Quelques revues systématiques de la littérature ont conclu qu’il y a suffisamment d’évidences pour appuyer le fait que la thérapie manuelle améliore la douleur et l’amplitude articulaire en ouverture de la bouche chez les patients avec TMD [173,174,224]. Dans une de ces revues de la littérature, on souligne notamment que la combinaison de la thérapie manuelle et des exercices de contrôle moteur est très prometteur pour estomper la douleur et l’invalidité en lien avec une TMD [224]. Toutefois, selon cette dernière revue de la littérature, il ne semble pas y avoir suffisamment d’évidences pour clairement démontrer que les exercices, sans thérapie manuelle, soient efficaces. Une étude a donc posé la question à un groupe de spécialistes internationaux, et il y a consensus que les exercices soient efficaces dans le traitement des TMD [228]. Il est intéressant de noter que plusieurs exercices proposés dans cette étude se retrouve dans le protocole proposé ci-haut pour l’évaluation du contrôle moteur de la région orofaciale. Évidemment, les exercices de contrôle de l’ouverture à la Rocabado ne sont pas en reste non plus.
Abstract
AIMS: To investigate whether an international consensus exists among TMD experts regarding indications, performance, follow-up, and effectiveness of jaw exercises. METHODS: A questionnaire with 31 statements regarding jaw exercises was constructed. Fourteen international experts with some geographic dispersion were asked to participate in this Delphi study, and all accepted. The experts were asked to respond to the statements according to a 5-item verbal Likert scale that ranged from « strongly agree » to « strongly disagree. » The experts could also leave free-text comments, which was encouraged. After the first round, the experts received a compilation of the other experts’ earlier responses. Some statements were then rephrased and divided to clarify the essence of the statement. Subsequently, the experts were then asked to answer the questionnaire (32 statements) again for the second round. Consensus was set to 80% agreement or disagreement. RESULTS: There is consensus among TMD experts that jaw exercises are effective and can be recommended to patients with myalgia in the jaw muscles, restricted mouth opening capacity due to hyperactivity in the jaw closing muscles, and disc displacement without reduction. The patients should always be instructed in an individualized jaw exercise program and also receive both verbal advice and written information about the treatment modality. CONCLUSION: This Delphi study showed that there is an international consensus among TMD experts that jaw exercises are an effective treatment and can be recommended to patients with TMD pain and disturbed jaw function.
Références
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- [174] Martins WR, Blasczyk JC, Aparecida Furlan de Oliveira M, et al. Efficacy of musculoskeletal manual approach in the treatment of temporomandibular joint disorder: A systematic review with meta-analysis. Man Ther 2016;21:10-17.
- [224] Armijo-Olivo S, Pitance L, Singh V, Neto F, Thie N, Michelotti A. Effectiveness of manual therapy and therapeutic exercise for temporomandibular disorders: systematic review and meta-analysis. Phys Ther 2016;96:9-25.
- [228] Lindfors E, Arima T, Baad-hansen L, Bakke M, et al. Jaw Exercises in the Treatment of Temporomandibular Disorders-An International Modified Delphi Study. J Oral Facial Pain Headache 2019;33 :389-398.