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Gretas Exercises

(Myofunctional Exercises for JIA-Kids)

On the occasion of a special case we have compiled Myofunctional Exercises which are especially suitable for young patients who are provably suffering from JIA  (Juvenile Idiopathic Arthritis). These exercises are part of a collection available as well as a printed book as in an internet presentation with the internet address: .

The exercise descriptions presented here are printed in a short form; for the full text see above link as well.

From the 150 exercises listed up under the mentioned link there are very probably several more valuable for the special case. To compile these first of all an accurate diagnostic muscle analysis is required as described under

Certainly there are, besides the described exercises for the temporomandibular joint moreover those quite important which are granting the rostral and retral closure of the oral cavity in order to regulate its pressure conditions.


To the Physiotehrapist:

There exists an intimate neural and muscular interconnection between

Orofacial, Mandibular, Diaphragm, Hyoid, Neck, Collum and Trunk musculature. It is this intertwining that causes neuro-muscular disorders to overlap to neighbouring muscle fields.

And it is this formation that MFT has to meet the disorders through an overlapping therapy approach  to avoid the boomerang-effect of disorders reacting from the adjacent fields after having succeeded in the therapy of an orofacial disorder (if it then would have happened at all with neglecting the said complexities).

To achieve this there is at hand a series of exercises as summed up in the following list.


(alphabetical order)

 (BASIC-POSITION)               Static, Stand-by Position.

EASY NODDING                    Kinetic, Fine Motor Skills.

NAPE-DIALTOR                    Static, Stretching, (Manipulative aid if needed).

NECK SIDE STRETCH          Static, Stretching (Manipulative aid if needed).

(POSITION EXERCISES)       Static, Stand-by Position.

ROLLING HEADS                  Kinetic, Slow-Motion, Stretching, Coordination.

(SITTING-POSITION)            Static, Stand-by Position.

STRETCHING                          Static, Stretching (Manipulative aid if needed).

TURN                                        Rather Static, Stretching (Manipulative aid if needed).

TURN YOUR HEAD               Kinetic, Slow-Motion, Stretching, Coordination.













OPEN AND CLOSE     / AUF UND ZU 049     

(Sublingiualmm. keeps Mandibula retral, Capitulum stays in fossa.)

-1 Mouth shut, the tongue is, as with FROZEN PLOP , sucked against the palate.

-2 While the tongue stays sucked against the palate the molars are lightly set upon each other. With the 

    rare cases of adductor muscle hypotone the patient puts the fingertips bilaterally against the angle 

    region  of the mandibula to feel the hump of the swelling masseter when occluding.

   In this position count to ten. By this training mode thy exercise may be stressed as a hold-exercise (see  


-3a (variation) The mouth opens and the tongue may let go from the palate wit a “pop”. Then back to the

    starting position.

-3 b (variation) While the tongue stays sucked to the palate the mouth is opened wide, this position held  

    while counting to ten. Then back to the starting position (or directly to step 2).

-3c In case of a deviation of the centering of a straight-line movement during opening or shutting:

- the lips stay open while the straight-line centering of the opening movement is monitored in a mirror.

In the initial training phase the hand may guide the chin (picture); for checking the motion sequence ‘rotation / prolation’ the exercise may be combined with the exercise “THE PEA

   Subsequently to relax the BAGGY TONGUE may be positioned in form of   ALTERNATIVE EXERCISE.








(feeling the Capitulum, retral and protrusive)

-1 First on both sides of the face of the therapist two fingertips of both hands of the patient are postioned between cheekbone and ear (tragus point) to demonstrate the opening movement of the mouth with and without forwards slipping of the condyli = the “pea”.

-2 Thereupon the procedure is repeated at the head of the patient.

- 3 The patient, under control of the Therapist, tries out several different positions and the

- 4 the maximum mouth opening without forward migration of the PEA!

Doing this, in the beginning the thumb may support the movement with the  ,DRAWER-IN’-EXERCISE.





-1 In the beginning the therapist will inform the patient thoroughly about the training goal – the specific posture.

-2 For this purpose the body feeling apropos Orientation, Stereognosis, positional relationship within the organism is awakened and addressed, if necessary, via sensory assistances and feed-back stimuli to gain a, mostly statomotor (statodynamic) eu-toning.

-3 Practicing at first runs under supervision within the training sessions then pointedly at home and more and more beyond distinct training complexes at all arising opportunities.

-4 The final phase will, then, lead to the habituation of the training contents.




-1 The patient seats himself on a stool or training ball.

     a.  heteromaipulated procedure:

-2 The therapist is positioned behind the patient, his head leaning against the therapist, and grasps the jaw with both hands as holding a platter.

-3 The patient is asked to loosen up the mandible.

-4 Now the therapist seeks to tilt up the mandible sensitively and without any force on the patients side (or on either sides) and , thus, to ‘tap’ the dental arches together. No muscle actions should be perceptible in the jaw. This will mostly be accomplished only after several tries. For diagnostic reasons the more or less high manageability or a failure are noted.

In its therapeutic handling the ‘Tap’ is carried out over some time, it is recommendable to practice the movement none rhythmically and asynchronic to avoid a covered collaboration of the muscles. The general idea of this exercise is to completely relax, to “unharness” the muscles. 

b. Self manipulated performing:

-2 not inevitably but as to make practicing easier the patient sets the elbow of one arm on the desk top before him bents it upward and tips the dorsum of the hand under his chin.

-3 This hand, now, will substitute the guiding hands of the therapist. The patient remembers the feeling sensed before to “let loose” the mandible as practiced under a. . His hand, then, chucks the mandible slightly upwards.

-4 all further steps as under a. .







-1 The patient is asked to try letting go the mouth muscles together with cheeks and mouth base as in the exercise  ,L-M’-POSITION. The tongue tip should stay at the POINT to help centring the mandible.

-2 the patient settles the molars on each other and positions the finger tips of digit and middle finger on the cheeks just above the jaw angle. When biting together more strongly, as in the MASSETER EXERCISE he will feel the muscle belly swelling. Now, during the following training, he will have to try not to let the muscle venter come up.


-3 Now the patient will practically reproduce the previously executed   ,TAP-TAP’-EXERCISE

Without a manipulation by jerking the mandible softly up feeling the concurrent tapping together of the dental bows. Immediately the jaw opens again and instantly will again be clapped shut and so on.



-1 The patient holds the stick in sagittal direction in the middle of the lip slit in a manner that it sticks into the mouth hole about two centimetres.

-2 The aspect of a mouth slit closure exercise is gained by the lips now holding the stick with minimal force.

-3 Now additionally the incisors are watched not to touch the stick initializing an adductor relaxation.

-4 Finally a protrusion tendency of the tongue is met by the tongue tip avoiding to touch the stick.

The further aspect of the POINT hold exercise is given by the demand for the tongue tip to keep the POINT reaching over the tip of the stick. This, again, supports the palatal directed version of the residuary tongue body simultaneously avoiding the mandibula protrusion.





-1 The patient prepares himself mentally for realizing the adductor hyperactivity (possibly by TEETHCLICKING).

-2 The tongue tip is positioned on to the POINT: “I am supporting the jaw by the tongue muscles. I am not standing on my teeth.”

-3 The posture will be maintained.




-1 The patient concentrates on his oral cavity (in this situation AT (Autogenous Training) may be adapted).

-2 Now, with a faint ‘Click’ the patient taps the incisors together suggesting the resulting feeling being extremely unpleasant.

-3 This procedure is repeated with the molar teeth on the right and on the left side.

-4 The patient internalizes:”When I sense this ‘Click’ I will immediately go back to the RESTPOSITION”, which he then adopts consciously.

These steps should be practiced as well over the day on the occasion of short breaks as before going to bed as to get in the right mood for the night time behaviour.

For a foreign or self manipulation the may be ,TAP-TAP'-EXERCISE introduced.




- Previous exercises: The patient should master or simultaneously practice the exercises ,L-M’-POSITION,,DRAWER-IN’-EXERCISE (CHIN-IN), ,TAP-TAP’-EXERCISE, and THE  PEA.

 -Starting position: ,DRAWER-IN’-EXERCISE.

-1 The mouth opens as in the exercise THE  PEA, i.e. maintaining the retral position of the mandible respectively the joint condyle. The musculature is kept in a maximum relaxed state as in the ,TAP-TAP’-EXERCISE. The patient “lets hang his jaw” as much as possible.

-2 The therapist is standing in front of the patient gripping the Mandibula with both hands. The thumbs are resting on both sides upon the dental arch, the fingers taking hold of the mandibular bone outwardly as if leading a wheelbarrow or handlebars of a bike.

-3 The patient is repeatedly admonished to let go his jaw. Now with his hands the therapist applies some pressure to the retral teeth mainly stressing the thumb tips guiding the Mandibula in a retral-caudal direction. This position is retained for a defined time (from half a minute upwards).





This exercise will generally be carried out by the therapist but, in special cases, may also be performed by the patient in self manipulation.

-1 The flat hand is supporting the head on the contralateral side of the conspicuous joint by resting on the plain of occiput-temple, one fingertip controlling the inactive position of the condyle (THE  PEA ).

The Thenar of the other hand, positioned on the mandibular angle region, is pressing the Corpus Mandibulae in the direction of the opposite hand. This is resulting in a minimal movement of the affected condyle in an inward direction, the pressure being exerted with “some” power.

-2 The gained position is maintained for two to three minutes then returned to ,L-M’-  or the BASIC-POSITION.



Additional Exercisesa: [,E’, ,O’ , CHERRY-MOUTH, TRUNK, (097, 016, 019, 020,)]


Previous exercises: Advisable would be the BASIC-POSITION-1 The lower lip is moved down slowly and under hand mirror control revealing the lower incisors. As an illustration the patient gets the instruction to draw a face as if finding something disgusting and therefore uttering an ‘Eeeeeeee’. With this besides the Platysma mainly the Depressor labii inferioris (Anatomy S.18) gets tensed. The meaning is to let the Mentalis

loose to facilitate the downward movement.

-1 a In case of the frequently occurring onset difficulties a starting aid may be added: The patient’s index finger is set on the chin tip pressing it softly down in the direction of the desired position. This helping hand should be omitted as soon as possible.

-2 a In the hold-mode the end position is held under counting .

-2b In the kinetic mode after attaining the end position immediately the start position is regained, then the end position, start position and so forth in a steady change counting on.

(-3 For an ALTERNATIVE EXERCISE  the BABBLE might be useful for loosening or else a contrasting movement as for instance with DUCKBILL, TIED-UP SACK or the like.)






-1 Performed as an  INCREASE-RRANGEMENT

(Figure see above) as step one the ,O’-Position is taken up – the rima oris pulled quite flatly together star-shaped towards the centre.

-2 Now the tension is increased as to protrude the lips out of the centre to form a cherry’ – the ,O’ is pushed forward.

-3 Thos position is additionally strained and the ‘cherry’ prolonged forward to build up the ‘trunk’.

-4a Now this might carried out as a static phase by counting while holding or

-4b as a kinetic, dynamic phase by changing the positions fluently over ‘cherry’ back to ‘O’, again up to ’trunk’ and back again.





Previous exercises: The ,M’-POSITION should be mastered as the

Starting position: (which could, as well, be the “physiologic mandibular rest position”.)

-a1Performed as a HOLD-EXERCISE, now the rima oris (oral fissure) is contracted from every side (above, sideways and front)  more and more, star-shaped, towards the middle as much as possible to form quite a point.

-a2 The position is kept while counting.

-a3 Return to start or shift to the counter-movement with an ALTERNATIVE EXERCISE  (see below).

-b1 As a kinetic exercise as step a1.

-b2 Immediate return to step one position, start-position.

-b3 Training- and start-position are gained in a steady and dynamic flow: step1, step 2, 1, 2….or

-c1 (as an ALTERNATIVE EXERCISE) like b1,

-c2 like b2, then:

-c3 shift to the second exercise chosen for the ALTERNATIVE EXERCISE, for example WIDE GRIN or LETTER SLOT.


- Previous exercises: Recommendable is a stepwise intensification in the training course ( see paragraph ‘Timing’).  For this purpose the ,L-M’-POSITION and the  ,O’-EXERCISE are needed

-Starting position: For a start the ,L-M’-POSITION is taken up


   a ‘Hold’-Exercise

-1 The lips now are pursed as if  to pipe but in its centre firmly closed. The patient gets a feeling as if forming a knot with his lips in the size of a cherry. This has to be done with much energy and the position kept while counting out.

    b Kinetic exercise in combination with an  ALTERNATIVE EXERCISE .

-1 the first step in this case is the brisk contracting of the mouth constrictor.

Right in the middle beyond the nose a tiny point like opening occurs, so as if forming a pinched ‘O’ (see ,O’-EXERCISE).

-2 Now the ‘O’ is being pushed forward to let the pursed lips swell to the size of a cherry.

-3 Afterwards back to step 1 to the ‘O’, then again step 2, 1, 2 etc.


Under a by holding the position a sequence is built up ( counting out to the, later on increasing).

Under b the position step 1 is held for one to two seconds and then position 2 taken up, held, as well, and so forth. This is building up a sequence with a frequency beat, a changing frequency.

By counting out the changes there might be added up about ten runs in exercising.

A further variation mode is the change not in frequency but in the sequence

For this purpose we start as with  mode a.

First sequence will be the  ,O’-EXERCISE followed by the sequence with exercise CHERRY.

Through these changes we have built up an INCREASE-ARRANGEMENT as a series. It may be completed by adding a further exercise from the before mentioned group as, for example the TRUNK- EXERCISE and applying it as with the others.


- Previous exercises: See Starting position. If planned as an ALTERNATIVE EXERCISE in combination with ,O’ and CHERRY MOUTH (see   ORBICULARIS EXERCISES) these will have to be practised before.

-Starting position: At best the not strained ,L’-POSITION should be taken up


-1 Performed as a single exercise the mouth is pursed and protruded maximally as “to imitate an elephant’s trunk”.

-2a In the static mode this position is kept with counting out.

-2b With the kinetic mode we get back to the start after having reached the maximum position and in the follow again take up the maximum posture.


-1 Performed as an  INCREASE-RRANGEMENT

(Figure see above) as step one the ,O’-Position is taken up – the rima oris pulled quite flatly together star-shaped towards the centre.

-2 Now the tension is increased as to protrude the lips out of the centre to form a cherry’ – the ,O’ is pushed forward.

-3 Thos position is additionally strained and the ‘cherry’ prolonged forward to build up the ‘trunk’.

-4a Now this might carried out as a static phase by counting while holding or

-4b as a kinetic, dynamic phase by changing the positions fluently over ‘cherry’ back to ‘O’, again up to ’trunk’ and back again.

- Timing:.

In 2a as a static single exercise hold and, as one sequence, count to ten (or later on increasing); several sequences combined to a series

In 2b as a kinetic single exercise strain and loosen in a frequency beat; in a secondly tact a sequence is formed containing about twenty to thirty actions.

The combination of these two modes results in a CHANGING EXERCISE , now in the series changing the mode from sequence to sequence, static // kinetic (a // b).

Within an  INCREASE-RRANGEMENT as with the combination of  ,O’-EXERCISE (selectively for the inner most muscle ring) > CHERRY MOUTH > (additionally the second, the medial ring) >  TRUNK EXERCISE (all three muscle rings) in a series one of these exercise at a time representing one sequence is applied (one exercise and count to ten, next exercise and count, third one..)

This arrangement is set up pyramid like.

In the static carry-out on top of the pyramid the position is held under counting to the ( later on increasing), in the kinetic phase on top of the pyramid follows the return backwards (,O’ > CHERRY > TRUNK > CHERRY > ,O’). A long exercise series is gained.