Effectiveness of mobilisation of the upper cervical region and craniocervical flexor training on orofacial pain, mandibular function and headache in women with TMD. A randomised, controlled trial
Abstract
Background Studies exploring interventions targeting the cervical spine to improve symptoms in patients with temporomandibular disorders (TMD) are limited. Objectives To determine whether mobilisation of the upper cervical region and craniocervical flexor training decreased orofacial pain, increased mandibular function and pressure pain thresholds (PPTs) of the masticatory muscles and decreased headache impact in women with TMD when compared to no intervention. Methods In a single-blind randomised controlled trial, 61 women with TMD were randomised into an intervention group (IG) and a control group (CG). The IG received upper cervical mobilisations and neck motor control and stabilisation exercises for 5 weeks. The CG received no treatment. Outcomes were collected by a blind rater at baseline and 5-week follow-up. Orofacial pain intensity was collected once a week. A mixed ANOVA and Cohen's d were used to determine differences within/between groups and effect sizes. Results Pain intensity showed significant time-by-group interaction (P 0.8). The decrease in orofacial pain over time was clinically relevant only in the IG. Change in headache impact was significantly different between groups, and the IG showed a clinically relevant decrease after the treatment. No effects were found for PPT or mandibular function. Conclusion Women with TMD reported a significant decrease in orofacial pain and headache impact after 5 weeks of treatment aimed at the upper cervical spine compared…
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Publication bias for pain versus sham was difficult to determine visually and could not be quantified using Egger regression because of the small number of trials.
“Publication bias was difficult to determine visually (figure 3B) and could not be quantified using Egger regression because of the small number of trials.44,45”
Compared with sham intervention, manual therapy did not significantly increase pressure pain threshold of the masseter (MD: 0.45 kg/cm2, 95% CI: -0.21 to 1.11, P=.18).
“Compared with sham intervention, MT did not significantly increase PPT of the masseter (MD: 0.45 kg/cm2, 95% CI: -0.21 to 1.11, P=.18; figure 5A)38,44,45 or temporalis muscle (MD: 0.37 kg/cm2, 95% CI: -0.03 to 0.77, P=.07; figure 6A).38,44, 45, 46”
Compared with sham intervention, manual therapy did not significantly increase pressure pain threshold of the temporalis muscle (MD: 0.37 kg/cm2, 95% CI: -0.03 to 0.77, P=.07).
“Compared with sham intervention, MT did not significantly increase PPT of the masseter (MD: 0.45 kg/cm2, 95% CI: -0.21 to 1.11, P=.18; figure 5A)38,44,45 or temporalis muscle (MD: 0.37 kg/cm2, 95% CI: -0.03 to 0.77, P=.07; figure 6A).38,44, 45, 46”
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References 55 · Cited by 75
- Authors
- Calixtre, L. B., Oliveira, A. B., de Sena Rosa, L. R., Armijo‐Olivo, S., Visscher, C. M., & Alburquerque‐Sendín, F.
- Affiliations
- Universidade Federal de São Carlos (BR)
- Laboratory of Clinical and Occupational Kinesiology (LACO) Department of Physical Therapy Federal University of São Carlos (UFSCar) São Carlos Brazil
- Faculty of Rehabilitation Medicine University of Alberta Edmonton Alberta Canada
- Academic Center for Dentistry Amsterdam (NL)
- University of Córdoba (ES)
- Corresponding author
- Calixtre, Letícia B.
- Venue
- Journal of Oral Rehabilitation
- Publisher
- Wiley
- Published
- 2018-10-26
- Volume
- 46
- Issue
- 2
- Pages
- 109-119
- ISSN
- 0305-182X (ISSN-L)
- 1365-2842
- OpenAlex
- W2897668495
- Cited by
- 75
- References
- 55
- Citations by year
- 2026: 9 · 2025: 13 · 2024: 14 · 2023: 9 · 2022: 11 · 2021: 10 · 2020: 9
- FWCI
- 7.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Oral Rehabilitation (publishedVersion)
- PubMed (publishedVersion)
- UvA-DARE (University of Amsterdam) (publishedVersion)
- VU Research Portal (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Fundação de Amparo à Pesquisa do Estado de São Paulo (2014/05276 7)
- 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, orofacial pain, headache, mandibular function, pressure pain threshold, masticatory muscles, women, cervical spine
- MeSH terms
- Adult, Cervical Vertebrae, Facial Pain, Female, Follow-Up Studies, Headache, Humans, Pain Measurement, Temporomandibular Joint Disorders, Single-Blind Method, Treatment Outcome, Pain Threshold, Neck Pain, Physical Therapy Modalities, Young Adult
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