Dry Needling & Upper Cervical Manipulation for Temporomandibular Disorder – RCT
Temporomandibular disorder (TMD) is a very common condition which affects 16% to 59% of the global population and has been shown to be the third most prominent pain condition world-wide. TMD is associated with a variety of factors, such as age, systemic illness, hormonal issues, habitual activity, occlusal variation, and psychosocial problems.
Patients with TMD typically manifest clinical signs and symptoms including pain in the temporomandibular joint (TMJ) and/or muscles of mastication, limited mandibular range of motion, crepitus, and functional limitation or deviation of the jaw. Headache and neck pain are also common symptoms associated with TMD. TMD has been classified according to the following three main groups: 1) muscle disorders, 2) disc displacements, and 3) joint dysfunction.
A variety of treatment modalities for TMD are in use, which can be summarized as follows:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants, which may improve symptoms (although significant adverse effects are possible when used long-term).
- The long-term efficacy of surgery in patients with TMD is not adequately supported by research.
- Electrophysical modalities such as laser therapy, ultrasound, TENS, iontophoresis, as well as isolated exercise have limited research support.
- Interocclusal splint therapy for TMD has been reported to improve range of motion and decrease the intensity and frequency of jaw pain.
- The evidence for the use of TMJ mobilization alone for TMD is inconclusive, although it is supported when combined with other conservative treatments, such as exercise.
- Upper cervical spine mobilization or manipulation, whether solely or along with a multi-modal treatment, such as exercise, mandibular mobilization, myofascial release, muscle energy, and/or tender-trigger point therapy, has been shown to significantly improve mouth opening and jaw pain.
- Dry needling (DN) refers to the insertion of monofilament needles into muscles, ligaments, tendons, connective tissue, scar tissue, and peri-neural tissue. The technique has been shown to be effective for certain neuromusculoskeletal conditions, including TMD.
Dry needling (DN) and upper cervical spinal manipulation have each been found to be moderately effective for TMD; however, no studies have combined these treatments to determine if there are any synergistic effects. Therefore, the objective of this study was to compare the combined effects of DN and upper cervical spinal manipulation to interocclusal splint therapy, NSAIDs, and TMJ mobilization in patients with TMD.
RESEARCH REVIEW: “Dry Needling & Upper Cervical Manipulation for Temporomandibular Disorder”
This paper was published in Cranio (2022 online ahead of print) and this Review is posted in Temporomandibular Joint (TMJ), Acupuncture – Dry Needling, Cervical Spine – Manipulation/Mobilization and the 2023 Archive.