Physical therapy may not be the first thing that comes to mind when a person experiences jaw pain, but it can be a valuable conservative management tool. Many treatments offered for temporomandibular joint dysfunction (TMD) have limited evidence available for their safety and efficacy. In light of the limited research available, providers should encourage patients to consider the treatments with the best evidence, and the lowest risks first.
Generally speaking, treatments like physical therapy that are minimally invasive, are lower risk than surgical or dental procedures that make permanent changes, or injections and medications that carry potential side effects. (See our other posts for more information on PT for the TMJ)
Finding a physical therapist who treats jaw problems well can be challenging. Many physical therapists receive minimal training on managing TMD in their entry level education, and continuing education courses focusing on the temporomandibular joint are uncommon.
Unfortunately, some therapists are pressured by their employers to accept all patients for the financial benefit of the company, even if they may not be the best qualified clinician in town to care for the patient. At this time, there aren't any provider registries for physical therapists who specialize in jaw problems so patients are left on their own to find a provider. Choosing a PT for TMD can be challenging. Here are 5 tips to help you interview your potential provider and avoid wasting time and money seeing a therapist who doesn’t specialize in TMD.
Ask to speak to the therapist directly before your evaluation. Front office staff are often trained to reassure patients that the company provides excellent care, but they are not clinicians and may not be aware of the experience of every clinician at the clinic. This is especially true for larger facilities like hospitals and physical therapy chains that utilize call centers.
Ask the therapist if they evaluate inside of your mouth. PTs who regularly treat jaw problems should be comfortable performing joint mobilizations and muscular/soft tissue assessment inside your mouth. If the therapist is not able/willing to do this, they are most likely not a TMJ specialist.
Ask what kind of jaw problems the therapist typically treats. According to the National Institute of Dental and Craniofacial Research, there are over 30 disorders that fall into the category of TMD (1). While your physical therapist may not treat every problem, they should be able to tell you about a few categories of patients they see. These might include people with joint degeneration/pain, disc problems, hypermobility disorders, muscle imbalances, and people with decreased/impaired mobility.
Ask how long the therapist has been treating jaw problems and be ready to interpret the response.
Some therapists may deflect by simply giving you the number of years they’ve been in practice. Press in to ask about how long they’ve specifically worked with jaw patients, or how many they have seen. If they’ve been practicing 15 years and have only seen 50 patients, 3 patients a year is not a lot. While most therapists’ whole caseloads are not TMJ patients, people who work with it regularly should at least see one patient in a given month. The benefit of working with older clinicians is in their experience level. If they don’t work with a condition regularly, and don’t pursue continuing education on the subject, their knowledge may be out of date for current best practices.
Some therapists may be hesitant to tell you they’ve only been practicing for a year. This does not mean they are not a qualified clinician if their schooling gave them added preparation for treating TMD, or they’ve sought out continuing education. Perhaps they even have a personal background of having TMD. Keep in mind that there are some benefits to working with younger clinicians in that they tend to have been educated on the most recent research available while in school. They may also be more motivated to do research outside of work to seek answers for how to better treat their patients because they are trying to fill in their knowledge gaps and establish themselves as a competent therapist.
5. Look into the therapist’s bio on their clinic website if it’s available. Is there
dedicated space on the company website for TMD patients? Therapists who
explicitly state that they treat jaw problems are ideal, but if you can’t find one,
individuals who specialize in neck pain, headache management, dizziness, and
chronic pain are sometimes familiar with treating jaw patients. If a therapist
holds a board specialty certification in orthopedics or an OCS, they may not
specialize in jaw problems, but they will have at least had to study the jaw in a
little greater detail than the average physical therapist.