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Manual therapy for the neck or jaw in patients with TMD

Does it help reduce pain in those with temporomandibular joint disorders?

The current literature acknowledges the proximity and relatedness of the temporomandibular joint (TMJ) to the cervical spine. Dysfunction in both of these structures can therefore be a source of pain and headaches.

Manual therapy – including joint mobilisations and soft tissue techniques – is often used to treat temporomandibular disorders (TMDs) and to support pain relief. Due to the anatomical location of the TMJ, manual therapy to either cervical spine or the jaw is sometimes used to treat pain associated to TMDs. 

Nevertheless, very few studies have compared cervico-craniomandibular manual therapy versus just cerical manual therapy to establish the therapeutic effect on pain in patients with TMD. The current systematic assessed the few known studies which have addressed this, and investigated the effectiveness of both therapies in reducing pain levels in those with TMDs.

It was found that both manual therapy treatments had led to a clinically significant reduction of pain in those with known TMD, but the strength of the evidence had limitations.

Upper cervical spine manual therapy can assist in mandibular depression (mouth opening) and improving pressure pain thresholds when compared to that of sham treatment. The studies that compared cervico-craniomandibular therapy vs. cervical manual therapy only found that both had good short-term outcomes with regards to improving pain associated to TMD, but that combined cervical spine and craniomandibular input is needed to achieve pain relief in the longer term.

The authors of this systematic review with meta-analysis highlight that there is a body of evidence to support targeted manual therapy for cervical spine and TMD. It needs to be targeted, however, and perhaps manual therapy alone is not sufficient as the sole treatment strategy in these conditions. Further research and support for additional input, such as further detailed exercise therapy for both cervical spine and TMD is also needed.

It was also concluded that a lack of longitudinal designs and lack of homogeneity among studies limits the wider application of their findings.

> From: La Touche et al., Pain Med 21 (2020) 2373-2384 (Epub ahead of print). All rights reserved to American Academy of Pain Medicine. Click here for the online summary.

Expert opinion

This study highlights the fact that, even though manual therapy is a commonly used tool and has principles of application, the evidence is not enough to justify hands-on therapy alone for long term pain relief.

The studies included in this systematic review did use additional therapeutic exercise, but the details provided about this are limited. Like most physiotherapy treatment strategies, a multimodal approach that would encompass exercise, education and postural input may yield better outcomes that just manual therapy alone.

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