Effects of cervical mobilization and exercise on pain, movement and function in subjects with temporomandibular disorders: a single group pre-post test

Abstract

Objective To investigate the effect of a rehabilitation program based on cervical mobilization and exercise on clinical signs and mandibular function in subjects with temporomandibular disorder (TMD). Material and Methods: Single-group pre-post test, with baseline comparison.Subjects Twelve women (22.08±2.23 years) with myofascial pain and mixed TMD according to the Research Diagnostic Criteria for Temporomandibular Disorders.Outcome measures Subjects were evaluated three times: twice before (baseline phase) and once after intervention. Self-reported pain, jaw function [according to the Mandibular Functional Impairment Questionnaire (MFIQ)], pain-free maximum mouth opening (MMO), and pressure pain thresholds (PPTs) of both masseter and temporalis muscles were obtained. Baseline and post-intervention differences were investigated, and effect size was estimated through Cohen’s d coefficient.Results Jaw function improved 7 points on the scale after the intervention (P=0.019), and self-reported pain was significantly reduced (P=0.009). Pain-free MMO varied from 32.3±8.8 mm to 38±8.8 mm and showed significant improvement (P=0.017) with moderate effect size when compared to the baseline phase. PPT also increased with moderate effect size, and subjects had the baseline values changed from 1.23±0.2 kg/cm2 to 1.4±0.2 kg/cm2 in the left masseter (P=0.03), from 1.31±0.28 kg/cm2 to 1.51±0.2 kg/cm2 in the right masseter (P>0.05), from 1.32±0.2 kg/cm2 to 1.46±0.2 kg/cm2 in the left temporalis (P=0.047), and from 1.4±0.2 kg/cm2 to 1.67±0.3 kg/cm2 in the right temporalis (P=0.06).Conclusions The protocol caused significant changes in pain-free MMO, self-reported pain, and functionality of the stomatognathic system in subjects with myofascial TMD, regardless of joint involvement. Even though these differences are statistically significant, their clinical relevance is still questionable.

Effectiveness of mobilisation of the upper cervical region and craniocervical flexor training on orofacial pain, mandibular function and headache in women withTMD. A randomised, controlled trial

“…This promising evidence could be related to the fact that several studies have specifically reported that subjects with TMD present abnormalities of the endurance and performance of the neck flexors and extensors muscles . In particular, stabilisation exercises for the neck in combination with manual therapy for the upper cervical spine have been found to increase maximum mouth opening and to raise pressure pain threshold (PPT) in the masticatory muscles in subjects with TMD. Nevertheless, because of their methodological limitations (including lack of a control or a placebo group), these studies provided limited evidence.…”

Effects of 8 weeks of masticatory muscles focused endurance exercises on women with oro‐facial pain and temporomandibular disorders: A placebo randomised controlled trial

“…38 Another study consisted of 10 sessions of muscle-conditioning techniques, manual therapy and stretching over 5 weeks in 12 women with mixed TMD (combining myofascial pain either with joint impairment or disc displacement). 16 The results showed significant mandibular function improvement and decreased self-reported pain score. Although systematic reviews and meta-analysis observed two major issues on the majority of studies involving exercises, they did not report interventions sufficiently to be reproducible, and co-interventions were also not controlled.…”

“…All subjects reported a reduction in jaw pain after the exercise programme, classified through a numerical rating scale . Another study consisted of 10 sessions of muscle‐conditioning techniques, manual therapy and stretching over 5 weeks in 12 women with mixed TMD (combining myofascial pain either with joint impairment or disc displacement) . The results showed significant mandibular function improvement and decreased self‐reported pain score.…”

“…Thirty‐four were analysed at 8‐week assessments. The Mandibular Function Impairment Questionnaire was used to classify the subjects in relation to the severity of the functional limitation related to TMD (Table ) . The baseline participant's characteristics were reported in Table .…”

“…The Mandibular Function Impairment Questionnaire was used to classify the subjects in relation to the severity of the functional limitation related to TMD (Table 1). 15,16 The baseline participant's characteristics were reported in Table 1. The ethics committee for human investigation of the Federal University of Juiz de Fora approved the procedures employed in the study (protocol number 68457617.6.0000.5147).…”