title: Effects of cervical mobilization and exercise on pain, movement and function in subjects with temporomandibular disorders: a single group pre-post test.
abstract: OBJECTIVE
  To investigate the effect of a rehabilitation program based on cervical mobilization and exercise on clinical signs and mandibular function in subjects with temporomandibular disorder (TMD).
  
  
  METHODS
  Single-group pre-post test, with baseline comparison.
  
  
  METHODS
  Twelve women (22.08±2.23 years) with myofascial pain and mixed TMD according to the Research Diagnostic Criteria for Temporomandibular Disorders.
  
  
  METHODS
  Subjects were evaluated three times: twice before (baseline phase) and once after intervention. Self-reported pain, jaw function [according to the Mandibular Functional Impairment Questionnaire (MFIQ)], pain-free maximum mouth opening (MMO), and pressure pain thresholds (PPTs) of both masseter and temporalis muscles were obtained. Baseline and post-intervention differences were investigated, and effect size was estimated through Cohen's d coefficient.
  
  
  RESULTS
  Jaw function improved 7 points on the scale after the intervention (P=0.019), and self-reported pain was significantly reduced (P=0.009). Pain-free MMO varied from 32.3±8.8 mm to 38±8.8 mm and showed significant improvement (P=0.017) with moderate effect size when compared to the baseline phase. PPT also increased with moderate effect size, and subjects had the baseline values changed from 1.23±0.2 kg/cm2 to 1.4±0.2 kg/cm2 in the left masseter (P=0.03), from 1.31±0.28 kg/cm2 to 1.51±0.2 kg/cm2 in the right masseter (P>0.05), from 1.32±0.2 kg/cm2 to 1.46±0.2 kg/cm2 in the left temporalis (P=0.047), and from 1.4±0.2 kg/cm2 to 1.67±0.3 kg/cm2 in the right temporalis (P=0.06).
  
  
  CONCLUSIONS
  The protocol caused significant changes in pain-free MMO, self-reported pain, and functionality of the stomatognathic system in subjects with myofascial TMD, regardless of joint involvement. Even though these differences are statistically significant, their clinical relevance is still questionable.
authors.affiliation: - Universidade Federal de São Carlos, Departamento de Fisioterapia, Laboratório de Cinesiologia Clínica e Ocupacional, São Carlos, SP, Brasil.
authors.forename: Letícia Bojikian
authors.initials: LB
authors.lastname: Calixtre
authors.affiliation: - Universidade Federal de São Carlos, Departamento de Fisioterapia, Laboratório de Cinesiologia Clínica e Ocupacional, São Carlos, SP, Brasil.
authors.forename: Bruno Leonardo da Silva
authors.initials: BL
authors.lastname: Grüninger
authors.affiliation: - Universidade Federal de São Carlos, Departamento de Fisioterapia, Laboratório de Avaliação e Intervenção do Complexo do Ombro, São Carlos, SP, Brasil.
authors.forename: Melina Nevoeiro
authors.initials: MN
authors.lastname: Haik
authors.affiliation: - Universidad de Salamanca, Departamento de Enfermería y Fisioterapia; Instituto de Investigación Biomédica de Salamanca, Salamanca,España.
authors.forename: Francisco
authors.initials: F
authors.lastname: Alburquerque-Sendín
authors.affiliation: - Universidade Federal de São Carlos, Departamento de Fisioterapia, Laboratório de Cinesiologia Clínica e Ocupacional, São Carlos, SP, Brasil.
authors.forename: Ana Beatriz
authors.initials: AB
authors.lastname: Oliveira
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002574:Cervical Vertebrae / Q000503:physiopathology*; D005157:Facial Pain / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006801:Humans; D020393:Manipulation, Spinal / Q000379:methods*; D008406:Masseter Muscle / Q000503:physiopathology; D052580:Muscle Stretching Exercises / Q000379:methods*; D010147:Pain Measurement; D017288:Pain Threshold; D056888:Patient Positioning / Q000379:methods*; D011312:Pressure; D057566:Self Report; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013703:Temporal Muscle / Q000503:physiopathology; D013705:Temporomandibular Joint Disorders / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult