Is TMJ physio absolutely necessary post-op?

[fixmenow]

Hey All, My orthodontist refereed me to a TMJ Physiotherapist. I'm schedule to start on Feb 8th. At that point I'll be 7 weeks post-op. I don't have insurance and am currently between jobs so money is tight! The initial session costs $120 and the following sessions are $70.

How often should I expect to have to go, and for how long? I'd like to get an idea of what this will end up costing in total.

And is it absolutely necessary to go to a specialist? Or could I just start doing exercises on my own? Has anyone else done exercises on there own without seeing a specialist? How did it go?

I found some exercises online, they say to begin 24 hours after surgery, but it would appear I am over 6 weeks late

EXERCISES
The exercises that you are to perform after the surgery are critical for the success
of the procedure. They are to be started within 24 hours after the surgery. The following set of exercises need to be performed five or six times a day for 4 - 5 minutes each time:

1. With the index finger of your right hand on the lower teeth in the left side of your lower jaw and your thumb on your upper front teeth, use firm finger pressure in a scissors-like fashion to increase the opening of your mouth. The best method is to open your mouth as wide as you can, then place your fingers in your mouth, as just described, and perform the exercise.

2. Move your lower jaw as far to the right as possible. Then, move your lower jaw as far to the left as possible. Repeat this 25 times. You should be moving your lower jaw about 1/8 of an inch to each side by 2 days after the surgery and about 3/8 of an inch to each side by the sixth day after surgery. It may be necessary for you to apply pressure to the sides of your lower jaw with one of your hands to aid in doing this exercise.

3. Move your lower jaw forward, then return to the normal resting position of your lower jaw. Repeat this 20 times. By the second week after the surgery, you should be able to move your lower jaw forward, so that your lower front teeth are in front of your upper front teeth.

[Jawbreak]

Those exercises sound TERRIFYING for someone 24h out of surgery :O Holy crap. I wasn't even allowed to open my mouth for like 3 weeks. Also, I started doing these exercises after about 4 weeks and when I casually told my surgeon, he was mad at me and told me to stop immediately. It probably depends on the surgeon and your particular case though, I know mine said I had very thin bones so that may be why. But yeah, to anyone reading this, make sure to ask your surgeon before doing any exercises (otherwise he will yell at you, or other sinister things could happen haha).

I have no idea about a TMJ physiotherapist; my surgeon didn't mention any and I'm 8 weeks post-op. I do know that a friend of mine had the surgery done a few years ago, and before I went in, she told me that she always regretted not doing exercises or seeing a professional to help stretch out her jaw. She says it feels "stiff" to this day (which is why I started doing the exercises in the first place, but my surgeon wants me to start next week instead I think). Anyways, I would say ask your surgeon if you can go to the first session and then do the exericses by yourself after that. Maybe he'll explain better why he thinks they're important in your case and help you make a decision?

[jaime]

Wow this is the first time I've heard of a surgeon insisting on it. In my case, I had a lot of ROM problems after surgery and my surgeon referred me to a physiotherapist. It did help my get my opening back a bit, but I was still in elastics and so I sort of lost the progress I'd made when the physio appointments stopped (I continued wearing braces and elastics for about 4.5 months after physio).

In light of my experience with reduced ROM, I'm inclined to tell you to go for it, but if money is tight right now, I think it's something that can wait, and you can manage at home IF you're diligent about it.

FYI I just looked in my calendar for last year and I went to about 10 or 11 physio appointments.

[fixmenow]

Hey jawbreaker and jamie, thanks both for your responses.

Those exercises sound TERRIFYING for someone 24h out of surgery :O Holy crap.

THIS IS VERY TRUE and probably not the best source to go by. I am 6 and a half weeks post-op and I now have the green light to do exercises. I spoke to my surgeon on the phone today, and I've requested to see her before I start physio. I am going to talk to her to see if physio is absolutely necessary, and to see if she has any exercises she can recommend. Plus I need to see her because my bottom teeth seem slanted, and I am hoping this is something orthodontics can fix, and that my jaw isn't actually slanted. I am still swollen so right now it looks symmetrical.

But for all the thousands of dollars I've paid to fix my jaw (braces/surgery/gum graft etc.) Maybe I shouldn't cheap out on physio, I don't want to end up with a stiff jaw like your friend jawbreaker. I'm hoping the physiotherapist will be ok to see me once a month, I can afford that.

A few questions for you jamie
1. What are ROM problems?
2. Of the 10-11 physio appointments you had, how often did you go/for how long?

[Nozzelnut]

Holy cow!! I couldn't imagine doing those exercises 24 hours after double jaw surgery. From what I've read, single lower jaw to fix an underbite isn't that bad and those exercises might be possible.

BUT I wouldn't take any PT advice from the internet!

[jaime]

Hey fixmenow.

ROM = range of motion. So any kind of loss of movement you used to have with your jaw.

In my case, I lost the ability to move my lower jaw from side to side or stick it out. My jaw also opens wonky now, it veers off to the side. I also can't open as wide but that's slowly coming back. My PT appointments were to address the limited opening because it was affecting my ability to eat.

I think the appointments were maybe 15 minutes at the most. The PT would do some manual stretches to my jaw, then give me some directions for the week. I worked on stretching my jaw with popsicle sticks at home every night, as well.

As far as the appointments, I generally went once a week from April to August. Toward the end, we spaced out the appointments a little more to see if my progress stuck.

[fixmenow]

Thanks for clarifying jamie

My ROM is limited, when I try to move side to side it seems like I only move a few millimeters. As for eating I can't chew with my back teeth and the maximum I can open my mouth (on good days) is two fingers turned sideways.

How far into your recovery did you begin seeing a PT?
I'm going to go and try to have it so I only see him once a month, hopefully that won't be an issue, and he'll just give me loads of exercises to do on my own at home.

I am also still in elastics and will be for quite a while, but I figure if I get exercises to do on my own I won't lose progress like you did.

It did help my get my opening back a bit, but I was still in elastics and so I sort of lost the progress I'd made when the physio appointments stopped (I continued wearing braces and elastics for about 4.5 months after physio).

[jaime]

Thanks for clarifying jamie

My ROM is limited, when I try to move side to side it seems like I only move a few millimeters. As for eating I can't chew with my back teeth and the maximum I can open my mouth (on good days) is two fingers turned sideways.

How far into your recovery did you begin seeing a PT?
I'm going to go and try to have it so I only see him once a month, hopefully that won't be an issue, and he'll just give me loads of exercises to do on my own at home.

I am also still in elastics and will be for quite a while, but I figure if I get exercises to do on my own I won't lose progress like you did.

It did help my get my opening back a bit, but I was still in elastics and so I sort of lost the progress I'd made when the physio appointments stopped (I continued wearing braces and elastics for about 4.5 months after physio).

It's really important to be diligent about doing the home exercises so if you can keep those up, you should be okay. That's easier said than done, though.

I didn't go see a physio until I was 10 months post-op. I got the referral at 8 months post-op but I was in the midst of moving cities so I waited.

[fixmenow]

Just an update, I went to physio and was given 5 exercises to do at home daily. The nice thing is all of these exercises are easy and I won't be needing to go back for a month to a month and a half