Cervical Spine Thrust Joint Manipulation, Education, and a Home Exercise Program for the Management of Individuals with Temporomandibular Disorder: A Prospective Case Series

Background and Purpose: Temporomandibular disorder (TMD) often leads to chronic pain and disability. Current evidence supporting potentially effective physical therapy (PT) intervention in TMD is limited, however, some support exists for manual therapy, education, and exercise. The purpose of this case series was to describe outcomes in participants with TMD treated with cervical spine manual therapy, education, and exercise. Methods: Five participants (mean symptom duration 2.2 years) with TMD were treated with atlanto-occipital and C2-3 cervical spine thrust joint manipulation (TJM), behavioral education, and a home exercise program for 3 visits over 4 weeks. Primary outcomes included jaw range of motion (ROM), Numeric Pain Rating Scale, Jaw Functional Limitation Scale, and Global Rating of Change (GROC). Secondary measures included pain pressure threshold (PPT), Neck Disability Index, TMD Disability Index, and cervical ROM. Results: Clinically meaningful change was noted in cervical and jaw ROM. Three of five participants (60%) reported symptoms at least “moderately better” (≥ 4 GROC) at 4-weeks. No adverse events were reported. Clinical Relevance: All participants had at least 1 year duration of pain indicating spontaneous recovery was unlikely. While cause and effect relationships cannot be determined, outcomes indicate the approach may be effective. Conclusion: Cervical spine TJM added to education and exercise over three visits may be effective in the chronic TMD population. Future randomized clinical trials are necessary to draw specific conclusion