Spinal high-velocity low-amplitude manipulation with exercise in women with chronic temporomandibular disorders

Evidence indicates that manual therapy alone or in combination with exercise can be beneficial for temporomandibular disorders (TMD). However, there is still insufficient information demonstrating the effectiveness of treatment directed to the cervical spine for the management of TMD. To investigate the effects of spinal high-velocity low-amplitude (HVLA) manipulation with exercise compared to patient education in patients with chronic TMD. Another objective was to assess the effects of adding spinal HVLA manipulation to exercise. Sixty female patients with TMD were randomized to three groups: cervical spinal manipulation plus neck exercise (CSM + NE), sham manipulation plus neck exercise (SM + NE), and patient education only (PE). Scores on a numeric rating scale (NRS), pressure pain thresholds (PPT), pain-free maximum mouth opening (MMO), and Short Form 36 (SF-36) were evaluated at baseline, posttreatment, and 1‑month follow-up after randomization. No further treatment of TMD (like dental correction) was applied during the study period. In terms of pain, significant differences were observed in the CSM + NE group vs. the SM + NE and PE groups posttreatment. Although PPT increased significantly in the CSM + NE group, no significant changes in any PPT were found in either the SM + NE or PE group. Regarding pain-free MMO and SF-36 scores, there were significant increases posttreatment in the CSM + NE and SM + NE groups compared to the PE group. Our study suggests that HVLA manipulation of the upper cervical spine with neck exercise can be effective for treatment of pain and dysfunction in patients with chronic TMD, it is not the TMD treatment itself. Therefore, it seems reasonable to add cervical manipulation to the rehabilitation program.