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Can a high-velocity low-amplitude thrust manipulation of C1-2 affect active depression of the temporomandibular joint in a symptomatic population?

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      Abstract

      Background

      The temporomandibular joint (TMJ) is arguably one of the most complex joints in the human body but its intricate structure and mobile nature make dysfunction in this region extremely common. With a reported prevalence of up to 85% of the general population experiencing at least one sign of temporomandibular dysfunction (TMD) at some point in their lives, a wide range of treatment options must be available to manage the array of disorders that may occur at this joint, in order to provide a tailored approach to suit the individuality of patients. The TMJ has a close topographical and functional relationship with the upper cervical spine (Csp) and dysfunction in one area is often concomitant with reduced function in the other. There is significant research supporting the use of physical therapy for Csp dysfunction but more definitive research needs to objectively assess the effectiveness of cervical treatment for TMD and the reciprocal approach.

      Aim

      To investigate whether it is possible to affect active depression of the TMJ via a High-Velocity Low-Amplitude Thrust (HVLAT) technique of the C1-2 spinal segment within a symptomatic population, in order to contribute to the current knowledge base.

      Methods

      A pilot study for a single-blind, randomised controlled trial (RCT), was carried out using 30 volunteers with current TMD symptoms, as defined by the National Health Service. The volunteers were randomly assigned to either the intervention or control group and their TMJ and upper Csp range of motion (ROM) were assessed three times pre- and post-intervention. The Csp was assessed via expert palpation and passive range of motion (PROM) testing and the TMJ was assessed using Silicon Coach video analysis software. The treatment consisted of an HVLAT technique of the C1/2 spinal segment and the control group did not receive any treatment. The data was analysed using Statistical Package for Social Sciences (SPSS) software via parametric t-tests.

      Results

      The results of the study demonstrated a statistically significant increase in TMJ AROM from baseline to post intervention (p < 0.01) in both dimensions of measurement (nose to chin and mandibular angle) for those in the treatment group. There was no change in TMJ AROM in either dimension in those assigned to the control group.

      Conclusion

      This study demonstrated that an HVLAT of the C1/2 spinal segment significantly increases active depression of the TMJ in a symptomatic population. Larger RCTs of this nature are recommended, with the use of a TMD assessment tool in order to investigate the effect of this technique on particular sub-groups of TMD.
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