Erson talks about a recent case where a patient with chronic TMJ pain and who kept asking for a medial pterygoid release finally got relief after coming across a novel technique on YouTube.
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[00:00:00] Welcome back to Untold Physio Stories Podcast. I'm your host, Dr. E with Modern Manual Therapy and Edge Mobility System.
[00:00:05] So I wanted to talk about a case, a patient who I've talked about a few times in the podcast in the past.
[00:00:10] I've seen her, she was centrally sensitized for some serious rib issues.
[00:00:14] She responded very, very well, ended up being a rapid responder despite being highly fear avoidant and centrally sensitized.
[00:00:23] So in the past, she's responded very well to myself, the therapy that I gave for her rib.
[00:00:30] And she had shoulder surgery for an issue I was unable to help her with.
[00:00:34] And then she came back after her surgery and rehab went very well.
[00:00:39] But she's had this kind of chronic jaw pain of varying degree that kept on getting worse and worse.
[00:00:45] And regardless of the treatment that I would give her, and she was seeing a ton of other different specialists,
[00:00:50] whether it was a chiropractor or the UB dental clinic that she was seeing,
[00:00:56] they would basically tell her, this is a medial pterygoid issue.
[00:00:59] It's a muscle imbalance issue. You need to have your tissues released.
[00:01:02] She would get varying degrees of success with some sort of tissue release.
[00:01:07] And she would come back to me sporadically and say, look, can you do an internal medial pterygoid release on me?
[00:01:12] And I said, look, when I got certified by the specialist I learned under Dr. Mariano Rocco Bato in 2004,
[00:01:19] he had pioneered physical therapy treatment for the TMJ.
[00:01:26] And he said as of 2004, and I don't know his stance now, that he had given up that internal soft tissue kind of deep friction massage.
[00:01:34] The way I describe it to patients is like you're palpating.
[00:01:38] And again, palpation isn't very reliable.
[00:01:41] We don't really even know for palpating the thing we're supposed to be palpating.
[00:01:44] And just because something is tender, it doesn't mean you need to go mash it.
[00:01:47] But even if we could palpate the medial pterygoid, we're palpating a very small percentage of that muscle.
[00:01:52] And it's often tender, even on people without any symptoms, just like the coracoid process or the upper trap.
[00:01:58] Those are very commonly tender places that just because they're tender doesn't mean you need to go, you know, mashing it to reduce the sensitivity.
[00:02:08] So I call the technique fish hulking because it's kind of like taking your finger and just going like, ah, just jamming it in and just rubbing an area that's tender.
[00:02:17] So I kind of refused to do that, stood my ground.
[00:02:20] Um, she had come to me for a completely different issue again and her rib issue flared up.
[00:02:27] She said, look, can you take a look at my jaw?
[00:02:28] And also I found, I found a video that relieved most of my complaints.
[00:02:34] And her complaints were other than her intraoral pain and lateral jaw pain and masseter pain.
[00:02:41] That stuff I was able to relieve at least 50%.
[00:02:45] One of her strangest complaints was that she had a coppery taste in her mouth and, you know, infection.
[00:02:50] And intraoral bleeds were all ruled out.
[00:02:52] But I thought that was kind of an unusual symptom that always had me worried in the back of my mind.
[00:02:57] So she, she had seen me and she said, look, I found a YouTube video and I know what you're going to say.
[00:03:02] And I was like, look, yeah, I don't want to, I don't want random doctor YouTube.
[00:03:05] I'm not, she's like, I look, I really want you to watch this.
[00:03:08] To me, I think it's like the side glide, the lumbar side glide of the jaw.
[00:03:14] So I look at this video and I can't remember if it's a chiropractor or a physical therapist or a dentist,
[00:03:20] but he basically says using the left side example.
[00:03:23] And this is also a video podcast.
[00:03:25] If you watch it on YouTube, um, if you take your thumb and you put it below the molars on the involved side,
[00:03:34] and you just push laterally, particularly on the pad to almost tilting it like that.
[00:03:38] And you push laterally toward the symptomatic side and you hold it for a minute to three minutes or so,
[00:03:43] then that will relieve complaints.
[00:03:45] And she did this and it was the only thing that gave her 80 to 90% relief.
[00:03:50] And the most interesting thing is that also completely eliminated that coppery taste,
[00:03:53] which I, I don't know, must've been some sort of referral pattern or something.
[00:03:58] So she, she, I watched the video and she said, can you do this to me too, to see if we get more relief?
[00:04:03] And the only modification I made was an opposing shear force on the temporal bone.
[00:04:10] So I would, I put my thumb in her mouth, pressed laterally,
[00:04:15] and I pushed medially on the same side temporal bone to give a little bit more overpressure.
[00:04:20] And it wasn't, it wasn't a lot of force, but I sustained that for about one to three minutes.
[00:04:24] I started off with some light oscillation, like pressure on, pressure off,
[00:04:27] almost like doing a lumbar side glide.
[00:04:31] And after this, she got a hundred percent relief.
[00:04:33] And I just continued to, I just told her to teach, I taught her the variation with the head,
[00:04:39] temporal force pushing medially.
[00:04:41] So she was really happy.
[00:04:43] And I learned a valuable lesson that you should give more credence to random YouTube videos
[00:04:48] every once in a while, especially when you are not getting anywhere with a patient.
[00:04:54] Let me know what you think of this case, or if you've ever run across,
[00:04:57] or if you do a similar technique yourself, especially for TMJ patients,
[00:05:00] or if you've ever heard of that coppery taste, which I thought was, again, an unusual complaint.
[00:05:04] As always, if you enjoyed this story, if you have, please rate Unsold Physio Stories five stars
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[00:05:15] And you guys have a great day.
[00:05:17] Thank you.