The Efficacy of Neck and Temporomandibular Joint (TMJ) Manual Therapy in Comparison With a Multimodal Approach in the Patients with TMJ Dysfunction: A Blinded Randomized Controlled Trial

Background: Temporomandibular joint disorders (TMJDs) are the main musculoskeletal cause of orofacial pain. This study aimed to assess the efficacy of manual therapy and routine treatment compared with routine treatment on pain, maximum mouth opening (MMO), and cervical range of motion (ROM) in patients with the temporomandibular joint disorder (TMJD). Methods: This study was performed at the biomechanics laboratory of the physiotherapy department of Iran University of Medical Sciences, Tehran, Iran. A total of 30 patients with TMJD were randomized into 2 groups: an intervention group (manual therapy plus routine treatment) and a control group (conventional treatment). Treatment included 10 sessions. The primary outcome was pain intensity and the secondary outcomes were MMO, and range of cervical flexion and extension. The outcomes were measured at the baseline, at the end of the treatment, and after a 4-week follow-up period. The repeated measures analysis of variance was used to assess group × time interaction, and the Bonferroni adjustment was used for between-group comparisons. The effects size of Cohen's d was used to determine the magnitude of between-group differences. Results: The results showed that there were significant group × time interactions for pain, MMO, and the cervical flexion ROM (P<0.001). In comparion with the baseline, the intervention group showed significant improvements in jaw pain, MMO, and cervical flexion ROM (P<0.001), while in the control group, compared with the baseline, only pain and MMO significantly improved (P<0.05). Results of between-group comparisons revealed that there were significant and clinical differences between the 2 groups after treatment, and the intervention group had lower jaw pain, more MMO, and cervical flexion than the control group (P<0.001). In addition, the efficacy of manual therapy based on the Cohen's d was large for the outcomes of pain, MMO, and cervical flexion. Conclusion: The findings showed that adding manual therapy of the upper cervical spine and TMJ to the routine treatment could be an effective intervention for patients with TMD.