Integration of Rehabilitation and Acupuncture in the Treatment of a Professional Musician with Temporomandibular Joint Dysfunction

Abstract

This case study describes the use of acupuncture in a professional musician with myogenic temporomandibular dysfunction. The 3-year history of symptoms was associated with persistent episodic tension-type headaches. Acupuncture was used for trigger point release, primarily of the masticatory muscles, in conjunction with exercise therapy. After 8 weekly acupuncture sessions, the patient's pain had completely resloved, headaches had resolved and the Patient-Specifi c Functional Scale showed signifi cant improvements. INTRODUCTIONThe number of patient referrals to physiotherapy for treatment of temporomandibular dysfunction (TMD) is increasing; however, the evidence for specifi c treatment of this condition remains limited and inconclusive. This case illustrates that the use of acupuncture can be effective as part of an integrated treatment for the relief of myogenic temporomandibular joint (TMJ) dysfunction even when chronic, allowing the patient to return to the activity that precipitated the problem. CASE HISTORYWe describe the case of a 32-year-old full-time Army band player whose role involved playing the clarinet for up to 6 h/day (fi gure 1). She presented to physiotherapy in June 2010 with a 3-year history of TMD with referral to the lateral aspect of the neck and a long history of temporal headaches that required daily analgesia.Her pain was intermittent, did not follow a 24-h pattern and had two components (P1 and P2) as shown in fi gure 2. A Patient-Specifi c Functional Scale (PSFS) was used to assess her functional status.3 This patient-specifi c outcome measure involves the patients selecting activities that they have diffi culty with due to their condition and rating the functional limitation associated with these activities on a 0-10-point scale, with 0 being no pain and 10 being the worst pain. The client noted a PSFS of 3/10 when playing the clarinet for 30 min and a PSFS of 2/10 when talking, more specifi cally when shouting in a nightclub for 20 min. Due to the severity of her pain, she was unable to continue with her band duties, thus preventing her from carrying out her primary army work role.No particular mechanism of injury was noted; however, she did commence her career in the armed forces when the symptoms started. Previous physiotherapy treatment within the army had included manual therapy of the cervical spine and upper quadrant, which had been unsuccessful; she had also been using a lower soft occlusal splint at night since 2009, which had not improved any of her symptoms.Pain-relieving factors included heat and playing the clarinet out of the side of her mouth. The subject's secondary pain, P2, was associated with increasing P1. The patient also had a 2-year history of temporal headaches that was currently requiring daily doses of ibuprofen to manage. MRI revealed a normal appearance of the TMJ in the closed position with no mandibular condyle translation demonstrated on dynamic imaging. Her medical history was insignifi cant; however, she noted an incident 10 years ago in which...

Wind Instrumentalists and Temporomandibular Disorder: From Diagnosis to Treatment

“…Regarding the presence of a TMD on this single reed instrumentalist, there could be many options for the treatment. The different approaches for the treatment of a TMD are: cognitive behavioural therapy, acupuncture, physiotherapy, the use of an intra-oral appliances such as occlusal splints, pharmacologic treatment and in irreversible TMD pathologies surgical treatments [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ].…”

The Application of Tensegrity Massage in a Professionally Active Musician – Case Report

“…A study on percussionists revealed the most severe pain in the cervical and lumbar spine, headaches, neuralgia within the upper extremities, exercise‐induced muscle tremor, and symptoms of depression caused by perceived dysfunctions (Macfarlance et al., ; Papandreou & Vervainioti, ). In addition to the overload of soft tissues in the upper extremities, violinists are often diagnosed with pain in the temporomandibular joint, head and neck, caused by the asymmetrical head position, holding, and pressure on the violin involving this joint (Bejjani, Kaye & Benham, ; Hunter, ).…”

“…When playing the violin, a musician takes a posture in which the head is leaning to the left side toward the violin, and the chin is directed to the right, causing the permanent contracture of the sternocleidomastoid muscle on the left side, and its stretching on the right side (Levy, Lee, Brandfonbrener, Press & Levy, ; Nagai & Eng, ). The left branch of the mandible and the left temporomandibular joint are involved in pressing down and holding the violin in position (Hunter, ; Kapandji, ); the left upper extremity is adducted and flexed in the shoulder joint, flexed in the elbow joint, the forearm and hand are in the supine position, the fingers of the left hand are flexed, the thumb is abducted and flexed to embrace and press the strings, the right free upper extremity is abducted to a 90° angle and flexed in the elbow joint to a 90° angle, the forearm and hand are pronated, and the fingers are positioned in a pinch grip to hold the violin bow (Berque & Gray, ; Sahrmann, ). In the sitting position, the left part of the shoulder girdle leans and rotates toward the right hip joint.…”

Level of awareness of dentists about the role of physiotherapy in temporomandibular disorders: a pilot study in Riyadh, Saudi Arabia

“…Physiotherapists (PTs) deal with TMJ as they treat other joints in the body and use different electrotherapy modalities such as electrical stimulation [16][17][18][19][20], ultrasound [21], acupuncture [22][23][24], and laser therapy [25][26][27] to reduce pain and inflammation which further promotes healing of tissues. Other conservative approaches including occlusal splint therapy [28], massage [28][29][30], manual therapy [4,31,32], therapeutic exercises, and home exercises program [33,34] are used to re-establish the proper flexibility and muscular length/ strength.…”