Exercise-induced temporomandibular disorder in a young boxer managed successfully with physiotherapy: A detailed case report

INTRODUCTION

Temporomandibular joint disorder (TMD) represents a heterogeneous group of conditions involving the temporomandibular joint (TMJ), masticatory muscles, and associated structures, often presenting with pain, joint sounds, and functional limitations.^[1] It is estimated that a significant proportion of the population experiences TMD-related symptoms at some point in life, with varying degrees of severity.^[2]

Among the multiple etiological factors, parafunctional habits such as bruxism and clenching play a pivotal role in the development and progression of TMD.^[3] These habits result in excessive loading of the masticatory muscles and joint structures, leading to muscle fatigue, inflammation, and dysfunction.^[4]

In athletes, particularly those involved in high-intensity sports such as boxing and weightlifting, involuntary clenching during exertion is commonly observed. Despite its clinical relevance, this factor is often overlooked during diagnosis. Early recognition and management are essential to prevent chronicity and functional impairment.

Conservative management, including physiotherapy, is considered the first line of treatment for most TMD cases due to its non-invasive nature and proven effectiveness.^[5] This case report presents a young athlete with exercise-induced TMD successfully managed using physiotherapy.

CASE REPORT

Clinical examination

• Maximum mouth opening (MMO): 22 mm

• Pain score visual analog scale (VAS): 7/10

• Tenderness in bilateral masseter muscles

• No deviation or deflection during opening

• Absence of joint sounds such as clicking or crepitus.

The pre-treatment restricted mouth opening is shown in Figure 1.

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Figure 1: Pre-treatment intraoral photograph showing restricted mouth opening.

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These findings suggested a muscular origin of the disorder.

Outcome and follow-up

The patient was reassessed after 15 days.

Clinical outcomes

Clinical outcomes are summarized in Table 1

Table 1: Clinical outcomes before and after physiotherapy treatment.

Parameter	Before treatment	After treatment
Mouth opening	22 mm	38 mm
Pain (Visual analog scale)	7/10	2/10
Muscle tenderness	Present	Significantly reduced

Functional improvement

• Improved chewing efficiency

• Increased duration of comfortable mouth opening

• Reduced discomfort during daily activities.

Significant improvement after physiotherapy is shown in Figure 2.

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Figure 2: Post-treatment intraoral photograph demonstrating significant improvement in mouth opening following physiotherapy intervention.

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DISCUSSION

TMD is commonly associated with parafunctional activities that result in excessive loading of the masticatory system.^[3] In the present case, repeated clenching during physical exertion likely contributed to muscle overuse and subsequent spasm. Previous studies have demonstrated a strong association between parafunctional habits and TMD symptoms.^[3,7] Athletes engaged in high-intensity training are particularly susceptible due to repetitive muscle strain and increased functional demand.^[8]

The absence of structural abnormalities in radiographic examination supported a diagnosis of muscle-related TMD, which is consistent with findings reported in earlier literature.^[9]

Physiotherapy plays a crucial role in the management of TMD by:

• Reducing inflammation (cryotherapy)

• Promoting tissue repair (ultrasound therapy)

• Restoring joint function (mobilization techniques)

• Improving neuromuscular coordination (exercises).^[5,10]

Several studies have reported the effectiveness of conservative therapies in reducing pain and improving function in TMD patients.^[5,11]

The significant improvement observed in this case within a short duration reinforces the importance of early intervention and non-invasive treatment strategies.

CONCLUSION

Exercise-induced parafunctional habits, particularly forceful teeth clenching during high-intensity physical activities, represent an important yet often overlooked etiological factor in the development of TMD. This case underscores the critical role of comprehensive history-taking in identifying such contributing behaviors, especially in young athletes engaged in strenuous training.

The absence of structural abnormalities on radiographic examination, combined with clinical findings of restricted mouth opening and muscle tenderness, supported a diagnosis of myofascial pain of muscular origin, which is consistent with established diagnostic criteria and guidelines. The significant improvement observed in both objective parameters (MMO from 22 mm to 38 mm) and subjective symptoms (pain reduction from VAS 7/10 to 2/10) highlights the effectiveness of early, conservative intervention.

Physiotherapy, incorporating modalities such as cryotherapy, ultrasound therapy, joint mobilization, and targeted exercises, proved to be a reliable and non-invasive treatment strategy. These approaches not only alleviate pain but also restore functional jaw movements, as supported by studies demonstrating the efficacy of physiotherapeutic interventions in TMD management

From a clinical perspective, this case emphasizes that early identification and modification of causative parafunctional habits are essential for successful management, and conservative, multidisciplinary approaches should be considered as first-line treatment before opting for invasive procedures. Increased awareness among clinicians regarding exercise-related TMD can facilitate accurate diagnosis and timely intervention.

Furthermore, this report contributes to the growing body of evidence supporting physiotherapy as an effective modality in managing muscle-related TMD, particularly in physically active individuals. Future research with larger sample sizes is recommended to further validate these findings and establish standardized treatment protocols.