The effects of manual therapy and exercise directed at the cervical spine on pain and pressure pain sensitivity in patients with myofascial temporomandibular disorders

Abstract

No studies have investigated the effects of the treatments directed at the cervical spine in patients with temporomandibular disorders (TMD). Our aim was to investigate the effects of joint mobilization and exercise directed at the cervical spine on pain intensity and pressure pain sensitivity in the muscles of mastication in patients with TMD. Nineteen patients (14 females), aged 19-57 years, with myofascial TMD were included. All patients received a total of 10 treatment session over a 5-week period (twice per week). Treatment included manual therapy techniques and exercise directed at the cervical spine. Outcome measures included bilateral pressure pain threshold (PPT) levels over the masseter and temporalis muscles, active pain-free mouth opening (mm) and pain (Visual Analogue Scale) and were all assessed pre-intervention, 48 h after the last treatment (post-intervention) and at 12-week follow-up period. Mixed-model anovas were used to examine the effects of the intervention on each outcome measure. Within-group effect sizes were calculated in order to assess clinical effect. The 2 x 3 mixed model anova revealed significant effect for time (F = 77.8; P < 0.001) but not for side (F = 0.2; P = 0.7) for changes in PPT over the masseter muscle and over the temporalis muscle (time: F = 66.8; P < 0.001; side: F = 0.07; P = 0.8). Post hoc revealed significant differences between pre-intervention and both post-intervention and follow-up periods (P < 0.001) but not between post-intervention and follow-up period (P = 0.9) for both muscles. Within-group effect sizes were large (d > 1.0) for both follow-up periods in both muscles. The anova found a significant effect for time (F = 78.6; P < 0.001) for changes in pain intensity and active pain-free mouth opening (F = 17.1; P < 0.001). Significant differences were found between pre-intervention and both post-intervention and follow-up periods (P < 0.001) but not between the post-intervention and follow-up period (P > 0.7). Within-group effect sizes were large (d > 0.8) for both post-intervention and follow-up periods. The application of treatment directed at the cervical spine may be beneficial in decreasing pain intensity, increasing PPTs over the masticatory muscles and an increasing pain-free mouth opening in patients with myofascial TMD.

Cervical Referral of Head Pain in Migraineurs: Effects on the Nociceptive Blink Reflex

“…Moreover, sustaining the examination repeatedly results not only in decreasing intensity of head pain referral but also in more expeditious resolution. Furthermore, patients presenting with allodynia frequently report that after lessening of their referred pain, the allodynia has decreased or resolved, [24][25][26] perhaps indicating that a pre-existing central sensitization state had diminished.…”

Spinal high-velocity low-amplitude manipulation with exercise in women with chronic temporomandibular disorders

“…It is highly likely that functional integration exists between jaw and cervical movements. Only one study by La Touche et al [22] has shown that mobilization of the cervical spine, together with cervical spine exercises, leads to increased pain-free MMO in the long term in a series of patients with TMD. Regarding pain-free MMO in our study, there were significant increases posttreatment in both groups of cervical intervention compared to the education group.…”

“…In the literature, the first study by La Touche et al [22] evaluating the effectiveness of upper cervical mobilization with neck exercises in TMD reported significant effects on PPT of masticatory muscles. However, the lack of a control group in this study does not allow distinction of the actual treatment effect in TMD.…”

“…The average of the last two measurements was calculated to obtain a single value for each of the measured sites in each assessment. PPT were assessed at two sites in the masseter muscle (M1: 2.5 cm anterior to the tragus and 1.5 cm inferior to the zygomatic arch and M2: 1 cm superior and 2 cm anterior to the mandibular arch) and one site in the temporalis muscle (T1: 3 cm superior to the midpoint between the end of the eye and the anterior part of the helix) [22]. Compression pressure was gradually increased until the pressure sensation turned into pain or discomfort, and the pressure value at that point was recorded.…”

Influence of Phototherapy on Thermographic Images and Pain in Individuals with Temporomandibular Disorder: Protocol for a Randomized, Placebo-Controlled, Double-Blind Clinical Trial

“…The volunteers must also have a pain score in the masticatory muscles greater than 3 points on the VAS. 23 …”