The Immediate Effects of Atlanto-occipital Joint Manipulation and Suboccipital Muscle Inhibition Technique on Active Mouth Opening and Pressure Pain Sensitivity Over Latent Myofascial Trigger Points in the Masticatory Muscles
Open accessAbstract
Design: A randomized controlled trial. Objective: To investigate the immediate effects on pressure pain thresholds over latent trigger points (TrPs) in the masseter and temporalis muscles and active mouth opening following atlanto-occipital joint thrust manipulation or a soft tissue manual intervention targeted to the suboccipital muscles. Background: Previous studies have described hypoalgesic effects of neck manipulative interventions over TrPs in the cervical musculature. There is a lack of studies analyzing these mechanisms over TrPs of muscles innervated by the trigeminal nerve. Methods: One hundred twenty-two volunteers, 31 men and 91 women, between the ages of 18 and 30 years, with latent TrPs in the masseter muscle, were randomly divided into 3 groups: a manipulative group who received an atlanto-occipital joint thrust, a soft tissue group who received an inhibition technique over the suboccipital muscles, and a control group who did not receive an intervention. Pressure pain thresholds over latent TrPs in the masseter and temporalis muscles, and active mouth opening were assessed pretreatment and 2 minutes posttreatment by a blinded assessor. Mixed-model analyses of variance (ANOVA) were used to examine the effects of interventions on each outcome, with group as the between-subjects variable and time as the within-subjects variable. The primary analysis was the group-by-time interaction. Results: The 2-by-3 mixed-model ANOVA revealed a significant group-by-time interaction for changes in pressure pain thresholds over masseter (P<.01) and temporalis (P = .003) muscle latent TrPs and also for active mouth opening (P<.001) in favor of the manipulative and soft tissue groups. Between-group effect sizes were small. Conclusions: The application of an atlanto-occipital thrust manipulation or soft tissue technique targeted to the suboccipital muscles led to an immediate increase in pressure pain thresholds over latent TrPs in the masseter and temporalis muscles and an increase in maximum active mouth opening. Nevertheless, the effects of both interventions were small and future studies are required to elucidate the clinical relevance of these changes. Level of Evidence: Therapy, level 1b. J Orthop Sports Phys Ther 2010;40(5):310–317. doi:10.2519/jospt.2010.3257
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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]).”
Oliveira-Campelo et al. and Gesslbauer et al. reported immediate symptom relief and increased mandibular range of motion immediately after treatment.
“The studies by Oliveira-Campelo et al. [26] and Gesslbauer et al. [31] reported immediate symptom relief and increased mandibular range of motion immediately after treatment.”
Physiotherapists consistently achieved significant outcomes in pain reductions and maximum mouth opening improvement.
“Physiotherapists consistently achieved significant outcomes in pain reductions [21–23] and MMO improvement [21,22,26].”
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.”
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].”
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.”
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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Lam, A. C., Liddle, L. J., & MacLellan, C. L. (2023) · Archives of Rehabilitation Research and Clinical Translation · doi:10.1016/j.arrct.2022.100242 · Cited by 14 · see citing works
“Of these, 1 contained multiple comparison groups.(38) See table 1 for information about each included trial.”
BackgroundMethodInfluentialChiaramonte, R., Ferrillo, M., de Sire, A., & Vecchio, M. (2026) · Journal of Manual & Manipulative Therapy · doi:10.1080/10669817.2026.2629282
“For instance, 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]).”
Influential
- Authors
- Oliveira-CampelO, N. M., Rubens-Rebelatto, J., MartÍn-Vallejo, F. J., Alburquerque-SendÍn, F., & Fernádez-de-las-Peñas, C.
- Venue
- Journal of Orthopaedic & Sports Physical Therapy
- Published
- 2010-05
- Volume
- 40
- Issue
- 5
- Pages
- 310-317
- ISSN
- 0190-6011 (ISSN-L)
- 1938-1344
- OpenAlex
- W2087786963
- Cited by
- 117
- References
- 0
- Citations by year
- 2026: 6 · 2025: 1 · 2024: 7 · 2023: 5 · 2022: 6 · 2021: 18 · 2020: 15 · 2019: 3 · 2018: 6 · 2017: 5 · 2016: 9 · 2015: 11 · 2014: 6 · 2013: 7 · 2012: 6
- FWCI
- 9.40
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- other-oa
- Locations
- Journal of Orthopaedic and Sports Physical Therapy (publishedVersion)
- PubMed (publishedVersion)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, other-oa)
- 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 › Complementary and alternative medicine › Acupuncture Treatment Research Studies
- Keywords
- masseter muscle, temporalis muscle, masticatory muscles, pressure pain threshold, cervical manipulation, trigeminal nerve, hypoalgesia, manual therapy, temporomandibular disorders
- MeSH terms
- Adolescent, Adult, Analysis of Variance, Atlanto-Occipital Joint, Female, Humans, Joint Diseases, Male, Manipulation, Orthopedic, Masseter Muscle, Masticatory Muscles, Mouth, Myofascial Pain Syndromes, Pressure, Temporal Muscle, Temporomandibular Joint Dysfunction Syndrome, Time Factors, Treatment Outcome, Muscle, Skeletal, Young Adult
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