The Myalgia or Myofascial pain protocol (MFP) is a self-directed home-based (and sometimes office-based) treatment approach, which includes several elements such as identifying and avoiding activities that are potentially harmful to the jaw system, increasing local blood flow in the tissues, and stretching stiff and painful muscles to decrease postural tone in the sore muscle.
The goal of therapy is to reduce muscle tenderness, relax taut bands, and increase blood flow in the muscle so that pain will diminish.
Related Reading: Diagnostic Tests for Temporomandibular Disorders
The MFP Protocol
1. Avoidance of Strain
Avoid all behaviors that strain or stress the jaw system (clenching, pressing or bracing of the jaw, tongue or lips) and any repetitive behavior such as gum chewing or repeated opening of the jaw to clear the ear pressure. This is best achieved by watching the patient and pointing out to them any observable habits they have.
To achieve reduced strain in the jaw system, strict limitation of all behaviors that generate strain or stress in the muscles, tendons, joints or teeth must be enforced. The teeth should not touch, the lips should not press together and the tongue should not be braced or pressed against the teeth, gingiva or palate. In addition the patient must avoid all hard or chewy foods and yawning or clicking the jaw.
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2. Relaxing the Jaw
In addition to stopping oral habits, it is necessary to have the patient practice both a relaxed jaw position as a way of changing the unconscious habit and relaxed head, shoulder and neck position.
The relaxed jaw position is done by saying the letter “N” and then holding this position for 10 seconds. The jaw is relaxed, the teeth are not touching, the lips are slightly apart in the “N” position. This position needs to be repeated every 10 minutes.
The neck and shoulders are relaxed when you have good posture. This is achieved by pulling the shoulders back, touching the thumbs to the shoulders and slightly tucking the chin down towards the chest. As with jaw rest position, this position needs to be held for 10 seconds and repeated every 10 minutes.
3. Stretches and Exercises
The third element of self-treatment involves teaching the patient how to stretch their sore jaw and neck muscles multiple times a day. Clinical experience suggests stretch therapy is critical to treatment of spontaneous muscle pain and tension. When the muscles exhibit taut band and stiffness, it involves two specific exercises:
- Tongue-up/jaw open
- Chin-chest stretch
Once you teach the patient how to perform the stretch, it is possible for the patient to do this at home. Patients are recommended to perform these stretches every two hours.
Begin by having the patient sit on a comfortable chair. Take precautions to cover the patient’s eyes, nose and mouth if spraying near the face. Hold the spray can upright. From a distance of 12 to 18 inches (30 to 46 cm), aim the stream so it meets the skin at an acute angle, lessening the shock of impact. Direct the spray in parallel sweeps 0.5 inches to 1 inch (1.5 to 2 cm) apart at the rate of approximately 4 inches per second (10 cm per second). The number of sweeps is determined by muscle size.
A. Tongue-up/Jaw Open Stretch
For the “Tongue-up/Jaw Open Stretch”, begin with the tongue-up position (tongue up against anterior palate), then stretch the jaw open in a straight line without dropping the tongue from contact with the roof of the mouth.
B. Chin-to-Chest Stretch
For the “Chin-to-chest stretch”, ask the patient to slowly tilt their chin to their chest and then add a slight pressure to the head during the stretch by having the patient place their hand on top of their head during the stretch. These exercises should be avoided in patients with substantial osteoarthritis of the neck or jaw and trigger point injections used instead.
Related Reading: Trigger Point Mapping: Theory & Step-by-Step Technique
If the neck or jaw muscles are tight, the patient will feel the muscles being stretched. They should hold this open position for about 5-6 seconds and repeat the stretch about 5-6 times every 2 hours. If the stretching is painful, ice packs can be used before and again after the stretching program to help the patient stretch more effectively. The ice pack is applied to the site for 1 minute before to block the pain and for 5 minutes after (see thermal therapy below) to increase deep tissue circulation.
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4. Thermal Therapy
Another element of the MFP protocol is thermal therapy, which involves trying to increase blood flow in the painful jaw muscles with the local application of either heat or ice packs applied to the painful site. The local application of heat or ice will both increase circulation and relax muscles in the region. Cold applications rather than heat are preferred by some patients.
The diagnoses that would link with this treatment procedure or protocol includes:
- Localized myalgia
- Myofascial pain
- Fibromyalgia
Related Reading: How to Diagnose Masticatory Muscle Disorders
Daily Stretching of Contracted or Fibrosed Jaw Muscles
The primary method for treating a muscle contracture or fibrosis which can occur spontaneously or more commonly after a trauma (e.g. intra-muscular injection of a local anesthetic), is stretching. In some select cases where a focal fibrosis is found, surgical release of the fibrosis can also be performed.
The only way to reverse a muscular or fascial fibrosis is with strong repeated stretching, but in some cases this treatment is ineffective simply due to the extent of the fibrosis. In other cases the stretching induces substantial pain that prevents the patient from performing the stretch. In these cases, stretching can be done for the patient in a surgical setting (after sedating the patient).
This treatment can be performed using a variety of methods including the patient’s own fingers, a set of stacked tongue blades, and an assistive stretching device (e.g. Therabyte device). All of these methods are used to pry open the jaw muscles and mobilize the TM joint.
The diagnoses that would link with this treatment procedure or protocol includes:
- Persistent trismus
- Contracture
- Post-surgical scaring of the facial cutaneous or subcutaneous tissues
Related Reading: Arthritic Temporomandibular Joint Disorders
Postgraduate Orofacial Pain and Oral Medicine Master’s Degree
Learn more about diagnosing, treating, and managing orofacial pain by enrolling in Herman Ostrow School of USC’s online, competency-based certificate or master’s program in Orofacial Pain and Oral Medicine.
