To test the effectiveness of an 8-week exercise program targeted to the neck muscles compared to manual therapy (MT) and placebo treatments on upper and global neck ROM in patients with TMD.
This was a double-blinded randomized controlled trial. It included fifty-four women between 18-45 years old with a diagnosis of masticatory myofascial pain or mixed TMD. All patients were evaluated with a Cervical ROM (CROM) device for upper (Flexion Rotation Test (FRT)) and global neck range of motion (ROM) at baseline, immediately after the end of treatment, four (one-month follow-up), and twelve (three-month follow-up) weeks after the end of the treatment. Participants were randomized into three groups: Neck Training Group (NTG), MT Group (MTG), and Placebo Group (PG). All groups were treated for eight weeks, once a week. A mixed ANOVA with repeated measures was conducted with Bonferroni post hoc test. All results were performed based on intention-to-treat analyses.
The NTG significantly improved right FRT than PG at the end of treatment, one-month, and three-month follow-up (effect size (ES)>0.7), while the MTG was better than PG just at the final assessment (ES >0.8). For left FRT, the NTG and MTG were better than PG at the end of treatment, one-month, and three-month follow-up (ES>0.7). Regarding global neck movements, MTG was better than NTG on flexion ROM at partial, final, and three-month follow-ups (ES>0.7). Also, MTG presented a better right lateral flexion than PG at the partial and one-month follow-up assessment (ES>0.7). For left lateral flexion, the NTG was better than PG at the partial, one-month, and three-month follow-up assessments, while the MTG was better than PG at the partial evaluation and not maintained over time. For neck rotation, the NTG had better neck left rotation than PG at the final and one-month follow-up assessments, and the MTG had better-left rotation than PG at the partial, final, and one-month follow-up assessments (ES>0.8). No differences were verified on the right rotation ROM.
Neck motor control exercises improved upper and some global neck movements in women with TMD when compared to a placebo intervention. MT improved almost all neck movements more effectively than the placebo treatment. These results provide promising evidence for using neck motor control exercises and neck MT in patients with TMD.
The data from this RCT provides an innovative, easy, and cost-effective strategy for treating patients with TMD. The results from this trial reinforce the importance of applying a neck exercise protocol to treat patients with chronic TMD. Also, it is suggested that future studies verify the long-term duration of these results in a longer follow-up (at least six months).
Neck exercise
Randomized controlled trial
