**6. TMJ management (TENS)**

Only 5–10% of patients require treatment for TMD, and 40% of patients have spontaneous resolutions of symptoms. In a long-term follow-up study, 50–90% of patients had pain relief after conservative therapy. There is evidence that supports the use of physical therapy for improving symptoms associated with TMD. TENS is one of such treatment modalities that merit unique consideration and it is one of the safest and most inexpensive modalities that are used to control both chronic and acute pains.

TENS FOR TMJ

TENS is a well-known physical therapy, which is useful for the relief of pain. Transcutaneous electrical nerve stimulation (TENS) is one of the most effective physical therapy techniques. TENS is the application of low-frequency current in form of pulsed rectangular currents through surface electrodes on the patient's skin to reduce pain.

Principles

TENS works on the principle that electrical stimulation is directed to pain areas *via* surface electrodes, and current passes through these areas, which reduces or eliminates pain. It is safe and non-invasive and effective method. Electrodes made of silicon are used for TENS. They are placed at the area with the highest pain, in the same dermatome, myotomes and/or myofascial trigger points. They can also be placed on the course or on the supplied muscles of the corresponding peripheral nerve.

**Patient's position**: sitting.

**Therapist position**: standing behind the patient. **Method:** direct method. **Electrode placement**: TM joint and nape of neck. **Pulse duration**: 50–200 μs. **Frequency:** 50 mA–100 mA. **Duration:** 15 min.
