|Effectiveness of cervical spine high velocity low amplitude thrust added to behavioral education, soft tissue mobilization, and exercise in individuals with temporomandibular disorder (TMD) with myalgia: A randomized clinical trial
from Journal of Orthopaedic & Sports Physical Therapy
The objective of this study was to determine the immediate and short-term effects of cervical spine high velocity low amplitude thrust (HVLAT) added to behavioral education, soft tissue mobilization, and a home exercise program (HEP) on reducing pain and dysfunction in individuals with a primary complaint of temporomandibular disorder (TMD) with myalgia.
TMD is a common and costly problem often leading to chronic pain. There is moderate evidence for physical therapy intervention in the management of TMD. A known relationship between TMD and the cervical spine exists; however, studies examining the efficacy of cervical interventions in this population are limited.
Fifty individuals with TMD (N=50) were randomly assigned to receive cervical HVLAT or sham manipulation for four visits over four weeks. Participants in both groups received other treatments including standardized behavioral education, soft tissue mobilization, and a HEP. Primary outcomes included maximal mouth opening (MMO), Numeric Pain Rating Scale (NPRS), Jaw Functional Limitation Scale (JFLS), Tampa Scale of Kinesiophobia (TSK-TMD), and Global Rating of Change (GROC). Self-report and objective measurements were taken at baseline, immediately after initial treatment, one week, and four weeks. A 2 x 4 mixed model ANOVA was used with intervention group as the between-subjects factor and time as the within-subjects factor. Separate ANOVAs were performed for dependent variables and the hypothesis of interest was the group by time interaction.
There was no significant interaction for MMO, NPRS, or secondary measures. Significant two-way interactions were noted in JFLS (d=0.60) and TSK-TMD (d=0.80). The HVLAT group had lower fear at four weeks and improved jaw function earlier (1-week). GROC favored the HVLAT group with significant differences in successful outcomes noted immediately after baseline treatment (thrust:6/25; sham:0/25) and at four weeks (thrust:17/25; sham:10/25).
Both groups improved over time, but differences between groups were small. Significant differences between groups were noted for JFLS, TSK-TMD, and GROC. The additive clinical effect of cervical HVLAT to standard care remains unclear in the treatment of TMD.
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