The Effect of Upper Cervical Mobilization/Manipulation on Temporomandibular Joint Pain, Maximal Mouth Opening, and Pressure Pain Thresholds: A Systematic Review and Meta-Analysis

OBJECTIVE: To evaluate the efficacy of upper cervical joint mobilization and/or manipulation on reducing pain and improving maximal mouth opening (MMO) and pressure pain thresholds (PPTs) in adults with temporomandibular joint (TMJ) dysfunction compared with sham or other intervention. DATA SOURCES: MEDLINE, CINAHL, EMBASE, and Cochrane Library from inception to June 3, 2022, were searched. STUDY SELECTION: Eight randomized controlled trials with 437 participants evaluating manual therapy (MT) vs sham and MT vs other intervention were included. Two reviewers independently extracted data and assessed risk of bias. DATA EXTRACTION: Two independent reviewers extracted information about origin, number of study participants, eligibility criteria, type of intervention, and outcome measures. DATA SYNTHESIS: Manual therapy was statistically significant in reducing pain compared with sham (mean difference [MD]: -1.93 points, 95% confidence interval [CI]: -3.61 to -0.24, P=.03), and other intervention (MD: -1.03 points, 95% CI: -1.73 to -0.33, P=.004), improved MMO compared with sham (MD: 2.11 mm, 95% CI: 0.26 to 3.96, P=.03), and other intervention (MD: 2.25 mm, 95% CI: 1.01 to 3.48, P<.001), but not statistically significant in improving PPT of masseter compared with sham (MD: 0.45 kg/cm(2), 95% CI: -0.21 to 1.11, P=.18), and other intervention (MD: 0.42 kg/cm(2), 95% CI: -0.19 to 1.03, P=.18), or the PPT of temporalis compared with sham (MD: 0.37 kg/cm(2), 95% CI: -0.03 to 0.77, P=.07), and other intervention (MD: 0.43 kg/cm(2), 95% CI: -0.60 to 1.45, P=.42). CONCLUSION: There appears to be limited benefit of upper cervical spine MT on TMJ dysfunction, but definitive conclusions cannot be made because of heterogeneity and imprecision of treatment effects.