Regional effects of orthopedic manual physical therapy in the successful management of chronic jaw pain

Josiah D. Sault*, Alicia J. Emerson Kavchak, Nancy Tow, Carol A. Courtney

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Objective and importance: Temporomandibular disorders (TMD) encompass a variety of dysfunction of the maxillofacial region. A strong relationship between TMD and cervical spine pain exists, and widespread hyperalgesia is common in TMD. This case describes the management and reduction in regional hyperalgesia in a patient with chronic TMD. Clinical presentation: A 23-year-old female with a 10-year history of tinnitus and bilateral (B) jaw pain, and 5-year history of intermittent neck pain, presented with pain, which could reach 10/10 on the numeric pain rating scale, locking, tightness and restricted eating habits. Cervical motion testing did not reproduce her jaw pain. Her mouth opening (MO) and B temporomandibular joint (TMJ) accessory glides were limited and painful. Accessory glides at the upper cervical facet joints reproduced her jaw pain. Pressure pain thresholds (PPT) at her B masseters and thenar eminences at the hand were diminished, indicating hyperalgesia. Intervention: Treatment included passive mobilizations at her TMJs and cervical spine. Home exercises included self-mobilization of her TMJs and neck. In six sessions, her MO improved from 30 to 45 mm and average pain improved from 4/10 to 0/10. The jaw pain and function questionnaire improved from 16/52 to 5/52. PPTs at her right/left masseter and thenar eminence improved from 140/106 and 221/230 kPa to 381/389 and 562/519 kPa, respectively. Conclusion: This case described the treatment and reduction of upper extremity hyperalgesia of a patient with chronic jaw and neck pain. Manual therapy may be a valuable intervention in the treatment of chronic TMD with distal hyperalgesia.

Original languageEnglish (US)
Pages (from-to)124-132
Number of pages9
JournalCranio - Journal of Craniomandibular Practice
Issue number2
StatePublished - Mar 3 2016


  • Central sensitization
  • Hyperalgesia
  • Mobilization with movement
  • Pressure pain threshold
  • TMD
  • TMJ
  • Temporomandibular

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Dentistry(all)


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