Effectiveness of Telerehabilitation in Individuals With Temporomandibular Joint Dysfunction and Myofascial Pain

TMJ, one of the most complex joints of the body, is a ginglimoarthrodial joint located in the front part of the external auditory canal, between the mandibular fossa (glenoid fossa) of the temporal bone and the condylar processes of the mandible, and also performs rotation and sliding movements. It is composed of fibrous connective tissue between the bone tissues that form the joint. There is a joint disc that divides the joint space into two parts, lower and upper. TMJ is effective in basic functions such as providing mandibular movement, speaking and chewing. A normal person uses TMJ a lot in daily life. For this reason, pathologies related to TMJ are encountered more frequently than other joints in the body. Clinical signs and symptoms of temporomandibular joint disorders may vary, but pain, noise from the joint, limitation of mandibular movements and tenderness in the chewing muscles are among the most frequently observed symptoms. It has been shown in many studies that the daily living activities of individuals with TMJ dysfunction are negatively affected, and this affects the quality of life of individuals. Therefore, identification, diagnosis and treatment of symptoms are important. Many methods such as analgesic and anti-inflammatory drugs, splint therapy, exercise and physical therapy modalities are used in the treatment of these individuals. When looking at the literature, it is seen that exercise therapy has an important place in TMJ rehabilitation and that a supervised rehabilitation program is effective in improving functional parameters. In the studies of Çapan et al., it was seen that active exercise and relaxation exercises applied to the chewing muscle groups were an effective treatment method on deviation and pain. Bae et al. showed that manual therapy and exercise applications for the cervical region had positive effects on pain threshold in chewing muscles and pain-free mouth opening in patients with myofascial type TMD. In a systematic review published in 2014, joint mobilization, soft tissue mobilization and friction massage were recommended to reduce pain, increase normal joint movement (ROM) and reduce other symptoms within the scope of manual therapy techniques (MTT) for TMJ problems. Especially in soft tissue mobilization, the method called pressure trigger point release technique; It is a noninvasive method based on gradually applying pressure on the trigger point in accordance with the patient's tolerance. Exercise is one of the approaches that have been used for a long time in the treatment of TMJ problems. Therapeutic exercises specific to TMJ problems can be used to specifically improve the functions between the TMJ and the craniomandibular system. Most exercise programs have an important place in increasing muscle coordination, normalizing range of motion, providing muscle relaxation and increasing muscle strength.

Telerehabilitation is a treatment method that allows the patient to access treatment remotely, regardless of where they are, thanks to developing technology. Telerehabilitation provides us with opportunities such as patient evaluation, monitoring, therapy, consultation, education and patient follow-up. Within the scope of our study, the effects of applying an exercise program to patients through home exercise program and telerehabilitation will be investigated.

The purpose of this study for individuals with temporomandibular joint dysfunction; To investigate the effectiveness of exercises for myofascial pain through telerehabilitation in individuals with myofascial pain and TMJ dysfunction.

Inclusion criteria

• People between the ages of 18-65 with myofascial temporomandibular pain
• Displacement of the disc with anterior reduction,
• Pain in the masticatory muscle/temporomandibular area lasting more than a month
• Symptoms lasting at least three months,
• People who have the opportunity to provide informed consent and participate in treatment and evaluation clinics.

Exclusion criteria

• Anterior disc displacement without reduction,
• Primary arthrogenic pain,
• Other temporomandibular disorders,
• Neurological or psychiatric disorders,
• People who have had temporomandibular joint and/or cervical spine surgery,
• Abuse of painkillers or abuse of existing medication.