Effect of Manual Therapy and Therapeutic Exercise Applied to the Cervical Region on Pain and Pressure Pain Sensitivity in Patients with Temporomandibular Disorders: A Systematic Review and Meta-analysis
Abstract
OBJECTIVE To assess the effectiveness of cervical manual therapy (MT) on patients with temporomandibular disorders (TMDs) and to compare cervico-craniomandibular MT vs cervical MT. DESIGN Systematic review and meta-analysis (MA). METHODS A search in PubMed, EMBASE, PEDro, and Google Scholar was conducted with an end date of February 2019. Two independent reviewers performed the data analysis, assessing the relevance of the randomized clinical trials regarding the studies' objectives. The qualitative analysis was based on classifying the results into levels of evidence according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). RESULTS Regarding cervical MT, MA included three studies and showed statistically significant differences in pain intensity reduction and an increase in masseter pressure pain thresholds (PPTs), with a large clinical effect. In addition, the results showed an increase in temporalis PPT, with a moderate clinical effect. MA included two studies on cervical MT vs cervico-craniomandibular MT interventions and showed statistically significant differences in pain intensity reduction and pain-free maximal mouth opening, with a large clinical effect. CONCLUSIONS Cervical MT treatment is more effective in decreasing pain intensity than placebo MT or minimal intervention, with moderate evidence. Cervico-craniomandibular interventions achieved greater short-term reductions in pain intensity and increased pain-free MMO over cervical…
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Adding cervico-craniomandibular manual therapy appears to provide greater benefit than cervical manual therapy alone.
“A recent systematic review23 suggested that both cervical and cervico-craniomandibular MT improve pain and maximal mouth opening (MMO) in individuals with TMJ dysfunction, and adding cervico-craniomandibular MT appears to provide greater benefit than cervical MT alone.”
These reviews suggest that manual therapy combined with other interventions improves outcomes for those with temporomandibular joint dysfunction.
“These reviews suggest that MT combined with other interventions improves outcomes for those with TMJ dysfunction.5,19,23”
A recent systematic review suggested that both cervical and cervico-craniomandibular manual therapy improve pain and maximal mouth opening in individuals with temporomandibular joint dysfunction.
“A recent systematic review23 suggested that both cervical and cervico-craniomandibular MT improve pain and maximal mouth opening (MMO) in individuals with TMJ dysfunction, and adding cervico-craniomandibular MT appears to provide greater benefit than cervical MT alone.”
Limitations with those reviews and their supporting evidence make it difficult to determine the efficacy of cervical spine joint mobilizations or manipulations.
“However, limitations with those reviews and their supporting evidence makes it difficult to determine the efficacy of cervical spine joint mobilizations or manipulations.”
Details about specific manual therapy techniques used were not consistently provided, and manual therapy techniques were variable.
“Details about specific MT techniques used were not consistently provided, and MT techniques were variable, including soft tissue release, joint mobilizations, and joint manipulations performed to the cervical spine and/or TMJ.5,19,23,24”
Other systematic reviews have investigated the efficacy of various cervical manual therapy techniques on temporomandibular joint dysfunction, including myofascial release, mobilization/manipulation, and combined interventions.
“Other systematic reviews have investigated the efficacy of various cervical MT techniques on TMJ dysfunction,5,19,23,24 such as myofascial release to the masticatory and cervical muscles, mobilization/manipulation to the cervical and thoracic spine, and interventions combining the two.5,19”
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References 51 · Cited by 60
- Authors
- La Touche, R., Martínez García, S., Serrano García, B., Proy Acosta, A., Adraos Juárez, D., Fernández Pérez, J. J., Angulo-Díaz-Parreño, S., Cuenca-Martínez, F., Paris-Alemany, A., & Suso-Martí, L.
- Affiliations
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Grupo de Investigación Motion in Brains, Instituto de Neurociencia y Ciencias del Movimiento (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Venue
- Pain Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2020-03-17
- Volume
- 21
- Issue
- 10
- Pages
- 2373-2384
- ISSN
- 1526-2375 (ISSN-L)
- 1526-4637
- OpenAlex
- W3011729819
- Cited by
- 60
- References
- 51
- Citations by year
- 2026: 10 · 2025: 10 · 2024: 10 · 2023: 14 · 2022: 10 · 2021: 4 · 2020: 2
- FWCI
- 2.38
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Pain Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Myofascial pain diagnosis and treatment
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- temporomandibular disorders, exercise therapy, pressure pain sensitivity, masseter muscle, temporalis muscle, pain intensity, headache, maximum mouth opening
- MeSH terms
- Exercise Therapy, Humans, Neck, Temporomandibular Joint Disorders, Pain Threshold, Musculoskeletal Manipulations
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