Trigger Point Dry Needling in the Treatment of Temporomandibular Joint Disorders (TMD)
I’ve received many inquiries about the benefits of dry needling for clients with temporomandibular joint disorders (TMD). To start with, let’s take a moment to briefly review dry needling.
Dry needling is a revolutionary pain relieving procedure performed by our Licensed Physical Therapists who are also Certified Myofascial Trigger Point Therapists (CMTPT) through Myopain Seminars. The invasive procedure involves inserting a solid filament needle into the skin and muscle, aimed directly at a myofascial trigger point, which elicits a twitch response. Myofascial trigger points consist of multiple contraction knots related to maintenance of the pain cycle. They are known to be involved in acute and chronic, localized and widespread pain including common conditions such as migraines, headaches, fibromyalgia, Achilles tendonitis, sciatica and tennis elbow and of course TMD or TMJ problems. Dry needling has been proven to reduce muscle tension, promote healing, and increase range of motion.
Based on the pioneering studies by Dr. Jay Shah and colleagues at the National Institutes of Health, we know dry needling causes favorable biochemical changes which assist in reducing pain. Dry needling has been shown to reduce abnormal EMG activity and aberrant muscle contraction. Furthermore, benefits have been shown to occur locally and widespread within the muscular system.
Dry needling is not necessarily our initial treatment of choice for TMD, and to be clear there needs to be a muscular component to our diagnosis for dry needling to be effective. I believe most of us who treat TMD would agree that in at least 70% of TMD cases there is a strong myofascial or muscle component. We have the legendary Steve Kraus, PT to thank for further validation of this. Steve recently published his article entitled: “Characteristics of 511 patients with temporomandibular disorders referred for physical therapy”. The largest diagnostic subset of TMD was myofascial pain or masticatory muscle pain.
Prior to performing dry needling treatment, I feel the treating physical therapist needs to establish a rapport with the TMD client. This includes determining their potential fears, anxiety and apprehension in regard to the suggested treatment plan, and how long they have potentially been in chronic pain. Remember, very often by the time a TMD patient finds a specialist like one of us they have been to 3 to 7 other healthcare providers with limited to poor success. Therefore, it is important to establish a trusting relationship before suggesting a needle. At that point, I do feel dry needling can have an amazing impact on patient success. When appropriate I will and have needled the masseter, temporalis, medial and lateral pterygoid, in addition to other facial muscles. I do not necessarily needle all of these muscles at once of course. I tend to proceed cautiously by dry needing one or two trigger points to start. I often start with the trapezius muscle in the neck. I find this is one of the more tolerable areas for our clients to first experience dry needling, and for clinicians to assess the patient’s response to dry needling before considering the facial area. It is important not to neglect the various cervical or neck muscles that can contribute to TMD or create referred pain patterns to the head and face. One of the other amazing findings featured in Steve Krause’s article is that 69% of all TMD clients had a cervical or neck component, once again validating the importance that treating the cervical spine or neck is crucial to the overall well-being of a TMD client.
In summary, dry needling can be a very effective technique to help clients with TMD featuring a muscular component. Included below are couple articles demonstrating positive treatment effects with dry needling to the masseter and the lateral pterygoid muscles.
Short-term effects of dry needling of active myofascial trigger points in the masseter muscle in patients with temporomandibular disorders. Fernández-Carnero J, La Touche R, Ortega-Santiago R, Galan-del-Rio F, Pesquera J, Ge HY, Fernández-de-Las-Peñas C. J Orofac Pain. 2010 Winter;24(1):106-12.
Conclusion of this article: The application of dry needling into active trigger points in the masseter muscle induced significant increases in PPT (Pain Pressure Threshold) levels and maximal jaw opening when compared to the sham dry needling in patients with myofascial TMD. In summary, jaw opening increased and pressure sensitivity decreased.
Treatment of temporomandibular myofascial pain with deep dry needling. Gonzalez-Perez LM, Infante-Cossio P, Granados-Nuñez M, Urresti-Lopez FJ. Med Oral Patol Oral Cir Bucal. 2012 Sep 1;17(5):e781-5.
Conclusion of this article: Although further studies are needed, our findings suggest that deep dry needling in the trigger point in the external pterygoid muscle can be effective in the management of patients with myofascial pain located in that muscle. They found a statistically significant relationship (p<0,01) between therapeutic intervention and the improvement of pain and jaw movements, which continued up to 6 months after treatment.