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

  • 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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Metadaten
Author:Cesar Fernández-de-las-PeñasORCiD, Harry von PiekartzORCiD
Title (English):Clinical Reasoning for the Examination and Physical Therapy Treatment of Temporomandibular Disorders (TMD) : A Narrative Literature Review
URN:urn:nbn:de:bsz:959-opus-28469
DOI:https://doi.org/10.3390/jcm9113686
ISSN:2077-0383
Parent Title (English):Journal of Clinical Medicine
Document Type:Article
Language:English
Year of Completion:2020
Release Date:2022/01/31
Tag:manual therapy; neurodynamics; pain neuroscience education; soft tissue; temporomandibular disorders
Volume:9
Issue:11
Page Number:21
Faculties:Fakultät WiSo
DDC classes:600 Technik, Medizin, angewandte Wissenschaften / 610 Medizin, Gesundheit
Review Status:Veröffentlichte Fassung/Verlagsversion
Licence (German):License LogoCreative Commons - CC BY - Namensnennung 4.0 International