Manual Therapy vs. Home Exercise in Myogenic TMD With Neck Pain

Comparative Effects of Manual Therapy Versus Home Exercise on Pain, Function, and Masseter Muscle Properties in Myogenic Temporomandibular Disorder With Neck Pain: A Randomized Controlled Trial.

Temporomandibular disorders (TMD) are common musculoskeletal conditions affecting the jaw joint and surrounding chewing muscles. Myogenic TMD specifically involves muscle pain and dysfunction, which is frequently accompanied by chronic neck pain due to the close anatomical and neurophysiological connections between the jaw and the cervical spine.

The purpose of this study is to compare the clinical effectiveness of two widely used physiotherapy interventions-a clinician-administered manual therapy protocol and a patient-conducted home exercise program-in individuals diagnosed with myogenic TMD and chronic neck pain. The main research question is to determine whether targeted manual therapy applied to both the temporomandibular and cervical regions yields superior improvements in pain, jaw and neck mobility, quality of life, and masseter muscle properties compared to the Rocabado 6x6 home exercise program alone.

1. A total of 34 participants aged 18-45 years with myogenic TMD and chronic neck pain will be randomly allocated into two equal groups:

   Manual Therapy Group: Participants receive 6 individual treatment sessions (3 days per week for 2 weeks) consisting of soft tissue mobilization, trigger point therapy, myofascial release, and joint mobilization techniques applied to the jaw and neck regions.

2. Exercise Group: Participants perform the standardized Rocabado 6x6 home exercise program 3 days per week for 2 weeks, with adherence monitored through daily exercise diaries.

All participants undergo comprehensive assessments at baseline and immediately following the 2-week intervention. Evaluated parameters include jaw and neck pain intensity (Visual Analog Scale), cervical and mandibular range of motion, cervical joint position sense, jaw proprioception, facial asymmetry, bruxism, TMD severity, movement-related fear (kinesiophobia), and quality of life. In addition, masseter muscle thickness and elasticity are objectively assessed using ultrasound imaging and elastography.

The findings of this trial aim to provide healthcare professionals with high-level evidence regarding effective, targeted physiotherapy strategies for managing myogenic TMD co-occurring with cervical pain.

Inclusion Criteria:

• Presence of TMJ pain at rest,
• TMJ pain persisting for at least 3 months,
• Neck pain persisting for at least 3 months,
• Willingness to participate in the study.

Exclusion Criteria:

• Any orthopedic and/or neurological condition that would preclude the assessments,
• Cardiac history or surgery severe enough to preclude exercise,
• Diagnosis of any psychiatric disorder,
• Any condition precluding assessment or communication,
• History of orthopedic surgery in any region,
• Receipt of physiotherapy or any other treatment for the TMJ or spinal region within the previous 6 months,
• Illiteracy,
• A positive vertebrobasilar artery test.