BACKGROUND AND PURPOSE: Individuals with temporomandibular disorder commonly experience pain in and around the temporomandibular joint, decreased mouth opening, headaches, tinnitus, and dizziness. Common treatments for temporomandibular disorder include modalities, soft tissue mobilizations, mandibular mobilizations/manipulations, tongue controlled mouth opening exercises, alterations in diet and habits, and massage. Due to the biomechanical and physiological relationship between the temporomandibular joint and the cervical spine, it has been hypothesized that treatment for temporomandibular disorder could be directed to the cervical spine. Spinal manipulation, which has been validated in the literature as an acceptable form of treatment to decrease pain and improve function, could be aimed at the cervical spine to affect temporomandibular joint pain. The purpose of this systematic review of the literature is to determine the effectiveness of cervical manipulation on the treatment of symptoms related to temporomandibular disorder. METHODS: The authors used Google Scholar, Cochrane, Scopus, PubMed, Ovid Medline, and Cumulative Index of Nursing and Allied Health (CINAHL) when conducting a review of the research. Additional studies were added to the search from an outside source. Studies were eliminated by title, abstract, and review of complete text. The 6 remaining articles were read and graded using the PEDro scale. Inclusion criteria included the use of a cervical manipulation applied to the cervical spine to assess changes in symptoms in patients with TMD symptoms. RESULTS: All 6 studies used cervical manipulation as a form of treatment. The studies that evaluated painfree active maximal mouth opening (PFAMMO) reported changes ranging from 1 to 15 mm with varied statistical significance. The studies that used the visual analog scale (VAS) and/or pain scale reported a minimal change of 4.5 out of 10 indicating a significant reduction. With regard to the two randomized controlled trials that evaluated pain pressure threshold (PPT), changes ranged from 0.1 kg/cm2 to 0.2 kg/cm2. Two of the 6 studies supported the use of cervical spine manipulation as an effective treatment option for improving symptoms related to temporomandibular joint dysfunction. LIMITATIONS: Limited available research, low PEDro scores, weak study designs, variation in manipulation methods, small sample sizes, and the simultaneous use of other treatment interventions. CONCLUSION: High velocity low amplitude thrust manipulation applied to the cervical spine may be beneficial in achieving positive effects in patients with TMD symptoms. If a clinician is considering treating TMD only with cervical manipulation, further study to support its determined effects is needed.

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