medicine, 9(11), 3686. https://doi.org/10.3390/jcm9113686

Clinical Reasoning for the Examination and Physical Therapy Treatment of Temporomandibular Disorders (TMD): A Narrative Literature Review

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