title: Regional effects of orthopedic manual physical therapy in the successful management of chronic jaw pain.
abstract: OBJECTIVE
  Temporomandibular disorders (TMD) encompass a variety of dysfunction of the maxillofacial region. A strong relationship between TMD and cervical spine pain exists, and widespread hyperalgesia is common in TMD. This case describes the management and reduction in regional hyperalgesia in a patient with chronic TMD.
  
  
  METHODS
  A 23-year-old female with a 10-year history of tinnitus and bilateral (B) jaw pain, and 5-year history of intermittent neck pain, presented with pain, which could reach 10/10 on the numeric pain rating scale, locking, tightness and restricted eating habits. Cervical motion testing did not reproduce her jaw pain. Her mouth opening (MO) and B temporomandibular joint (TMJ) accessory glides were limited and painful. Accessory glides at the upper cervical facet joints reproduced her jaw pain. Pressure pain thresholds (PPT) at her B masseters and thenar eminences at the hand were diminished, indicating hyperalgesia.
  
  
  METHODS
  Treatment included passive mobilizations at her TMJs and cervical spine. Home exercises included self-mobilization of her TMJs and neck. In six sessions, her MO improved from 30 to 45 mm and average pain improved from 4/10 to 0/10. The jaw pain and function questionnaire improved from 16/52 to 5/52. PPTs at her right/left masseter and thenar eminence improved from 140/106 and 221/230 kPa to 381/389 and 562/519 kPa, respectively.
  
  
  CONCLUSIONS
  This case described the treatment and reduction of upper extremity hyperalgesia of a patient with chronic jaw and neck pain. Manual therapy may be a valuable intervention in the treatment of chronic TMD with distal hyperalgesia.
authors.affiliation: a Department of Outpatient Physical Therapy , University of Illinois Hospital and Health Sciences System , Chicago , IL , USA .|c Fellowship in Orthopedic Manual Physical Therapy , University of Illinois at Chicago , Chicago , IL , USA.
authors.forename: Josiah D
authors.initials: JD
authors.lastname: Sault
authors.affiliation: a Department of Outpatient Physical Therapy , University of Illinois Hospital and Health Sciences System , Chicago , IL , USA .
authors.forename: Alicia J
authors.initials: AJ
authors.lastname: Emerson Kavchak
authors.affiliation: a Department of Outpatient Physical Therapy , University of Illinois Hospital and Health Sciences System , Chicago , IL , USA .
authors.forename: Nancy
authors.initials: N
authors.lastname: Tow
authors.affiliation: b Department of Physical Therapy , University of Illinois at Chicago , Chicago , IL , USA .
authors.forename: Carol A
authors.initials: CA
authors.lastname: Courtney
mesh_terms: D059350:Chronic Pain / Q000209:etiology* / Q000628:therapy*; D005081:Exercise Therapy; D005157:Facial Pain / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D007568:Jaw / Q000503:physiopathology; D026201:Musculoskeletal Manipulations; D019547:Neck Pain / Q000209:etiology / Q000628:therapy; D013705:Temporomandibular Joint Disorders / Q000503:physiopathology*; D014012:Tinnitus / Q000503:physiopathology; D016896:Treatment Outcome; D055815:Young Adult
keywords: Central sensitization; Hyperalgesia; Mobilization with movement; Pressure pain threshold; TMD; TMJ; Temporomandibular