Doctor of Philosophy (PhD) in Physical Therapy
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College of Health Care Sciences - Physical Therapy Department
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Nova Southeastern University
Breanna C. Reynolds. 2019. Thrust Joint Manipulation to the Cervical Spine in Participants with a Primary Complaint of Temporomandibular Disorder (TMD): A Randomized Clinical Trial. Doctoral dissertation. Nova Southeastern University. Retrieved from NSUWorks, College of Health Care Sciences - Physical Therapy Department. (76)
Background: Temporomandibular disorder (TMD) is a common and costly problem often leading to chronic pain. There exists moderate evidence for physical therapy (PT) interventions in the management of TMD. A known relationship between TMD and the cervical spine exists with some evidence to support cervical intervention treatments. Cervical spine thrust joint manipulation (TJM) is an effective PT intervention explored in a limited fashion for this population. Objectives: To determine the immediate and short term (1 and 4 week) effects of cervical TJM on pain, dysfunction, and perception of change in individuals with a primary complaint of TMD. Methods: In this single blind randomized clinical trial, individuals with TMD (n=50) were randomly assigned to receive cervical TJM or sham manipulation in 4 PT visits over 4-weeks. All participants also received behavioral education, a home exercise program, and soft tissue mobilization. Primary outcomes included jaw range of motion (ROM), Numeric Pain Rating Scale (NPRS), TMD Disability Index, Jaw Functional Limitation Scale (JFLS), Tampa Scale of Kinesiophobia (TSK-TMD), and Global Rating of Change (GROC). Self-report and objective measurements (with blinded assessor) were taken at baseline, immediately after baseline treatment, 1-week, and 4-weeks. A 2 x 4 mixed model ANOVA was used with treatment 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. Results: Statistically significant 2-way interactions were noted in JFLS (p = .026) and TSK-TMD (p = .008), favoring the thrust manipulation group. Both groups showed statistically significant main effects in all measures over time. GROC and PASS favored the thrust manipulation group with statistically significant differences in successful outcomes noted immediately after baseline treatment (NNT = 5) and at 4-weeks (NNT = 4). Conclusion: Both groups received identical multi-modal treatments with the addition of the randomized intervention: cervical TJM or sham manipulation. Differences between groups were small, however, improvements favored the TJM on all measures. Cervical TJM may be beneficial in the treatment of TMD.
Health and environmental sciences, Cervical spine, Jaw pain, Manual therapy, Physical therapy, Temporomandibular disorder, Thrust joint manipulation