Neck Exercises for TMJ Dysfunction

Overseen By Susan Armijo-Olivo, PhD

Age: 18 - 65

Sex: Female

Trial Phase: Academic

Sponsor: University of Alberta

Disqualifiers: Metabolic, Rheumatoid, Psychiatric, others

Compensation: Varies

Number of Visits: 18

Duration: 8 weeks

113 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of neck exercises as a treatment for TMJ dysfunction?

Research shows that neck exercises, when combined with other therapies, can help reduce pain and improve function in people with TMJ dysfunction. Studies indicate that focusing on the neck and cervical spine can positively impact TMJ symptoms, suggesting that neck exercises may be beneficial. ^{1 2 3 4 5}

Are neck exercises safe for humans?

Neck exercises, including those combined with spinal manipulation, have been associated with non-serious musculoskeletal adverse events (like muscle soreness) in elderly participants. Serious adverse events are rare, but they can occur, such as falls during supervised sessions. ^{6 7 8 9 10}

How do neck exercises differ from other treatments for TMJ dysfunction?

Neck exercises for TMJ dysfunction are unique because they focus on improving neck mobility and function, which can indirectly alleviate jaw pain and improve jaw function. This approach is different from other treatments that may directly target the jaw or use medication, as it addresses the interconnectedness of neck and jaw issues. ^{1 11 12 13 14}

What is the purpose of this trial?

This trial tests if specific neck exercises with visual feedback can help women with chronic jaw pain. The exercises aim to improve muscle control and reduce pain by potentially reversing brain changes linked to chronic pain. The study will measure pain levels, brain changes, and muscle function before and after the exercise program.

Research Team

Susan Armijo-Olivo, PhD

Principal Investigator

University of Alberta

Eligibility Criteria

This trial is for women aged 18-60 with chronic muscle pain in the jaw, diagnosed as TMD. They must have had this pain for at least 3 months and a moderate to severe pain level. Excluded are those with certain diseases like rheumatoid arthritis, psychiatric disorders, abnormal neurological exams, MRI contraindications (like metal implants), substance abuse history, recent exercise therapy or electrotherapy experience, and pregnant or planning pregnancy.

Inclusion Criteria

I am a woman aged 18-60 with diagnosed muscle pain in my jaw or face.

I have had jaw muscle pain for at least 3 months.

I have long-term jaw muscle pain not caused by recent injury, infection, or inflammation.

Exclusion Criteria

Pregnant or planning a pregnancy

I have a diagnosed psychiatric condition like depression or schizophrenia.

I have undergone electrotherapy before.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive 8 weeks of progressive motor control training using visual feedback for the cervical muscles, twice per week.

8 weeks

16 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment, with assessments at 2 and 6 months post-treatment.

6 months

2 visits (in-person)

Treatment Details

Interventions

• Neck Exercises
• Placebo

Trial Overview The study tests if neck exercises can help women with TMD by reducing pain and improving jaw function. It involves comparing motor control training using visual feedback against a placebo (inactive treatment). Participants will be randomly assigned to either the active exercise group or the placebo group and tracked over time to see changes in their condition.

Participant Groups

Group I: Exercises Experimental Treatment 1 Intervention

Neck flexors Training: Each patient will initially perform cranio-cervical flexion to sequentially reach 5 pressure targets in 2 mmHg increments from a baseline of 20 mmHg to the final level of 30 mmHg. For each target level, the contraction duration will be increased to 10 s, and the participant trained to perform 10 repetitions with brief rest periods between each contraction. Once one set of 10 repetitions of 10 s is achieved at one target level, the exercise will be progressed to train at the next target level up to the final target. Neck extensors training: Patients will perform cranio-cervical extension and upper cervical rotation in a prone on elbows position while maintaining the cervical spine in a neutral position, progressing to a 4-pt kneeling position.

Group II: Placebo Placebo Group 1 Intervention

The placebo group will receive placebo TENS (switched-off TENS apparatus with no perceptible stimulation). Four electrodes, 50 x 35 mm, will be placed on the neck muscles. The participant will be informed that this therapy is called a "subthreshold current" and they might not be able to feel any sensation underneath the electrodes during the treatment. The placebo treatment will be for 30 min twice a week for 8 weeks, as for the intervention group.

Who Is Running the Clinical Trial?

University of Alberta

Lead Sponsor

Trials

957

Recruited

437,000+

Findings from Research

A rehabilitation program involving cervical mobilization and exercise significantly improved jaw function and reduced self-reported pain in 12 women with temporomandibular disorder (TMD), as evidenced by a 7-point improvement on the Mandibular Functional Impairment Questionnaire and a reduction in pain levels.

Participants also experienced a significant increase in pain-free maximum mouth opening and pressure pain thresholds in the jaw muscles, indicating enhanced mandibular function, although the clinical relevance of these improvements remains uncertain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of cervical mobilization and exercise on pain, movement and function in subjects with temporomandibular disorders: a single group pre-post test. Calixtre, LB., Grüninger, BL., Haik, MN., et al.[2022]

Exercise therapy is effective in providing moderate short-term relief from pain and improving range of motion in patients with temporomandibular joint dysfunction, based on a systematic review of six studies involving 419 participants.

Mobility and mixed exercise approaches are the most commonly used methods, but while they help reduce pain and increase range of motion, they do not significantly improve overall function.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effectiveness of exercise therapy for temporomandibular dysfunction: a systematic review and meta-analysis. Dickerson, SM., Weaver, JM., Boyson, AN., et al.[2018]

In a study involving 241 elderly participants undergoing spinal manipulative therapy (SMT) and exercise for chronic neck pain, 130 reported non-serious adverse events (AEs), highlighting the prevalence of musculoskeletal issues associated with these treatments.

Participants in the supervised exercise group reported three times more AEs compared to those receiving home exercise alone, indicating that while SMT and exercise can be effective, they also carry a risk of AEs that should be considered in treatment planning.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse events among seniors receiving spinal manipulation and exercise in a randomized clinical trial. Maiers, M., Evans, R., Hartvigsen, J., et al.[2022]

Cervical manipulation and mobilization techniques for neck pain are generally effective but can be associated with rare serious adverse events, as highlighted by a review of studies from 1998 to 2009.

The review found that while 17 out of 76 studies reported no major adverse events, minor adverse events like transient neurological symptoms and increased neck pain were noted, indicating a need for better reporting of adverse events in manual therapy research.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse events associated with the use of cervical manipulation and mobilization for the treatment of neck pain in adults: a systematic review. Carlesso, LC., Gross, AR., Santaguida, PL., et al.[2022]

The author addresses concerns regarding the risks of serious adverse events associated with orthopaedic manual therapy, paracetamol, and NSAID treatments for neck pain, emphasizing the need for careful consideration of these risks in clinical practice.

The response highlights the importance of balancing treatment efficacy with safety, suggesting that while these interventions can be effective for neck pain, practitioners should remain vigilant about potential adverse effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Response to the Letter to the Editor-in-Chief. Rushton, A., Carlesso, LC., Flynn, T., et al.[2023]

References

1. Brazil pubmed.ncbi.nlm.nih.gov

Effects of cervical mobilization and exercise on pain, movement and function in subjects with temporomandibular disorders: a single group pre-post test. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Impact of Cervical Spine Rehabilitation on Temporomandibular Joint Functioning in Patients with Idiopathic Neck Pain. [2022]

3. Russia (Federation) pubmed.ncbi.nlm.nih.gov

[The role of therapeutic exercises in the combined treatment and rehabilitation of patients with pain syndrome associated with the dysfunction of temporomandibular joint]. [2010]

4. Switzerland pubmed.ncbi.nlm.nih.gov

Effectiveness of Physiotherapy in the Treatment of Temporomandibular Joint Dysfunction and the Relationship with Cervical Spine. [2022]

5. England pubmed.ncbi.nlm.nih.gov

The effectiveness of exercise therapy for temporomandibular dysfunction: a systematic review and meta-analysis. [2018]

6. Scotland pubmed.ncbi.nlm.nih.gov

Adverse events among seniors receiving spinal manipulation and exercise in a randomized clinical trial. [2022]

7. Scotland pubmed.ncbi.nlm.nih.gov

Adverse events associated with the use of cervical manipulation and mobilization for the treatment of neck pain in adults: a systematic review. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Response to the Letter to the Editor-in-Chief. [2023]

9. United States pubmed.ncbi.nlm.nih.gov

Resistance, Motor Control, and Mindfulness-Based Exercises Are Effective for Treating Chronic Nonspecific Neck Pain: A Systematic Review With Meta-Analysis and Dose-Response Meta-Regression. [2023]

10. United States pubmed.ncbi.nlm.nih.gov

Exercise therapy for craniomandibular disorders. [2022]

11. England pubmed.ncbi.nlm.nih.gov

Effect of therapeutic jaw exercise on temporomandibular disorders in individuals with chronic whiplash-associated disorders. [2006]

12. England pubmed.ncbi.nlm.nih.gov

Effectiveness of dynamic muscle training, relaxation training, or ordinary activity for chronic neck pain: randomised controlled trial. [2022]

13. United States pubmed.ncbi.nlm.nih.gov

Ultrasound Investigation of Dorsal Neck Muscle Deformation During a Neck Rotation Exercise. [2021]

14. United States pubmed.ncbi.nlm.nih.gov

Adding Temporomandibular joint treatments to routine physiotherapy for patients with non-specific chronic neck pain: A randomized clinical study. [2021]