Exercise based multisite pain management in temporomandibular dysfunction and chronic low back pain: a randomized controlled trial

Temporomandibular disorders (TMDs) and chronic low back pain (CLBP) frequently coexist, with CLBP reported in 29% of TMDs cases. This co-occurrence emphasizes the importance of multisite pain management approaches.

To compare the effects of Rocabado's exercises alone or combined with structured back exercises on TMD-related pain, mandibular range of motion (ROM), and CLBP severity.

Forty participants with myogenic TMD and nonspecific CLBP were randomly assigned to a control group (CG, Rocabado only) or complex exercise group (CEG, Rocabado + back exercises). Both underwent 24 supervised sessions over six weeks. Pain was assessed via the Graded Chronic Pain Scale (GCPS-2.0), Short Form-McGill Pain Questionnaire (SF-MPQ), and Numeric Pain Rating Scale (NPRS). Jaw function and ROM were evaluated using the Jaw Functional Limitation Scale (JFLS-20) and objective mandibular movement measures. Oral health-related quality of life was assessed via the Oral Health Impact Profile-14 (OHIP-14).

Both groups showed significant improvements in pain, jaw function, ROM, and OHIP scores (p < .001). A large effect size was observed for pain reduction as measured by the GCPS-2.0 (d = 0.876) in both groups and by the NPRS in the complex exercise group (d = 3.756). Sensory pain on SF-MPQ improved more in CEG (p = .045). JFLS-20 and ROM showed significant within-group improvements with large effect sizes (p < .001, d > 0.8).

Rocabado's exercises reduced TMDs pain and improved jaw function, while structured back exercises provided additional benefits for the pain severity of CLBP and sensory pain of TMDs.

Clinical trial approval was obtained at https://www.clinicaltrials.gov/, and the registration status was made publicly available with the number NCT06343155 on April 1, 2024. (https://clinicaltrials.gov/study/NCT06343155).