Overview of Osteopathic Manipulative Treatment: Facial Muscle Energy, Direct MFR, and BLT Procedure – for TMJ Dysfunction

Muscle Energy Technique, or MET, is a type of therapy used by osteopaths. It involves the patient using their muscles in a specific way while the therapist applies a force, essentially helping the body overcome limitations in movement without putting too much strain on it. It can be used to help lengthen stiff muscles, strengthen weak ones, and increase movement in the jaw joint, or the temporomandibular joint (TMJ). The amount of force used can vary.

Myofascial Release, or MFR, is another type of therapy that involves the therapist stretching and moving tissues and joints of the TMJ. Through a process of twisting, pressing, and feeling (or palpating) the tissues and joints, the therapist helps the body move from a state of being too tight to being more loose and flexible. Balanced Ligamentous Tension (BLT) is yet another technique that uses body movements to restore order in the jaw muscles guided by the ligaments, which are tissue that connect bones.

Though not widely discussed in medical studies, these techniques are known to successfully lower pain in the TMJ and surrounding areas.

Dentists have been identifying problems with the TMJ in dental cases since the 1950s, originally calling it temporomandibular dysfunction. It was generally understood that issues such as a misalignment between the upper and lower teeth (malocclusion) was the main cause. But later on, experts realized that other factors not related to dental alignment could also cause these issues.

In 1979, the understanding of the condition evolved and it began to be recognized as a condition related to how our bones and joints work, or an orthopedic condition. Now, all conditions related to TMJ including issues with related structures are called temporomandibular disorders, or TMD.

Osteopathic manipulative therapy, or OMT, is used to encourage movement in the TMJ, helping it to move past any impairments it might have. It does so without pushing it beyond its normal physiological limits, reducing the likelihood of any injuries. This article reviews how OMT is used to treat TMD.

Anatomy and Physiology of Osteopathic Manipulative Treatment: Facial Muscle Energy, Direct MFR, and BLT Procedure – for TMJ Dysfunction

Important features of the temporal bone and jawbone (mandible) you can feel include the mastoid, parietal notch, and zygomatic processes in the temporal bone, and the ramus, angle, body, articular prominence, and mental protrusion in the jawbone. There are also important features one cannot feel but are still significant; these include the external ear canal, occipital mastoid suture, spheno-squamous pivot, mandibular fossa, and eustachian tube in the temporal bone; and the condylar process, articular cartilage, medial and lateral ligaments, stylomandibular ligament, and sphenomandibular ligament in the jawbone.

Inside the jaw, there’s a balance between the lateral temporomandibular ligament and joint capsule, and the sphenomandibular ligament. At the bottom of the jaw, the angle of the jaw attaches to the styloid process by the stylomandibular ligament, which can contract and relax, aiding in opening and closing the jaw. In an MRI image, when the jaw is fully open, this connection looks like a bow-tie with the articular disc in the middle in front of the condyle (a rounded bone end). Pathologies with jaw movement often present as overextension, which is why bite blocks are recommended to prevent this.

Many people who suffer from TMJ (temporomandibular joint disorder) have an overbite, which in dentistry is known as a class II overbite. There are also class I overbite patients who have little to no overbite, and class III patients who have an underbite or protruding lower teeth. While treatment frequently focuses on the joint itself, muscles affected by the joint dysfunction are also treated.

The cranial nerve V controls the muscles that help us chew, including the temporalis, masseter, lateral and medial pterygoids. The temporal muscle starts at the temporal fossa and attaches to the medial aspect of the ramus and coronoid process of the mandible. The masseter muscle helps with chewing and starts on the zygomatic arch and maxilla and attaches to the posterolateral aspect of the mandibular angle. The lateral and medial pterygoid muscles start on the greater wing of the sphenoid and medial side of the lateral pterygoid plate of the sphenoid, respectively, and attach to the mandible.

The TMJ helps the jaw to open, close, jut out, retract, move laterally, and chew. For the jaw to drop open, a hinge and glide motion allow it to drop around 50mm, about the difference of 3 knuckles of the dominant hand. When the jaw is open in a CT or MRI image, the joint looks like a bow-tie. Closing involves bringing the jaw upwards. Protrusion and retrusion refer to moving the jaw forwards and backwards, respectively. Lateral motion entails moving the jaw to either side. Chewing requires all four muscles of mastication.

Why do People Need Osteopathic Manipulative Treatment: Facial Muscle Energy, Direct MFR, and BLT Procedure – for TMJ Dysfunction

If you go to the doctor with jaw pain, they might check for problems with your temporomandibular joints (TMJ). These are the joints that connect your jawbone to your skull. The doctor will look at how you stand and move, and at the alignment of your face, because imbalances or stiffness could suggest TMJ problems. Pain in and around your jaw, and neck pain, could also point to TMJ difficulties.

An important part of the doctor’s examination involves gently touching your jaw as you open and close your mouth. If you’re experiencing TMJ problems, your jaw may deviate to one side, and you might feel pain. The doctor might also hear clicking or popping noises when you open your mouth, which are signs of joint issues.

The doctor will likely also examine other parts of your neck and head, paying careful attention to the joints at the back of your head and neck (specifically the occipital joint, and two joints in the neck called the C2 and C3). They might examine your skull to see if your bones are moving in a typical way. They will also focus on specific bones and muscles in the head and face, including the temporal bones (at the side of your skull), and the suprahyoid muscles (under your chin), as well as the temporalis (at the side of your head), the masseter (at the jaw), and the medial and lateral pterygoids (at the back of your mouth).

The doctor might also check for knotting or imbalances in the muscles around your shoulders. Finally, they might measure how wide you can open your mouth; usually, adults should be able to open their mouths to around 40 millimeters, just over an inch and a half.

When a Person Should Avoid Osteopathic Manipulative Treatment: Facial Muscle Energy, Direct MFR, and BLT Procedure – for TMJ Dysfunction

Facial muscle energy is a common technique doctors use to directly intervene or treat an issue. This method requires the doctor to apply strong, deliberate forces. However, sometimes this is not the best approach, especially if the patient is exceptionally weak, has broken their jaw, has unstable joints, or just underwent surgery.

Myofascial release (MFR) is a treatment that although can be gentle, it also either directly or indirectly intervenes with the problem. That’s why it might not be suitable for everyone; especially for those who are healing from a broken bone, who have severe diabetes, who have brittle and weak bones (severe osteoporosis), who suffer from rheumatoid arthritis (a type of autoimmune disease that causes pain, swelling, and stiffness in the joints), who have cancer (malignancy), or who have an abnormal widening of a blood vessel (aneurysm).

Balanced Ligamentous Tension (BLT) is another method, often more accepted by patients because it doesn’t require as much active involvement. Yet, it’s not suitable for everyone. If you refuse the procedure, recently fractured your jaw, have cancer in your temporal bone (which is on the side of your skull near your ears), or have a history of bone infection (osteomyelitis), you might not be able to undergo BLT.

Equipment used for Osteopathic Manipulative Treatment: Facial Muscle Energy, Direct MFR, and BLT Procedure – for TMJ Dysfunction

To carry out treatment methods for jaw joint problems using manual therapy, the following items are needed:

  • A table for medical examination
  • A table specifically designed for osteopathic manipulative treatment (OMT, treatments where doctors use their hands to diagnose or treat illnesses or injuries)
  • A table for performing massages
  • An extra location where the patient can sit comfortably, also ensuring that the doctor can apply the treatment without discomfort.

Who is needed to perform Osteopathic Manipulative Treatment: Facial Muscle Energy, Direct MFR, and BLT Procedure – for TMJ Dysfunction?

To treat issues with your TMJ (temporomandibular joint – the hinge that connects your jaw to the rest of your skull) using OMT (osteopathic manipulative treatment – a technique that involves moving your muscles and joints using stretching, gentle pressure, and resistance), a few important roles need to be filled:

First is you, the patient. You need to give your official consent both verbally and through writing before the treatment can proceed. A chaperone, who is present to monitor the procedure, may be there too.

The procedure will be done by a specialized doctor, either a DO (doctor of osteopathic medicine – a doctor who focuses on how your body’s systems are interconnected) or an MD (medical doctor – a doctor who diagnoses and treats illnesses). This doctor should have received specific training in OMT. You should also know that, in some countries, osteopaths (health professionals who focus on treating the body as a whole) who aren’t doctors can also perform this procedure.

Preparing for Osteopathic Manipulative Treatment: Facial Muscle Energy, Direct MFR, and BLT Procedure – for TMJ Dysfunction

Before using OMT (osteopathic manipulative treatment) techniques to treat TMJ (temporomandibular joint) dysfunction, there are several important steps that need to be taken:

First, it’s crucial to ensure that the patient is completely in the know about what the procedure involves. Along with this, they should also be told about the potential risks, the likely benefits, and other treatments they may choose to undergo instead of OMT.

Once the patient has all this information, they will then need to formally agree to move ahead with the procedure. This is usually referred to as ‘giving consent’.

Next, it’s vital to make sure that the treatment area is clean and well-sanitized. This is done to help prevent infection and ensure the safety of the patient during the procedure.

Finally, a method called ‘creating friction’ is often used. This involves rapidly rubbing surfaces together to generate heat. This helps to warm up the hands before applying OMT, a step that can make the treatment more comfortable for the patient.

How is Osteopathic Manipulative Treatment: Facial Muscle Energy, Direct MFR, and BLT Procedure – for TMJ Dysfunction performed

There are different methods to treat or relieve tension in your jaw joint, known as the temporomandibular joint (TMJ). Here are a few that your doctor might use:

Facial MET for the TMJ:

If you experience any dizziness or nausea during any of these steps, the process will be stopped.

  1. Your doctor will sit at the head of the table while you lay flat (supine). You’re asked to slowly open your mouth. Your doctor will look for any out of the ordinary movement toward the side of your jaw with restrictions.
  2. Your doctor will gently move your lower jaw (mandible) in different directions – neutral, flexion, and extension – to identify a TMJ restriction.
  3. Your doctor will support your lower jaw with one hand, opposite to the barrier, and move your jaw into flexion and extension positions. You’re asked to slowly open your mouth in alignment with the restricted barrier while the doctor applies an equal resistance for about 3 to 5 seconds.
  4. You will be asked to relax, then gently push your jaw to the side towards new restrictive barrier.
  5. This push-and-pull activity will be repeated 3 to 5 times or until the barrier is engaged, which means less tension or resistance is felt.

Your doctor will recheck the TMJ’s motion to confirm proper alignment.

Direct MFR for the TMJ:

  1. Your doctor will place one hand on your lower jaw and the other on the jaw’s opposite side. Gently, your jaw will be abducted, or moved away from the center of your body with a firm and still pressure applied until the tissue releases – meaning feelings of tension decrease.
  2. Your doctor will slowly rotate your jaw and move it even further from the center of your body, continuing the firm pressure until the tissues release again.
  3. Then, your doctor will gently adduct – or move your jaw towards the center of your body – while keeping the outward rotation, applying steady pressure until tissue release is achieved.
  4. Your jaw will be slowly returned to its resting position, and your doctor will reassess the TMJ’s motion to ensure the correct alignment.

BLT for the TMJ:

  1. Your doctor will apply the vault hold – a gentle holding technique – to feel the TMJ joint and assess any irregular movement.
  2. Exaggerating the asymmetry, or unevenness, your doctor will softly push your TMJ into alignment.
  3. Your doctor will continue this process until your TMJ stops at a balance point, maintaining this position until your TMJ returns to a neutral position before lessening the pressure.
  4. Your TMJ and its aligned structures will be rechecked to ensure proper balance is restored.

Possible Complications of Osteopathic Manipulative Treatment: Facial Muscle Energy, Direct MFR, and BLT Procedure – for TMJ Dysfunction

Injuries caused by Osteopathic Manual Treatment (OMT), a type of hands-on care technique used by physicians and therapists, are quite rare according to a study that looked at cases from 1925 to 1993. They only found 185 injuries caused by OMT during that time. After this type of treatment, some patients may experience muscle soreness. The level of discomfort can vary greatly from person to person and depends on the method, angle, and pressure used by the physician or therapist during the treatment.

Two types of OMT procedures are passive and active treatments. Passive treatments like Balance Ligamentous Tension (BLT) techniques are generally safe and students usually don’t cause any harm. However, active treatments, like Muscle Energy techniques, could lead to some minor musculoskeletal issues.

Of all the OMT techniques, Muscle Energy procedures are considered to have the highest risk. This type of treatment requires the physician to use their own strength to correct muscle imbalance. While it’s noted that 1 in 50,000 active interventions can lead to a harmful outcome, there’s no strong evidence to suggest that active manual treatments performed by well-trained physicians and providers are exceedingly risky and need to be re-evaluated.

To reduce the risk of post-treatment soreness, patients should warm up properly before treament and drink enough water afterwards. Also, the more experienced the physicians and providers are with OMT, the better they become at performing these procedures, which often leads to better patient experiences.

What Else Should I Know About Osteopathic Manipulative Treatment: Facial Muscle Energy, Direct MFR, and BLT Procedure – for TMJ Dysfunction?

Muscle Energy Technique (MET) is a form of manual therapy that uses the patient’s own energy in the form of gentle, controlled muscle contractions to help improve range of motion, reduce muscle tension and provide pain relief. This technique is often used by medical professionals like physical therapists, physiotherapists, and osteopaths. It has been thoroughly tested and proven to be effective.

One study analyzed the effects of MET on patients with neck pain, similar to the pain experienced by those with jaw joint issues, also known as TMJ dysfunctions. The researchers found that MET was better for managing pain and improving neck function compared to traditional stretching exercises. The improvements were tracked using pain scales and the Neck Disability Index, which measures how neck pain affects a person’s daily activities.

Direct Myofascial Release (MFR) is another technique used primarily to stretch muscles and reduce tightness, but it also has a significant benefit of pain relief. Through scientific experiments, researchers discovered that this method stimulates cells in a way that reduces inflammation and promotes healing. Ongoing research suggests that MFR can even speed up wound healing by interacting with the matrix of proteins and fibers outside the cells.

The Balanced Ligamentous Tension (BLT) procedure is a gentle treatment method that is particularly useful in treating patients with severe pain who may have difficulty cooperating with other types of therapy. It involves gentle manipulation of the body to release tension and restore balance to affected areas. Research involving elderly pneumonia patients in hospitals showed that BLT led to shorter hospital stays and lowered the likelihood of death during hospitalization. This suggests that this technique can be a helpful addition to conventional treatments for hospitalized patients.

Regardless of the technique, it’s important to collaborate closely with your doctor to determine the best treatment approach for your individual situation.

Frequently asked questions

1. What are the potential risks and benefits of Osteopathic Manipulative Treatment (OMT) for TMJ Dysfunction using Facial Muscle Energy, Direct MFR, and BLT Procedure? 2. Are there any alternative treatments or therapies that I should consider for my TMJ Dysfunction? 3. How many sessions of OMT do you recommend for my specific case of TMJ Dysfunction? 4. Can you explain the steps involved in each of the OMT techniques (Facial Muscle Energy, Direct MFR, and BLT Procedure) and how they will help alleviate my TMJ Dysfunction? 5. Are there any specific precautions or aftercare instructions I should follow after receiving OMT for my TMJ Dysfunction?

Osteopathic Manipulative Treatment (OMT) for TMJ Dysfunction, specifically Facial Muscle Energy, Direct MFR, and BLT procedures, can have a positive impact on the individual. These treatments aim to address the dysfunction in the temporomandibular joint (TMJ) and the associated muscles. By using techniques such as muscle energy, myofascial release, and balanced ligamentous tension, OMT can help improve jaw movement, alleviate pain, and restore proper function to the TMJ.

You may need Osteopathic Manipulative Treatment: Facial Muscle Energy, Direct MFR, and BLT Procedure for TMJ Dysfunction if you do not have any contraindications or conditions that would make these treatments unsuitable for you. These treatments can help alleviate the symptoms of TMJ dysfunction by directly intervening or indirectly addressing the problem. However, it is important to consult with a healthcare professional to determine if these treatments are appropriate for your specific condition and medical history.

You should not get the Osteopathic Manipulative Treatment procedures for TMJ Dysfunction if you are exceptionally weak, have a broken jaw, have unstable joints, or have recently undergone surgery. Additionally, if you have severe diabetes, severe osteoporosis, rheumatoid arthritis, cancer, an aneurysm, cancer in your temporal bone, or a history of bone infection, these procedures may not be suitable for you.

The text does not provide specific information about the recovery time for Osteopathic Manipulative Treatment (OMT) procedures such as Facial Muscle Energy, Direct MFR, and BLT for TMJ Dysfunction.

To prepare for Osteopathic Manipulative Treatment (OMT) for TMJ Dysfunction, it is important to first understand the procedure and its potential risks and benefits. You should give your official consent both verbally and in writing before the treatment can proceed. The treatment area should be clean and well-sanitized, and the doctor may use a method called "creating friction" to warm up their hands before applying OMT.

The text does not specifically mention the complications of Osteopathic Manipulative Treatment (OMT) for TMJ Dysfunction using Facial Muscle Energy, Direct MFR, and BLT procedures.

Symptoms that require Osteopathic Manipulative Treatment for TMJ Dysfunction include pain in and around the jaw, neck pain, jaw deviation to one side, clicking or popping noises when opening the mouth, imbalances or stiffness in the face, and limited mouth opening (less than 40 millimeters).

Based on the information provided, there is no specific mention of the safety of Osteopathic Manipulative Treatment (OMT) techniques, including Facial Muscle Energy, Direct Myofascial Release (MFR), and Balanced Ligamentous Tension (BLT) procedures, for TMJ dysfunction during pregnancy. It is important to note that the safety of any medical treatment during pregnancy should be evaluated on an individual basis, taking into consideration the potential risks and benefits. Pregnancy is a unique physiological state, and certain manual therapy techniques may need to be modified or avoided altogether to ensure the safety of both the mother and the developing fetus. It is recommended to consult with a healthcare provider, such as an obstetrician or a healthcare professional experienced in treating TMJ dysfunction during pregnancy, to discuss the potential risks and benefits of OMT techniques in this specific context. Additionally, it is important to consider alternative treatment options for TMJ dysfunction during pregnancy, such as non-invasive therapies, physical therapy exercises, and pain management strategies that are deemed safe for pregnant individuals.

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