Effectiveness of Cervical Spine High-Velocity, Low-Amplitude Thrust Added to Behavioral Education, Soft Tissue Mobilization, and Exercise for People With Temporomandibular Disorder With Myalgia: A Randomized Clinical Trial
Abstract
Objective: To determine the immediate and short-term effects of adding cervical spine high-velocity, low-amplitude thrust (HVLAT) to behavioral education, soft tissue mobilization, and a home exercise program on pain and dysfunction for people with a primary complaint of temporomandibular disorder (TMD) with myalgia. Design: Randomized clinical trial. Methods: Fifty individuals with TMD were randomly assigned to receive cervical HVLAT or sham manipulation for 4 visits over 4 weeks. Participants in both groups received other treatments, including standardized behavioral education, soft tissue mobilization, and a home exercise program. Primary outcomes included maximal mouth opening, the numeric pain-rating scale, the Jaw Functional Limitation Scale (JFLS), the Tampa Scale of Kinesiophobia for TMD (TSK-TMD), and a global rating of change (GROC). Self-report and objective measurements were taken at baseline, immediately after initial treatment, and follow-ups of 1 week and 4 weeks. A 2-by-4 mixed-model analysis of variance was used, with intervention group as the between-subjects factor and time as the within-subject factor. Separate analyses of variance were performed for dependent variables, and the hypothesis of interest was the group-by-time interaction. Results: There was no significant interaction for maximal mouth opening, the numeric pain-rating scale, or secondary measures. There were significant 2-way interactions for the JFLS (d = 0.60) and TSK-TMD (d = 0.80). The HVLAT group had lower fear at 4 weeks and improved jaw function earlier (1 week). The GROC favored the HVLAT group, with significant differences in successful outcomes noted immediately after baseline treatment (thrust, 6/25; sham, 0/25) and at 4 weeks (thrust, 17/25; sham, 10/25). Conclusion: Both groups improved over time; however, differences between groups were small. There were significant differences between groups for the JFLS, TSK-TMD, and GROC. The additive clinical effect of cervical HVLAT to standard care remains unclear for treating TMD. J Orthop Sports Phys Ther 2020;50(8):455–465. Epub 6 Jan 2020. doi:10.2519/jospt.2020.9175
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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].”
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).”
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].”
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].”
Conservative interventions such as physiotherapy and manual therapy directly affect the muscular system to reduce excessive tension and minimize pain in the temporomandibular joints and chewing muscles.
“These interventions directly affect the muscular system, in order to reduce its excessive tension, and thus minimize pain in the area of the temporomandibular joints, and in muscles involved in the chewing process [1,3,19,20,21,22,23,24,25,26].”
From The Application of Manual Techniques in Masticatory Muscles Relaxation as Adjunctive Therapy in the Treatment of Temporomandibular Joint Disorders (2021) · cites this paper as [24]
Cites
Schiffman, E., Ohrbach, R., Truelove, E., Look, J., Anderson, G., Goulet, J.-P., List, T., Svensson, P., Gonzalez, Y., Lobbezoo, F., et al. (2014) · Journal of Oral & Facial Pain and Headache · doi:10.11607/jop.1151 · Cited by 4,567 · see citing works
Armijo-Olivo, S., Pitance, L., Singh, V., Neto, F., Thie, N., & Michelotti, A. (2016) · Physical Therapy · doi:10.2522/ptj.20140548 · Cited by 413 · see citing works
Assessing the impact of attrition in randomized controlled trials
Hewitt, C. E., Kumaravel, B., Dumville, J. C., & Torgerson, D. J. (2010) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.01.010 · Cited by 139 · see citing works
La Touche, R., París-Alemany, A., Mannheimer, J. S., Angulo-Díaz-Parreño, S., Bishop, M. D., Lopéz-Valverde-Centeno, A., von Piekartz, H., & Fernández-Carnero, J. (2013) · The Clinical Journal of Pain · doi:10.1097/ajp.0b013e318250f3cd · Cited by 112 · see citing works
Kalamir, A., Graham, P. L., Vitiello, A. L., Bonello, R., & Pollard, H. (2013) · Chiropractic & Manual Therapies · doi:10.1186/2045-709x-21-17 · Cited by 76 · see citing works
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Urbański, P., Trybulec, B., & Pihut, M. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182412970 · Cited by 73 · see citing works
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
“Pain was evaluated in 5 trials.(40,42,44,45,47) MMO was evaluated in 6 trials,(38,40-42,46,47) PPT of the masseter was evaluated in 4 trials,(38,42,44,45) and PPTof the temporalis was evaluated in 5 trials.”
MethodChiaramonte, R., Ferrillo, M., de Sire, A., & Vecchio, M. (2026) · Journal of Manual & Manipulative Therapy · doi:10.1080/10669817.2026.2629282
“…c) Disc displacement without reduction (closed locking): treated with upper cervical HVLA [23], intra-oral manipulations [38] in physical therapy [23] and oral surgery setting [38]; d) Non-specified TMD: treated by physiotherapists [31] and osteopaths [24] using jaw and upper cervical HVLA [26].”
Influential
- Authors
- Reynolds, B., Puentedura, E. J., Kolber, M. J., & Cleland, J. A.
- Affiliations
- South College (US)
- Venue
- Journal of Orthopaedic & Sports Physical Therapy
- Published
- 2020-08
- Volume
- 50
- Issue
- 8
- Pages
- 455-465
- ISSN
- 0190-6011 (ISSN-L)
- 1938-1344
- OpenAlex
- W2998615814
- Cited by
- 43
- References
- 5
- Citations by year
- 2026: 9 · 2025: 10 · 2024: 5 · 2023: 6 · 2022: 5 · 2021: 5 · 2020: 1 · 2015: 2
- FWCI
- 4.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Orthopaedic and Sports Physical Therapy (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, myalgia, cervical manipulation, high-velocity low-amplitude thrust, soft tissue mobilization, behavioral education, home exercise program, jaw function, kinesiophobia, pain, maximum mouth opening, jaw functional limitation, sham manipulation, multimodal therapy, temporomandibular myalgia
- MeSH terms
- Behavior Therapy, Cervical Vertebrae, Exercise Therapy, Fear, Humans, Pain Measurement, Patient Education as Topic, Temporomandibular Joint Disorders, Range of Motion, Articular, Manipulation, Spinal, Myalgia
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