Dry needling and upper cervical spinal manipulation in patients with temporomandibular disorder: A multi-center randomized clinical trial

Manual therapy was effective in reducing pain immediately after treatment, independent of the professional category.

“Manual therapy was found to be effective in reducing pain immediately after treatment, independent of the professional category (Table 2).”

Comparator groups varied widely, including sham or no-treatment control, standard care, splint therapy, and pharmacological treatments.

“Comparator groups varied widely, including sham or no-treatment control [23,27], standard care [21], splint therapy [25,29,32] and pharmacological treatments [38].”

Intervention formats ranged from single-session treatments to multi-week protocols.

“intervention formats ranged from single-sessions treatments (e.g. one atlanto-occipital thrust in Oliveira-Campelo et al. [26]) to multi-week protocols (e.g. eight sessions of dry-needling combined with upper cervical HVLA over four weeks in Dunning et al. [25]).”

Manual therapy was effective across all professional categories, with significant reductions in pain and improvements in maximum mouth opening.

“Manual therapy was effective across all professional categories, with significant reductions in pain [21–25] and improvements in MMO [21–26].”

In this systematic review, most studies applied Axis I criteria, while a subset incorporated both Axis I and II.

“In this systematic review, most studies applied Axis I criteria [22,25,27,30,35], while a subset incorporated both Axis I and II [21,33] to identify TMD subtypes most responsive to manual therapy.”

HVLA techniques applied to the jaw and cervical spine demonstrated efficacy in reducing pain and improving maximum mouth opening.

“HVLA techniques applied to the jaw [24,29,31] and cervical spine [21,23,25–27] demonstrated efficacy in reducing pain and improving MMO.”

Dunning et al. and Kalamir et al. observed improvements within six weeks, confirming the short-term efficacy of manual therapy.

“Similarly, Dunning et al. [25] and Kalamir et al. [35] observed improvements within six weeks, confirming the short-term efficacy of manual therapy.”

Several studies emphasized that manual therapy was performed by professionals with specialized training, reinforcing the notion that clinical expertise is critical to achieving effective results.

“Several studies [21,22,25,26,29,31,34] emphasized that manual therapy was performed by professionals with specialized training, reinforcing the notion that clinical expertise is critical to achieving effective results.”

Dunning et al. demonstrated that combining dry needling with upper cervical manipulation outperformed splint therapy, diclofenac, and TMJ mobilization.

“Dunning et al. [25] demonstrated that combining dry needling combined with upper cervical manipulation outperformed splint therapy, diclofenac, and TMJ mobilization.”

For Axis I temporomandibular disorders, positive outcomes were reported with upper cervical HVLA techniques, likely due to interruption of nociceptive signaling via trigemino-cervical convergence mechanisms.

“For Axis I TMD, positive outcomes were reported with upper cervical HVLA techniques, likely due to interruption of the nociceptive signaling via trigemino-cervical convergence mechanisms [21,25,27].”