Physiotherapy Guide: Trigeminal Neuralgia

Physiotherapy can play a supportive role in managing trigeminal neuralgia (TN), although it is not typically the primary treatment. The main goal of physiotherapy is to improve quality of life, reduce pain, and help with the management of symptoms. Here’s how physiotherapy can help: 

1. Pain Management and Reduction 

Physiotherapists can use various manual therapy techniques to help alleviate pain, particularly if the trigeminal neuralgia is associated with muscular tension or trigger points in the face or jaw. These techniques may include: 

• Gentle massage: Targeting areas of muscle tension around the jaw, neck, and shoulders to reduce discomfort and ease muscle spasms. 

• Myofascial release: A technique aimed at releasing tightness in the fascia (connective tissue) that could contribute to muscle tension and discomfort. 

• Stretching exercises: To improve flexibility and reduce stiffness in muscles around the head and neck that may be exacerbating the pain. 

2. Jaw Alignment and Mobilisation 

In cases where trigeminal neuralgia may be linked to dental or jaw issues, such as temporo-mandibular joint (TMJ) dysfunction, physiotherapists can work on improving jaw alignment and mobility. Techniques may include: 

• TMJ mobilisation exercises: To gently realign the jaw and reduce tension that could be contributing to nerve irritation. 

• Postural correction: Addressing any poor posture that might affect the neck and jaw, which could indirectly relieve pressure on the trigeminal nerve. 

3. Breathing Exercises 

Chronic pain, such as that associated with trigeminal neuralgia, can lead to tension and stress, which can worsen symptoms. Physiotherapists can guide patients through relaxation and breathing exercises, such as diaphragmatic breathing or deep breathing techniques, to help manage stress and reduce pain sensitivity. 

4. Desensitisation Techniques 

Some people with trigeminal neuralgia experience hypersensitivity or allodynia (pain from stimuli that usually wouldn’t cause pain, such as touch or wind). Physiotherapists can teach desensitisation exercises, which involve gradually exposing the skin in affected areas to varying stimuli in a controlled way. This can help reduce the sensitivity over time. 

5. Education on Lifestyle and Trigger Avoidance 

A physiotherapist can provide guidance on avoiding triggers that could exacerbate trigeminal neuralgia symptoms, such as: 

• Managing posture to avoid jaw strain. 

• Avoiding excessive facial movements that may irritate the trigeminal nerve. 

• Optimising ergonomics at home and work to reduce muscle strain on the neck and face. 

6. Neurodynamic Techniques 

Physiotherapists trained in neurodynamics can use techniques that involve nerve gliding exercises. These exercises can help reduce any nerve tension or irritation, although this approach is generally more useful for conditions involving nerve entrapment rather than nerve compression as seen in trigeminal neuralgia. 

Limitations 

While physiotherapy can assist with symptom management, it is not a cure for trigeminal neuralgia. If the condition is caused by nerve compression or another structural issue, medical treatments, such as medications or surgery, are typically more effective. Physiotherapy should be used as part of a comprehensive treatment plan, in conjunction with medical care. 

Conclusion 

Physiotherapy can provide valuable support for individuals with trigeminal neuralgia by addressing muscle tension, jaw alignment, stress management, and improving overall quality of life. It is most effective when combined with other medical treatments, and a physiotherapist can work alongside a medical team to optimise care.