Temporomandibular disorders (TMDs) primarily affect the 20 to 40-year-old age group, show a higher prevalence in females and are the second most common cause of orofacial pain after dental pain. Although not fully understood, the etiology of TMDs is thought to be multifactorial – related to structural, psychological, and functional factors.
Because of the functional, anatomical, and neurophysiological relationship between the temporomandibular joint (TMJ) and the upper cervical spine, TMDs are often associated with other craniocervical conditions, such as neck pain and headache. Also, the facial area and cervical spine have a common innervation that involves afferent neurons of the trigeminocervical complex.
Manual therapy (MT) involving TMJ mobilization and soft tissue techniques to improve function and reduce pain are commonly used in the treatment of TMD. Cervical MT techniques are also commonly added to craniofacial treatments to address the previously mentioned relationships between the craniofacial area and the upper cervical spine.

Cervical spine manipulation or mobilization techniques have been shown to have a positive effect on pain intensity in TMD patients and it is thought that cervical MT could increase the therapeutic effectiveness of MT applied to the TMJ and facial region. Cervical MT could also be used in TMD patients who are not good candidates for MT in the mandibular region.
The effectiveness of cervical spine MT for patients with TMD and the comparison of cervico-craniomandibular MT versus cervical treatment remains unclear. Therefore, the objectives of this study were: 1) to perform a systematic review and meta-analysis on the effectiveness of cervical MT in patients with TMD; and 2) to compare the effectiveness of cervico-craniomandibular MT treatment versus cervical treatment in patients with TMD.
THIS WEEK'S RESEARCH REVIEW: “Effectiveness of Cervical Manual Therapy & Exercise for Temporomandibular Disorders”
This paper was published in Pain Medicine (2020 - in press at time of posting) and this Review is posted in Recent Reviews, Temporomandibular Joint (TMJ) and the 2020 Archive.
TMJ pain