Treatment Sequence and Methodology

A specific comprehensive treatment paradigm is developed for each patient that is based upon the obtained data from the initial comprehensive evaluation. Each treatment consists of the following components:

A: Subjective reassessment and review of:

  • Current pain status

  • Review/re-instruction of current home exercise program

  • Review/re-instruction of recommended sleep, sit and driving positions

  • Review of initial ergonomic recommendations

  • Review/re-instruction of recommended home devices or postural support

B: Treatment commences with 8-10 minutes of cervical-shoulder girdle and craniofacial heat in supine to:

  • Promote reduction of soft tissue tightness

  • Increase restricted circulation (blood flow) to the involved region

  • Promote overall relaxation prior to the initiation of:

C: Manual muscle (myo) & associated soft tissue (fascia) myofascial release and joint mobilization techniques that comprise the main component of each treatment.

  • Individually developed eclectic myofascial paradigm geared to hyperactive/tight and painful regions (neck-shoulder girdle temporomandibular joints-cranial and orofacial) that cause and/or perpetuate your dysfunction and symptomatology.

  • Includes manual sub-occipital tractional techniques.

  • Includes manual joint mobilization techniques to increase pain-free mobility of the cervical spine (neck), shoulder girdle and temporomandibular joints.

  • Two sets of the above are performed in supine, prone and/or sitting positions.

The following pictures represent key components of a comprehensive therapeutic paradigm for one patient that commenced 48 hours after bilateral TMJ arthroscopy. Patient’s pre-op status was previously known from prior treatment. Proper sequencing of adjunctive modalities, manual soft tissue release, and joint mobilization techniques with therapeutic exercise are utilized to address acute inflammation, pain, muscle guarding, and restricted active ROM. Active TMJ vertical ROM at the time of the initial visit was 15-18 mm. The following series of images depict a composite of various manual procedures, therapeutic exercise, and adjunctive techniques during the total course of treatment to the cervical-shoulder girdle and cranio-mandibular regions. Active TMJ vertical ROM at the time of the final visit was 30-33 mm.

If needed, I will incorporate an adjunctive modality, ergonomic device or garment for clinic and/or home use such as electrical stimulation, cold laser, or sub-occipital traction to augment pain reduction, range of motion, and/or postural correction:

Adjunctive 1-2 Hz low intensity electrical stimulation of the sternocleidomastoid via the flat surface of metal thumbtack electrodes to decrease pain from muscle hypertrophy and /or trigger point activation.

Adjunctive 1-2 Hz low intensity electrical stimulation of the sternocleidomastoid via the flat surface of metal thumbtack electrodes to decrease pain from muscle hypertrophy and /or trigger point activation.

Adjunctive 1-2 Hz low intensity electrical stimulation augmented by cupping electrodes overlying trigger points of the upper trapezius to decrease muscle hypertrophy and trigger point activation.

Adjunctive 1-2 Hz low intensity electrical stimulation augmented by cupping electrodes overlying trigger points of the upper trapezius to decrease muscle hypertrophy and trigger point activation.

Patient with longstanding post radiation trismus following maxillopalatal surgery using a passive mandibular stretching device “Therabite” as a specifically instructed adjunctive technique within his home therapeutic paradigm.

Patient with longstanding post radiation trismus following maxillopalatal surgery using a passive mandibular stretching device “Therabite” as a specifically instructed adjunctive technique within his home therapeutic paradigm.

D: The manual component of each treatment ends with a specific 10-minute massage followed by relaxation with heat.

E: Review/re-instruction and/or progression of your home exercise program

  • NOTE: I AM ABLE TO OFFER THIS COMPREHENSIVE TREATMENT BECAUSE:
    • I only treat one patient at a time
    • I do not have any aides or physical therapy assistants who administer and/or supervise any component of your treatment!!
    • Each patient receives exercise videos to review at home.

  • You will not spend 15-30 minutes of your one-hour treatment lying down while receiving electrical stimulation and/or ultrasound.

  • You will not be given an exercise program to perform in the gym for 15-30 minutes as part of each individual treatment.

  • I will instruct you in a progressive series of therapeutic exercise to perform at home periodically during the day.

  • If you belong to a gym, I will instruct you in the exercises that you can do as well as those that you should not do.