Effects of cervical mobilization and exercise on pain, movement and function in subjects with temporomandibular disorders: a single group pre-post test

OBJECTIVE: To investigate the effect of a rehabilitation program based on cervical mobilization and exercise on clinical signs and mandibular function in subjects with temporomandibular disorder (TMD). Material and Methods: Single-group pre-post test, with baseline comparison. SUBJECTS: Twelve women (22.08±2.23 years) with myofascial pain and mixed TMD according to the Research Diagnostic Criteria for Temporomandibular Disorders. OUTCOME MEASURES: Subjects were evaluated three times: twice before (baseline phase) and once after intervention. Self-reported pain, jaw function [according to the Mandibular Functional Impairment Questionnaire (MFIQ)], pain-free maximum mouth opening (MMO), and pressure pain thresholds (PPTs) of both masseter and temporalis muscles were obtained. Baseline and post-intervention differences were investigated, and effect size was estimated through Cohen’s d coefficient. RESULTS: Jaw function improved 7 points on the scale after the intervention (P=0.019), and self-reported pain was significantly reduced (P=0.009). Pain-free MMO varied from 32.3±8.8 mm to 38±8.8 mm and showed significant improvement (P=0.017) with moderate effect size when compared to the baseline phase. PPT also increased with moderate effect size, and subjects had the baseline values changed from 1.23±0.2 kg/cm(2) to 1.4±0.2 kg/cm(2) in the left masseter (P=0.03), from 1.31±0.28 kg/cm(2) to 1.51±0.2 kg/cm(2) in the right masseter (P>0.05), from 1.32±0.2 kg/cm(2) to 1.46±0.2 kg/cm(2) in the left temporalis (P=0.047), and from 1.4±0.2 kg/cm(2) to 1.67±0.3 kg/cm(2) in the right temporalis (P=0.06). CONCLUSIONS: The protocol caused significant changes in pain-free MMO, self-reported pain, and functionality of the stomatognathic system in subjects with myofascial TMD, regardless of joint involvement. Even though these differences are statistically significant, their clinical relevance is still questionable.