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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if specific neck exercises can help women with chronic jaw muscle pain, known as temporomandibular disorder (TMD). Researchers will explore how these exercises might reduce pain and improve jaw function by examining changes in brain structure and networks. Participants will either perform neck exercises or receive a placebo treatment to compare effects. Women who have experienced jaw muscle pain for at least three months and have moderate to severe discomfort may be suitable for this study. As an unphased trial, this study offers participants the chance to contribute to innovative research that could lead to new treatment options.

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 prior data suggests that these neck exercises are safe for treating TMJ dysfunction?

Research has shown that neck exercises are generally safe. Studies on similar exercises have found benefits for conditions like Temporomandibular Joint (TMJ) dysfunction. For instance, exercises that improve posture can stretch and strengthen muscles, potentially reducing TMJ symptoms such as pain and stiffness.

Neck exercises are often used in physical therapy and are considered low-risk. They typically aim to enhance muscle strength and flexibility without invasive procedures. The trial's "Not Applicable" phase indicates that the exercises are expected to be well-tolerated, with minimal risk of serious side effects.

In summary, existing evidence suggests that neck exercises are a safe option with benefits for those with TMJ issues. Prospective participants can expect a low risk of harm while potentially experiencing symptom relief. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about neck exercises for TMJ dysfunction because they offer a novel, non-invasive approach compared to typical treatments like pain medications, dental splints, or surgery. These exercises specifically target the neck flexors and extensors, potentially addressing underlying muscular issues that contribute to TMJ problems. By strengthening these muscles, the exercises could improve jaw function and reduce pain without the side effects associated with medications. This method also empowers patients to take an active role in their treatment through simple, structured physical therapy.

What evidence suggests that neck exercises might be an effective treatment for TMJ dysfunction?

Research has shown that neck exercises might help with TMJ (temporomandibular joint) problems. One study found that exercises to stabilize the neck reduced TMJ symptoms and improved neck posture and movement. Another review highlighted that neck exercises can relieve pain. In this trial, participants in the experimental arm will perform specific neck exercises targeting both the jaw and neck, which may help with TMJ issues by stretching tight muscles and strengthening weak ones. These findings suggest that neck exercises could effectively reduce pain and improve function for those with TMJ disorders. ^{3 6 7 8 9}

Who Is on the Research Team?

Susan Armijo-Olivo, PhD

Principal Investigator

University of Alberta

Are You a Good Fit for This Trial?

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 for a Trial Participant

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)

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

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]

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]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12351786/

Effectiveness of cervical stabilization training in individuals ... This study demonstrates that CST may contribute to alleviating TMJ symptom severity and improving cervical posture, mobility, and muscle ...

2. sciencedirect.com sciencedirect.com/science/article/abs/pii/S2468785525003167

Review Efficacy of manipulation and therapeutic exercise ... This study aimed to evaluate comprehensively and quantitatively the efficacy of manipulation and therapeutic exercise acting on the neck region ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9448471/

The Efficacy of Neck and Temporomandibular Joint (TMJ ... The results showed that manual therapy of the upper cervical spine combined with TMJ could be an effective intervention in relieving pain and increasing month ...

4. nature.com nature.com/articles/s41598-025-03846-3

Effects of combined jaw and cervicoscapular exercises on ... Posture training has been shown to improve TMJ dysfunction by stretching shortened muscles and strengthening weakened ones due to poor posture.

5. bmcmusculoskeletdisord.biomedcentral.com bmcmusculoskeletdisord.biomedcentral.com/counter/pdf/10.1186/s12891-025-09055-3.pdf

Effectiveness of cervical stabilization training in individuals ... Exercises for the cervical region may also be effective in improving pain and function in TMJ disorders [8–10]. However, these exercise programs have often ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10036235/

The Effect of Upper Cervical Mobilization/Manipulation on ... Our results suggest that mobilization or manipulation of joints of the upper cervical spine does not appear to reduce signs and symptoms of TMJ ...

7. clinicaltrials.gov clinicaltrials.gov/study/NCT06472141

Effectiveness of Cervical Stabilization Exercises in ... It is planned to examine the effect of cervical stabilization exercises on Temporomandibular Joint (TMJ) symptoms in individuals with TMJ disorder. Detailed ...

8. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12381817/

Physiotherapy Approaches for Temporomandibular Disorders Stretching exercises are beneficial for both arthrogenous and myogenous TMDs [28]. These exercises include lateral jaw movement and opening ...

9. aafp.org aafp.org/pubs/afp/issues/2023/0100/temporomandibular-disorders.html

Temporomandibular Disorders: Rapid Evidence Review This rapid evidence review focuses on patient-oriented evidence for managing patients with issues related to the temporomandibular region.