Manual Therapy for TMJ Dysfunction Furto Joshua Whitman

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ABSTRACT: The purpose of this study was to investigate the outcome of a series of consecutive

patients with temporomandibular disorder (TMD) who were treated with manual physical therapy inter-

ventions and exercise. Consecutive patients with the clinical presentation of TMD completed several

self-report measures and underwent a standardized historical and physical examination. Following the

examination, patients received a multimodal treatment approach incorporating manual physical therapy

and exercise. All self-report questionnaires were completed at a 2-week follow-up. Paired t-tests were

performed between the baseline and 2-week follow-up scores. The mean TMD Disability Index scoreswere 32.1% (15.4%) at baseline and 18.3% (12.5%) at the 2-week follow-up, representing an improve-

ment of 13.9% (CI: 8.2%, 19.5%) (p<0.05). Patient Specific Functional Scale (PSFS) scores improved

3.1 points (CI: 2.3, 3.9) (p<0.05). These results suggest that patients with TMD who are treated with a

rehabilitation program including manual physical therapy interventions plus exercise, with or without

iontophoresis with dexamethasone, can demonstrate clinically meaningful improvements in disability

and overall perceived change in a relatively short period of time.

Eric Furto is a physical therapist in the Newsome Physical Therapy Center in

Plainfield, Illinois and is on faculty at theUniversity of St. Augustine for HealthSciences in St. Augustine, Florida. He

obtained his bachelor of physical therapydegree in 2000 from Northern Illinois

University. Additionally, Mr. Furto servesas a continuing education instructor onspinal manipulation for the University of

St. Augustine.

Over ten million people in the United States sufferfrom temporomandibular disorders (TMD).1

Temporomandibular disorders are classified as a

musculoskeletal condition resulting in craniofacial pain,

functional limitations and disability.2 Symptoms associ-

ated with TMD can include temporomandibular joint

(TMJ) pain, decreased jaw mobility, joint clicking,

headaches, neck pain, tinnitus, and pain of the intraoral

structures.3 Temporomandibular disorders may be the

result of osteoarthritic degeneration, disk dislocation, or

involuntary guarding of the muscles of mastication.3

The debate surrounding the effectiveness of surgical

intervention for TMD has led many patients to seek con-servative care for the management of their pain and asso-

ciated loss of function.4,5 A retrospective cohort study by

Godden, et al.5 revealed that only 50% of patients who

underwent a TMJ arthroplasty viewed their outcomes as

favorable. These outcomes were obtained through a six

year follow-up survey and demonstrated that patients

experienced a reduction in pain, as measured with the

visual analog scale, to within 75% of normal; however,

the majority of patients still reported their jaw opening

was restricted (66%).5 These outcomes were determined

Manual Physical Therapy Interventions and Exercise

for Patients with Temporomandibular Disorders

Eric S. Furto, P.T.; Joshua A. Cleland, D.P.T., Ph.D.; Julie M. Whitman, P.T., D.Sc.;

Kenneth A. Olson, P.T., D.H.Sc.

PHYSICAL THERAPY

Manuscript receivedMarch 16, 2006; revisedmanuscript receivedJuly 10, 2006; acceptedAugust 1, 2006

Address for reprint requests:Eric S. Furto, P.T.Newsome Rehabilitation, Inc.920 Essington Rd.Joliet, IL 60544E-mail: [email protected]



based on subjective interpretations when they were asked

if they were prepared to undergo a further arthroscopy.

Conservative treatment options for TMD include

occlusion correction with the use of intraoral appliances,

orthodontics, cortisone injections, and joint manipula-

tion.3,5,6 Theoretically, intraoral appliances are used tocreate a natural resting position of the mandible, which in

turn should inhibit excessive tension in the muscles of

mastication and relieve pain and improve function.6

However, a decrease in pain does not necessarily corre-

late with an increase in range of motion (ROM) or

improvements in jaw function.5

Manual therapy directed at the TMJ combined with

exercise has been shown to be superior to treatment with

soft repositioning splint therapy in the management of

patients with radiographically confirmed anterior dis-

placed temporomandibular disk syndrome (ADTMD).7

In this study, the manual therapy combined with activeexercise group demonstrated significant reductions in

pain and increases in ROM, while the soft repositioning

splint group failed to show significant changes in either

dependent measure.7

Physical therapy management of TMD often consists

of manual therapy including TMJ and cervical/thoracic

spine mobilization/manipulation, soft tissue mobiliza-

tion, postural education/ergonomics, therapeutic exer-

cises for neuromuscular stabilization of the TMJ, and

physical modalities, such as iontophoresis, electrical

stimulation, or ultrasound.6 Rocabado6 has described

techniques to facilitate neuromuscular stabilizationthrough the use of repetitive lateral deviation motions

purportedly used to assist with mobility. Theoretically,

the muscles of mastication are then recruited to apply a

compressive force to the disk, thereby improving the

condylar-disk-eminence congruency and ultimately

improving function.6 These techniques can also be used

as a proprioceptive exercise to increase functional mobil-

ity with lowered pain response.6 However, limited evi-

dence exists to support such a treatment approach.

Only preliminary evidence exists to support the use of

manual physical therapy in the treatment of TMD.8-10 In a

single case design, Cleland, et al.9

described the outcomeof a patient with anterior bilateral disk displacement who

was treated with a combination of manual physical ther-

apy, exercise, and patient education.9 Over eight visits,

the patient achieved a reduction in pain of 48.8 mm on the

visual analog scale, an increase in mandibular depression

of 17.5 mm, and marked improvements in all three scales

of the Steigerwald/Maher TMD disability question-

naire.9,11 In a case series of 20 patients with TMD who

received TMJ exercises, postural education, and relax-

ation techniques, 16 participants experienced a complete

resolution of pain, 13 a full return to function, and only

three patients had continued ROM limitations at a six

month follow-up.8,10 Furthermore, data collected on these

patients at a 12-month follow-up visit continued to sug-

gest favorable results for the use of exercise and manual

therapy in the management of TMD.The evidence available regarding noninvasive care for

patients with TMD is sparse, and the literature is limited

by methodological shortcomings. Future studies should

ultimately examine clinical outcomes for patients prospec-

tively, including detailed descriptions of interventions

provided, use of well-defined self-report instruments to

capture levels of disability, and including a comparison

group. The current study is the first step in this process.

The purpose of this pilot study is to report clinical out-

comes (pain, disability, and function) for a series of

patients with TMD treated with manual physical therapy,

therapeutic exercise, and iontophoresis. The results of this pilot work will facilitate the design of future random-

ized controlled trials, as well as develop further hypothe-

sis formation.

Materials and Methods

During a six month period, fifteen participants were

recruited for participation in this case series (14 females).

Consecutive subjects referred to Northern Rehabilitation

and Sports Medicine Associates in DeKalb, IL with non-

specific orofacial pain were examined for eligibility crite-

ria over a 6-month period. All patients were referred fromlocal dentists, ear-eye-nose-throat physicians, and/or

general practitioners with a diagnosis of TMD or orofa-

cial pain. Eligible patients had to present with a primary

report of pain in the temporomandibular region. Eligible

patients could also exhibit cervical or thoracic spine pain,

headaches, radicular pain, and/or shoulder pain; however,

their most bothersome area had to be the TMJ. Exclusion

criteria included post surgical conditions involving the

neck or temporomandibular region. All examination and

treatment procedures in this case series were performed

by two physical therapists. Both therapists were trained in

the examination and treatment of TMD as a requirementof an American Physical Therapy Association creden-

tialed and American Acad-emy of Orthopaedic Manual

Physical Therapists recognized Manual Therapy

Fellowship Program. All participants signed an informed

consent approved by the Institutional Review Board at

Franklin Pierce College, Concord, NH prior to the initial

evaluation.

Data Collection

Prior to the initial examination, all participants com-

pleted a number of self-report questionnaires including:

PT INTERVENTIONS FOR TMD PATIENTS FURTO ET AL.

2 THE JOURNAL OF CRANIOMANDIBULAR PRACTICE OCTOBER 2006, VOL. 24, NO. 4



the TMD Disability Index, two pain diagrams and the

Numeric Pain Rating Scale (NPRS). The TMD Disability

Index consists of ten questions regarding disability asso-

ciated with TMD, and each question is scored from 0-4.

Higher scores represent greater levels of disability. The

psychometric properties of this questionnaire have notbeen reported. The NPRS was used to capture the patient’s

level of pain. Patients were asked to indicate the intensity

of current, best, and worst levels of pain over the past 24

hours using an 11-point scale ranging from 0 (no pain) to

10 (worst pain imaginable).12-14 The average of the three

ratings was used to represent the patient’s level of pain

over the previous 24 hours. In addition, all patients com-

pleted the Patient Specific Functional Scale (PSFS).15

The PSFS is a patient-specific outcome measure, which

investigates functional status by asking the patient to

nominate activities that are difficult to perform based on

their condition, and rate the level of limitation with eachactivity. The patient rates each activity on a 0-10 scale,

with 0 representing the inability to perform the activity,

and 10 representing the ability to perform the activity

as well as they could prior to the onset of symptoms.16

The PSFS has been shown to identify changes in status

and to be valid and responsive to change for patients with

various clinical conditions, including neck pain,16 cervi-

cal radiculopathy,17 knee pain,18 and low back pain,15

however, the PSFS has not been used to study patients

with TMD.

Following the completion of the self-report measures,

the patient’s therapist performed a standardized historicaland physical examination. The historical examination

consisted of recording the patient’s age, gender, past

medical history, symptom location (with the use of

a body diagram), duration and nature of symptoms,

relieving/aggravating activities, and prior episodes of

TMJ pain.

The physical examination consisted of a comprehen-

sive evaluation of the TMJ and the upper quarter. Quantity

and quality of the bilateral active and passive TMJ, cervi-

cal, and thoracic mobility were assessed as described by

Paris.19,20 Active range of motion was assessed visually

by asking the patient to initially maneuver his/her cervi-cal spine throughout the cardinal planes, followed by an

assessment of the thoracic spine.19,20 Passive mobility of

the cervical spine was assessed by applying overpressure

in the direction of the ROM being tested actively.19,20

Temporomandibular joint active range of motion was

assessed by asking the patient to actively depress the

mandible, laterally deviate the mandible bilaterally, and

protrude the mandible.6,22 The motion was quantified in

millimeters utilizing a millimeter ruler between the cen-

tral incisors of the mandibular and maxillary row.6,22

Passive overpressure was not applied for the TMJ. The

quality of the motion was also assessed for compensatory

motions, visible through lateral condylar motion, through-

out the range. Accessory motion and joint play of the

TMJ, cervical spine and thoracic spine were also assessed

in combination with the patient’s pain response (eitherincreased symptoms, no change, or decreased symp-

toms).19,20 Each cervical and thoracic vertebral segment

was assessed for passive intervertebral mobility. 19,20

Capsular mobility of the temporomandibular joint was

assessed by applying a long axis distraction through the

mandible for six repetitions.6,22

Other assessments applied included an anterior

mandibular glide, a medial mandibular glide, and a lateral

mandibular glide.6,22 Mobility was graded on a 0 to 6

scale with three indicating normal capsular mobility, six

being unstable, and zero being ankylosed.19,20 Tissue

tension and flexibility were assessed for the cervicalmusculature, posterior subcranial musculature, and the

lateral pterygoid muscles.21,22 Occlusion was also assessed

by the evaluating physical therapist using maximal inter-

cuspation (MIC). MIC assesses the closed pack position

of the TMJ after swallowing. The patient is asked to bring

his/her teeth together with maximal force through biting.

The physical therapist can then assess the role the

neuromusculoskeletal system will have with maximal

muscle contraction (i.e., biting into food).6 Similar to that

of a patient with rotator cuff pathology, the neuromuscu-

lar control of the musculature surrounding the TMJ can

have an effect on the biomechanics of the mandible anddirectly affect MIC. The MIC can be compared to the

loose pack position of the mandible, or freeway space,

where the teeth rest together without biting.6,22 If there

is a shift with biting during MIC, the neuromuscular con-

trol of the muscles of the TMJ are likely participating in

the pathology.6,22

Interventions

The patient’s therapist used an impairment-based

manual physical therapy approach for the treatment of the

TMJ, cervical spine, thoracic spine, posture, and the use

of iontophoresis as indicated. In an impairment-basedmodel of care, the therapist prioritizes identified physical

impairments in the order of hypothesized importance or

contribution to the patient’s disorder. The therapist then

provides treatment, or interventions, targeting these iden-

tified physical impairments, such as joint mobility restric-

tions, muscle length limitations, postural limitations and

neuromuscular deficits.

Manual physical therapy directed at identified impair-

ments of the cervical spine consisted of nonthrust manip-

ulations for facet upglides and downglides to facilitate

FURTO ET AL. PT INTERVENTIONS FOR TMD PATIENTS

OCTOBER 2006, VOL. 24, NO. 4 THE JOURNAL OF CRANIOMANDIBULAR PRACTICE 3



normal facet joint motion, subcranial forward bending

and sidebending non-thrust manipulations, and subcra-

nial myofascial distraction.19,20 Stretches to the surround-

ing cervical musculature were also applied as described

by Kendal.21 Non-thrust temporomandibular joint manip-

ulations consisted of long axis distraction, medial glide,and lateral glide as described by Rocabado.22 Acupressure

techniques were also applied to the lateral pterygoid mus-

culature.22 All treatment applications are described in

Table 1.

Each patient was instructed in a condylar remodeling

exercise program as described by Rocabado.22 Phase one

of this program consists of painfree lateral deviation

away from the side of pain or hypermobility as deter-

mined with accessory motion testing with a 0.5 inch piece

of surgical tubing resting between the mandibular and

maxillary row of teeth. If pain is bilateral, the device is

maneuvered away from the side of greatest hypermobil-ity. If painfree, a bite is incorporated.6 The patient was

instructed to release the contraction before returning to

midline. The third phase consists of the same submaximal

contraction as phase two, but the contraction is main-

tained until the tubing returns to midline. The fourth

through sixth phases are similar to phases one through

three, but are performed for protrusion rather than lateraldeviation. Patients were instructed to perform six repeti-

tions every two hours3 (see Appendix). The exercise

program was reviewed at each treatment session. The

exercise program focused on ROM and stability exercises

for all patients suspected to exhibit anterolateral disk

translation during the clinical examination (n=8). The lat-

eral deviation motion that accompanies the condylar

reeducation exercise program has been purported to

enhance mobility throughout the range of motion. This

program can be converted to a controlled neuromuscular

stabilization exercise program by incorporating and

maintaining a bite throughout the ROM.22

In addition to the aforementioned interventions, ion-

tophoresis with dexamathasone was incorporated with

patients where ROM was restricted primarily due to pain

(less than 20 mm of mandibular opening). An aqueous

solution of 2.5 cc dexamethasone was applied superfi-

cially at 40 milliamps minutes to the affected TMJ. The

treatment was applied for fifteen minutes and then

removed.

Follow-Up

At the two-week follow-up visits, all patients again

completed the TMD Disability Index, PSFS, body dia-grams, and NPRS. In addition, all patients completed the

Global Rating of Change scale.23 Patients were asked to

rate their overall perception of improvement since begin-

ning physical therapy on a scale ranging from –7 (a very

great deal worse) to zero (about the same) to +7 (a very

great deal better). It is recommended that scores on the

GROC between ±1 and ±3 represent small changes,

scores between ±4 and ±5 represent moderate changes,

and scores of ±6 or ±7 convey large changes in patient

status.23

Statistical Analysis

Descriptive information including patient gender, age,

duration of symptoms, number of physical therapy visits,

and interventions provided was recorded for all patients.

The mean change score and associated 95% confidence

intervals were calculated for all outcome measures

assessed at baseline and at the 2-week follow-up. Paired

t-tests were performed between the baseline and 2-week

follow-up scores (α=0.05) to evaluate if the change expe-

rienced was significant over time.



Table 1

Descriptive Characteristics of ParticipatingPatients at Baseline (N=15)

Number (%)Variable of Patients*

Age (years), mean (SD) 50.5 (15.5)

Sex - female 14 (93%)- male 1 (7%)Race - Caucasian 15 (100%)Median duration of

TMD symptoms (range) 6 mos. (0.07-120)Depression (self-report) 6 (40%)Symptom descriptions

TMJ region symptoms 15 (100%)- bilateral 3 (20%)- painful 13 (87%)- sharp 3 (20%)- dull 2 (13%)- aching 13 (87%)

Headache symptoms 13 (87%)- median duration

symptoms (range) 6 mos. (0.07-60)- dizziness associated

with headache 2 (13%)Cervical spine symptoms 9 (60%)

- median durationsymptoms (range) 30 mos. (2-252)

- bilateral symptoms 6 (40%)Thoracic spine symptoms 7 (47%)Upper extremity symptoms 5 (33%)

- bilateral symptoms 2 (13%)*n (%) provided unless otherwise noted



Results

All participants were asked to complete the TMD

Disability Index, with three (20%) participants electing to

bypass the question regarding the level of sexual function

limitation. Demographics for all patients can be found inTable 1. The median length of symptoms in the region of

the TMJ was six months (range 0.07-120 months).

Thirteen (87%) of the patients also experienced headache

symptoms with the median duration also being six months

(range 0.07 to 60 months). As recorded by the PSFS, the

following percentage of patients noted difficulty chew-

ing, yawning, talking, and opening the jaw, respectively:

15 (100%), seven (47%), four (27%), and one (7%). At

the two-week follow-up session, the group had received a

mean of 4.3 physical therapy intervention sessions.

Specific interventions received can be found in Table 2.

The mean TMD Disability Index scores were 32.1% atbaseline and 18.3% at the 2-week follow up, representing

an improvement of 13.9% (CI: 8.2%, 19.5%) (p<0.05)

(Figure 1). Eleven patients (73%) reported they were

somewhat better to a very great deal better on the GROC

(Table 3), and Patient Specific Functional Scale (PSFS)

scores improved 3.1 points (CI: 2.3, 3.9) (p<0.05) (Figure

2).

Discussion

There currently is a lack of conclusive evidence to sup-

port the use of conservative management strategies in themanagement of TMD. The purpose of this study was to

describe the outcomes of a cohort of patients undergoing

physical therapy management of their TMD. Outcomes

were favorable for all patients in this study and are simi-

lar to findings of Nicolakis, et al.8 who provided a six and

twelve month follow-up supporting the use of manual

therapy and exercise with a case series of twenty patients

with TMD.10 Interventions used in the Nicolakis, et al.8

study were similar this study and included nonthrust

manipulative therapy directed at the TMJ and an isomet-

ric exercise program aimed at maximizing stability of the

TMJ.We have provided a detailed description of the inter-

ventions used to treat TMD in this pilot study and used

physical impairment as well as self-report outcomes to

capture the patient’s levels of pain and disability. Our

patients, similar to those in the Nicolakis, et al.8 case

series, demonstrated an overall reduction in pain and

improvement in function following two weeks of physi-

cal therapy management. During a six-month period, fif-

teen participants received intervention for their TMD

complaints.10 Of the 15 patients treated in this pilot study,

13 also experienced headache symptoms at the time of the initial examination. It is hypothesized that poor pos-

ture with increased posterior rotation of the cranium on

the atlas will place undue strain on the posterior occipital

musculature.6,22 This strain may impinge upon the greater

occipital nerve and may result in referred pain into the

craniofacial region, most typically into the distribution of

the trigeminal nerve.24 In a study by Aprill, et al.25 it was

discovered that 21 of 34 participants who underwent a

nerve block to C1/C2 experienced complete resolution of

their headache symptoms. These findings are indicative

of the comorbidity between TMJ pain and headache and

may also support the possibility of referred pain to theTMJ from the subcranial spine. Therefore, it is possible

that participants in the study may have not experienced

symptoms related to the TMJ, but they could also have

been experiencing symptoms referred from the cervical

spine.

The exercise program used in this pilot study was

aimed at neuromuscular reeducation of the musculature

surrounding the temporomandibular joint (Appendix).

The exercises prescribed to each patient used a piece of

tubing in a similar fashion to that of an anterior loading

splint.6 The piece of tubing was placed between the

incisors and a series of motions were performed and com-bined with biting. Once the patient was able to perform

painfree lateral deviation with the exercise program, they

were instructed to perform protrusion. Lateral deviation

is typically performed initially to ensure appropriate

ROM of the affected TMJ before recruiting the opposite

joint during protrusion. The patients were instructed to

perform the exercises in a pain free fashion, every two

hours to enhance functional joint stability.6

Exercise has been shown to be effective in the man-

agement of TMD. In a randomized clinical trial, Yoda, et



Table 2

Number (Percentage) of Patients (n=15) TreatedWith Various Physical Therapy Interventions

Number (%)Manual technique of Patients

Cervical spine manipulation- subcranial (occiput-C2) 11 (73%)- cervical spine (C2-C7) 6 (40%)

TMJ manipulation 15 (100%)Thoracic spine manipulation 4 (27%)Postural education 12 (80%)Iontophoresis to the TMJ 5 (33%)



al.26 compared an exercise program to education on the

condition for patients with anterior disk displacement

with reduction (ADDWR). The results demonstrated that

the exercise group had statistically significant better out-

comes for decreased pain and increased ROM (p=0.0001).

Forty-two patients participated in the study, of which

61.9% of the exercise group had favorable outcomes

(13/21 patients), while 0% of the control group had favor-able results.26 Success was measured on the severity of

joint sounds and/or pain with maximal mouth opening.

Of the 13 patients that experienced a successful outcome,

only 23.1% (three) of the patient’s TMJ disks were actu-

ally recaptured when reexamined on MRI. The authors

reported that the 61.9% success rate experienced by the

exercise group is similar to that of splint therapy but is a

more cost effective option.26

The exercises proposed by Yoda, et al.26 differ fromthose proposed by Rocabado22 in that maximal ROM is



Figure 1TMD Disability Index scores at baseline

and at 2-week follow-up.

Figure 2Patient Specific Functional Scale scores atbaseline and at 2-week follow-up.



required in the Yoda approach from the initiation of the

exercise program. In many cases, painful ROM is the

reason for consultation by a physical therapist, thus

making maximal ROM to the point of reduction a diffi-

cult starting point for the initiation of exercises. The pro-

gram described by Rocabado22 and used in the currentstudy encourages small ranges of motion into lateral

deviation, which may accomplish the same objective:

reduced pain and improved function. While research

exists to support the use of exercise in the management of

TMD, limited evidence exists to support the specific

exercise regimen used in this study.6,26,27

Additionally, we included the use of iontophoresis

with dexamethasone in the treatment of patients within

this pilot study. While dexemethasone has been demon-

strated to be effective in reducing pain and inflammation,

the delivery method of iontophoresis has been ques-

tioned. In a study by Majwer, et al.,28 27 of 32 cases of post-traumatic TMD benefited with decreased pain from

the application of dexamethasone (n=8) or xylocane

(n=24) through iontophoresis. Since different medica-

tions were used, it is possible that the patients benefited

most from the electrical stimulation of the iontophoresis

rather than the medication itself.

The present study allows for hypothesis formulation

and the development of a future randomized clinical trial.

Follow-up studies should include examining the effec-

tiveness of exercise and manual physical therapy when

compared to other conservative treatment approaches.

The patients in this study exhibited positive outcomesafter receiving only two weeks of the above described

multimodal physical therapy treatment regimen.

Limitations of the current study include the lack of a

control or comparison group which precludes the abil-

ity to infer a cause and effect relationship between the

treatment and outcomes, as well as, only short-term out-

comes are provided in this report. It is the aim of the

authors to identify the long-term effects of the treatment

interventions used in this pilot study and determine if a

specific subgroup of patients with TMD exists that would

be most likely to benefit from exercise and manual phys-

ical therapy.

Conclusion

The results of this study demonstrate that physical

therapy intervention consisting of manual therapy, a

specific exercise program, and iontophoresis with

dexamethasone can be beneficial to patients presenting

with symptoms similar to that of TMD. Future research

should focus on the specific interventions as described

above to determine the most beneficial form of treatment.

Clinical decision making rules may also be established to

enhance the identification of particular patients that are

likely to respond rapidly and dramatically to specific

interventions.

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Appendix



Dr. Joshua A. Cleland is currently an assistant professor at FranklinePierce College and is the research coordinator at Rehabilitation Servicesof Concord Hospital. He recently completed a fellowship in the manual

therapy program through Regis University in Denver, Colorado. Dr.

Cleland’s research interest includes investigating the effectiveness of manual therapy and exercise in patients with extremity and spinal disor-ders. He recently authored a text on the orthopedic clinical examinationand has published numerous articles in peer reviewed journals.

Dr. Julie M. Whitman is an assistant professor in the Department of Physical Therapy at Regis University in Denver, Colorado. She received

an M.P.T. degree from the U.S. Army-Baylor University GraduateProgram in Physical Therapy from Baylor University in 2001. Shecompleted a manual physical therapy residency program in 2000 and has

over 12 years of primary care physical therapy experience in the civilianand military environments. Dr. Whitman is actively involved in clinicalresearch relating to orthopedic/manual physical therapies for muscu-

loskeletal disorders and has over 20 publications in these areas.

Dr. Kenneth A. Olson is president of the physical therapy private

practice, Northern Rehabilitation and Sports Medicine Associates in DeKalb, Illinois. Dr. Olson is also a guest lecturer at Marquette

University and serves as a mentor for the University of St. Augustine Manual Therapy Fellowship program. He graduated with a B.S.P.T. from Northern Illinois University, a Master of Science in orthopedic

physical therapy from the University of St. Augustine, and a Doctor of Health Science USA. He is also a graduate of the USA Manual Therapy

Fellowship Program.



Documents

Manual Therapy for TMJ Dysfunction Furto Joshua Whitman