This protocol addresses myogenous temporomandibular disorder — TMD in which jaw pain arises primarily from the muscles — in patients who have already undergone a structured course of adjunctive management but have not achieved adequate improvement.
The preceding treatment step combined multiple adjunctive approaches alongside self-management — including acupuncture or dry needling, splint therapy, low-level laser therapy, manual therapy, therapeutic exercise, cognitive behavioural therapy, and analgesics for acute exacerbation. The goals of that line were decreased pain and increased range of jaw movement and function. When those goals have not been achieved, escalation to this protocol is indicated.