Patients at group A: patients will receive Rocabado exercises plus transcutaneous
electrical nerve stimulation and traditional exercises For 8 weeks : Rocabado exercises
form of 2 parts , 6×6×6 exercises and mobilization exercises part (1): 6×6×6 exercises
are (1).The rest position of the tongue , (2). Shoulder retraction exercises, (3).
Stabilized head flexion ,( 4). The axial extension of the neck , (5).Control of TMJ
rotation , (6).Rhythmic stabilization technique .these 6 exercises are repeated 6 times a
day for 20 minutes for each repetition.
part (2): Joint mobilization (non-thrust manipulation) includes Distraction, Distraction
given with anterior glide, Distraction given with anterior and lateral glide right/left &
Lateral glide without distraction. . These mobilization exercises is done by the
therapist 3 times a week for 20 min ,each mobilization is performed for 10-15 times and
repeated for 5-6 times.
Transcutaneous electrical nerve stimulation device(TENS):
TENS is used, with a maximum frequency of 120 Hz and an intensity range of 0 to 99.5 mA
and the pulse width is between 50-200 microseconds.
TENS electrodes (diameter 35-52 mm) are placed bilaterally on mandibular elevator
muscles, on the superficial masseter muscle above the gonial angle, and bilaterally on
the upper back (Cacho et al.,2022).
The TENS will be applied for 20 min 2 sessions/week for 8 weeks.
Traditional exercises are passive , active Rom exercises and massage, these exercises are
performed for 30 minutes and repeated 2 times daily.
Passive ROM exercises are done by stacked tongue depressors and number of tongue
depressors are increased when improvement occur .
Active Rom exercises are mouth opening and closing ,side way movement and protrusion
repeated for 10-15 times with holding for 5 seconds for each position.
Massaging for cheeks muscles for 2minutes .
Patients at group B: patients will receive Rocabado exercises and traditional exercises
For 8 weeks : Rocabado exercises form of 2 parts , 6×6×6 exercises and mobilization
exercises part (1): 6×6×6 exercises are (1).The rest position of the tongue ,(2).
Shoulder retraction exercises, (3) .Stabilized head flexion , (4).The axial extension of
the neck , (5).Control of TMJ rotation ,( 6).Rhythmic stabilization technique .these 6
exercises are repeated 6 times a day for 20 min for each repetition.
part(2): Joint mobilization (non-thrust manipulation) includes Distraction, Distraction
given with anterior glide, Distraction given with anterior and lateral glide right/left &
Lateral glide without distraction. . These mobilization exercises is done by the
therapist 3 times a week for 20 min ,each mobilization is performed for 10-15 times and
repeated for 5-6 times.
Traditional exercises are passive , active Rom exercises and massage, these exercises are
performed for 30 minutes and repeated 2 times daily.
Passive ROM exercises are done by stacked tongue depressors and number of tongue
depressors are increased when improvement occur .
Active Rom exercises are mouth opening and closing ,side way movement and protrusion
repeated for 10-15 times with holding for 5 seconds for each position.
Massaging for cheeks for 2minutes .
patients at group C: patient will receive Transcutaneous electrical nerve stimulation
device(TENS) and traditional exercises: TENS is used, with a maximum frequency of 120 Hz
and an intensity range of 0 to 99.5 mA and the pulse width is between 50-200
microseconds.
TENS electrodes (diameter 35-52 mm) are placed bilaterally on mandibular elevator
muscles, on the superficial masseter muscle above the gonial angle, and bilaterally on
the upper back (Cacho et al.,2022).
The TENS will be applied for 20 min 2 sessions/week for 8 weeks.
Traditional exercises are passive , active Rom exercises and massage, these exercises are
performed for 30 minutes and repeated 2 times daily.
Passive ROM exercises are done by stacked tongue depressors and number of tongue
depressors are increased when improvement occur .
Active Rom exercises are mouth opening and closing ,side way movement and protrusion
repeated for 10-15 times with holding for 5 seconds for each position.
Massaging for cheeks for 2 minutes .