Massage Therapy and Jaw Pain

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My current goal is to promote the value of massage therapy to medical professionals by synthesizing and simplifying noteworthy finds and best available supporting evidence applicable to massage therapy.

Here are some notes and resources for jaw pain.

Massage Therapy and Jaw Pain

Therapeutic effects of intra-oral and extra-oral massage, and self-care management of temporomandibular dysfunction has been demonstrated in a number of randomized control trials and systematic reviews. (Martins et al. 2016von Piekartz & Hall 2013Randhawa et al. 2015)

Evidence also suggests that temporomandibular disorder may be a contributing factor to cervicogenic headache (von Piekartz & Hall 2013).

Intra-oral and extra-oral massage is not complicated, it can be preformed in the clinic or as self care. In its simplest form it could include working on: the masseter, medial pterygoid and the deep tendon of the temporalis.

Mechanism of Action

Massage therapy has been shown to be a safe, non-pharmacological therapeutic intervention that is simple to carry out, economical, and has very few side effects. In terms of clinical responses to massage therapy there are a couple of proposed mechanisms of action, including but not limited to:

• Neurodynamics - “A clinical concept that uses movement (1) to assess increased mechanosensitivity of the nervous system; and (2) to restore the altered homeostasis in and around the nervous system.” Grieve's Modern Musculoskeletal Physiotherapy.

• Contextually Aided Recovery - The way we present ourselves and present our techniques is tied to clinical outcomes, the magnitude of a response may be influenced by mood, expectation, and conditioning (Bialosky et al. 2017).

• Neuromodulation - Massage has an affect on peripheral and central processes - input from large sensory neurons may prevent the spinal cord from amplifying nociceptive signaling (Bishop et al. 2015Vigotsky et al. 2015).

• Social Grooming - Nervous system regulated by touch (social grooming) helps modulate the activity of neural circuits important for maintaining resting state. This reduced physiological and behavioural reactivity to stressors results in improved mood/affect (Ellingsen et al. 2016Walker et al. 2017).

• Mechanotherapy - "Any intervention that introduces mechanical forces with the goal of altering molecular pathways and inducing a cellular response that enhances tissue growth, modeling, remodeling, or repair.” (Thompson et al. 2016).


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Research Links

Armijo-Olivo, S., Pitance, L., Singh, V., Neto, F., Thie, N., Michelotti, A. (2016). Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis. Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/26294683

Martins, W. R., Blasczyk, J. C., Oliveira, M. A., Gonçalves, K. F., Bonini-Rocha, A. C., Dugailly, P., & Oliveira, R. J. (2016). Efficacy of musculoskeletal manual approach in the treatment of temporomandibular joint disorder: A systematic review with meta-analysis. Manual Therapy.
https://www.ncbi.nlm.nih.gov/pubmed/26144684

Randhawa, K., Bohay, R., Côté, P., Velde, G., Sutton, D., Wong, J., . . . Taylor-Vaisey, A. (2016). The Effectiveness of Non-invasive Interventions for Temporomandibular Disorders. The Clinical Journal of Pain.
https://www.ncbi.nlm.nih.gov/pubmed/25924094

Shaffer, S.M., Brismée, J.M., Sizer, P.S., Courtney, C.A. (2014). Temporomandibular disorders. Part 1: anatomy and examination/diagnosis. J Man Manip Ther.
https://www.ncbi.nlm.nih.gov/pubmed/24976743

Shaffer, S.M., Brismée, J.M., Sizer, P.S., Courtney, C.A. (2014). Temporomandibular disorders. Part 2: conservative management. J Man Manip Ther.
https://www.ncbi.nlm.nih.gov/pubmed/24976744

von Piekartz, H. V., & Hall, T. (2013). Orofacial manual therapy improves cervical movement impairment associated with headache and features of temporomandibular dysfunction: A randomized controlled trial. Manual Therapy.
https://www.ncbi.nlm.nih.gov/pubmed/23415640

von Piekartz, H. V., Pudelko, A., Danzeisen, M., Hall, T., & Ballenberger, N. (2016). Do subjects with acute/subacute Temporomandibular Disorder have associated cervical impairments: A cross-sectional study. Manual Therapy.
https://www.ncbi.nlm.nih.gov/pubmed/27744136 

Wu, J.Y., Zhang, C., ... Deng, M.H. (2017). Acupuncture therapy in the management of the clinical outcomes for temporomandibular disorders: A PRISMA-compliant meta-analysis. Medicine (Baltimore).
https://www.ncbi.nlm.nih.gov/pubmed/28248862