STUDY DESIGN: Randomized clinical trial. OBJECTIVES: To determine the immediate and short-term effects of cervical spine high velocity low amplitude thrust (HVLAT) added to behavioral education, soft tissue mobilization, and a home exercise program (HEP) on reducing pain and dysfunction in individuals with a primary complaint of temporomandibular disorder (TMD) with myalgia. BACKGROUND: TMD is a common and costly problem often leading to chronic pain. There is moderate evidence for physical therapy intervention in the management of TMD. A known relationship between TMD and the cervical spine exists, however, studies examining the efficacy of cervical interventions in this population are limited. METHODS: Fifty individuals with TMD (n = 50) were randomly assigned to receive cervical HVLAT or sham manipulation for four visits over 4-weeks. Participants in both groups received other treatments including standardized behavioral education, soft tissue mobilization, and a HEP. Primary outcomes included maximal mouth opening (MMO), Numeric Pain Rating Scale (NPRS), Jaw Functional Limitation Scale (JFLS), Tampa Scale of Kinesiophobia (TSK-TMD), and Global Rating of Change (GROC). Self-report and objective measurements were taken at baseline, immediately after initial treatment, 1-week, and 4-weeks. A 2 x 4 mixed model ANOVA was used with intervention group as the between-subjects factor and time as the within-subjects factor. Separate ANOVAs were performed for dependent variables and the hypothesis of interest was the group by time interaction. RESULTS: There was no significant interaction for MMO, NPRS, or secondary measures. Significant 2-way interactions were noted in JFLS (d = 0.60) and TSK-TMD (d = 0.80). The HVLAT group had lower fear at 4-weeks and improved jaw function earlier (1-week). GROC favored the HVLAT group with significant differences in successful outcomes noted immediately after baseline treatment (thrust 6/25; sham 0/25) and at 4-weeks (thrust 17/25; sham 10/25). CONCLUSION: Both groups improved over time, however, differences between groups were small. Significant differences between groups were noted for JFLS, TSK-TMD, and GROC. The additive clinical effect of cervical HVLAT to standard care remains unclear in the treatment of TMD. LEVEL OF EVIDENCE: Therapy, level 1b.

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