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/cm2 to 1.4 +/- 0.2 kg/cm2 in the left masseter (P=0.03), from 1.31 +/- 0.28 kg/cm2 to 1.51 +/- 0.2 kg/cm2 in the right masseter (P>0.05), from 1.32 +/- 0.2 kg/cm2 to 1.46 +/- 0.2 kg/cm2 in the left temporalis (P=0.047), and from 1.4 +/- 0.2 kg/cm2 to 1.67 +/- 0.3 kg/cm2 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. (AU)