Effectiveness of Manual Physical Therapy, Therapeutic Exercise, and Patient Education on Bilateral Disc Displacement Without Reduction of the Temporomandibular Joint: A Single-Case Design

Abstract

Single-case A1-B-A2 design. To determine if manual physical therapy, therapeutic exercise, and patient education would be an effective management strategy for a patient with a disc displacement without reduction of both temporomandibular joints. A number of conservative management strategies have been proposed for the treatment of temporomandibular disorders. However, little evidence exists to indicate the effectiveness of physical therapy interventions in patients with bilateral disc displacement without reduction. Phase A1 of the study consisted of a baseline condition in which no intervention was initiated. Phase B included manual physical therapy, therapeutic exercise, and patient education focusing on the temporomandibular joint and cervical spine. Phase A2 consisted of withdrawal of the intervention. The Steigerwald/Maher disability questionnaire was used to collect data relative to function. A visual analog scale was used to collect pain data and maximal mouth opening measurements were obtained as an indicator of range of motion. Visual analysis and the 2 standard deviation band method of statistical analysis were used to compare data. Following the implementation of the intervention phase, the patient demonstrated significant reductions in pain and improvements in maximal mouth opening and function as measured by the Steigerwald/Maher disability questionnaire. These observed improvements were maintained at the time of a 3-month follow-up. The results of our study suggest that manual physical therapy, therapeutic exercise, and patient education may have been an effective management strategy for a patient with bilateral disc displacement without reduction of the temporomandibular joints. Further outcome studies in the form of randomized controlled trials are needed to determine the clinical utility of this treatment approach in a larger population.