Effects of Core Strengthening Exercises for Treating TMD

NCT ID: NCT07226505

Last Updated: 2025-11-10

Basic Information

• Recruitment Status: NOT_YET_RECRUITING
• Clinical Phase: NA
• Total Enrollment: 50 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-11-01
• Study Completion Date: 2027-01-31

Brief Summary

Temporomandibular disorders (TMD) are commonly managed with non-invasive interventions such as manual therapy, therapeutic exercise, relaxation techniques, and patient education. Core strengthening (also known as abdominal strengthening) is a fundamental element of physical therapy that engages deep and superficial trunk musculature to enhance postural control and functional performance. Protocols such as the Shirley Sahrmann progression have demonstrated increased activation of key core stabilizing muscles. Emerging evidence suggests a potential relationship between core stability training and reductions in TMD-related pain, though improvements in functional outcomes remain inconclusive. Biomechanical links between the pelvic floor, spine, and temporomandibular joint further support the rationale for core-focused interventions. Nevertheless, few studies have isolated the effects of core strengthening on TMD symptomatology. This study seeks to determine whether the integration of core stability exercises into TMD management can reduce pain, improve function, and enhance quality of life.

Detailed Description

This single-blinded randomized controlled trial will evaluate the effects of core strengthening exercises in addition to standard physical therapy for patients with Temporomandibular Joint Dysfunction (TMD). The study aims to determine whether integrating core stability exercises can reduce TMD-related pain, improve function, and enhance quality of life compared to standard physical therapy alone.

A total of 50 participants, aged 18-70, who have a primary complaint of TMD within the last 30 days and are willing to complete at least six physical therapy visits over a three-month period will be enrolled. Participants must speak English or have access to a verified interpreter and be able to safely participate in exercise.

Participants will be randomly assigned to one of two groups:

Group 1: Core strengthening exercises (Shirley Sahrmann progression) combined with standard TMD physical therapy, including therapeutic exercises, manual interventions, soft tissue mobilization, neuromuscular re-education, and education. Home exercise programs will support adherence.

Group 2: Standard TMD physical therapy alone, including the same therapeutic exercises, manual interventions, soft tissue mobilization, neuromuscular re-education, and education.

Key exclusion criteria include recent TMJ or spinal surgery, recent head/neck trauma or neurologic symptoms, pregnancy, concurrent physical therapy for other movement disorders, low back or pelvic health dysfunction in the past three months, use of dentures, or current chemotherapy/radiation involving the head, neck, pelvis, spine, or hip.

Participants will undergo initial evaluation, intervention sessions, and post-treatment assessment by blinded evaluating therapists to measure pain, function, and core strength outcomes. Safety will be continuously monitored throughout the study.

Conditions

Temporomandibular Joint Dysfunction; TMD; TMJ Internal Derangement; Myofascial Pain

Keywords

Core strengthening; physical therapy; RCT

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Group 1: Core Strengthening + Standard TMD Physical Therapy

Participants in this group will receive the Shirley Sahrmann core strengthening protocol, which involves progressive levels of dynamic movements designed to maintain a neutral spine and activate deep core muscles. Exercises begin in hook-lying or supine positions, with gradual progression through five levels, and may include upper extremity movements once core control is achieved. In addition, participants will follow a structured home exercise program with daily exercises (approximately 20 minutes), supported with printed instructions and video demonstrations through the MedBridge platform.

Group Type: EXPERIMENTAL

Experimental: Group 1: Core Strengthening

Intervention Type: BEHAVIORAL

Participants perform Shirley Sahrmann core exercises (5 progressive levels maintaining neutral spine and deep core activation), possibly adding upper extremity movements. Standard TMD PT includes jaw exercises, manual therapy, soft tissue mobilization, neuromuscular re-education, and patient education. A home exercise program (\~20 min/day) is provided with printed and video instructions.

Group 2: Standard TMD PT

Intervention Type: BEHAVIORAL

Participants receive standard TMD PT including jaw exercises (Rocabado 6x6), manual therapy for TMJ and cervical spine, soft tissue mobilization, neuromuscular re-education to improve jaw mechanics, and education on jaw positioning, diet/chewing modifications, and parafunctional habits. A home exercise program is provided as part of treatment.

Group 2: Standard TMD Physical Therapy

Participants in this group will receive standard physical therapy for TMD, including:

Therapeutic exercises (e.g., Rocabado 6x6) for jaw mobility and posture.

Manual therapy to restore normal TMJ and cervical spine joint mechanics.

Soft tissue mobilization targeting masticatory and cervical muscles as clinically indicated.

Education on jaw rest position, diet/chewing modifications, and avoidance of parafunctional habits.

Neuromuscular re-education to improve TMJ opening mechanics, including deep neck flexor activation and mirror training.

Group Type: ACTIVE_COMPARATOR

Group 2: Standard TMD PT

Intervention Type: BEHAVIORAL

Participants receive standard TMD PT including jaw exercises (Rocabado 6x6), manual therapy for TMJ and cervical spine, soft tissue mobilization, neuromuscular re-education to improve jaw mechanics, and education on jaw positioning, diet/chewing modifications, and parafunctional habits. A home exercise program is provided as part of treatment.

Interventions

Experimental: Group 1: Core Strengthening

Participants perform Shirley Sahrmann core exercises (5 progressive levels maintaining neutral spine and deep core activation), possibly adding upper extremity movements. Standard TMD PT includes jaw exercises, manual therapy, soft tissue mobilization, neuromuscular re-education, and patient education. A home exercise program (\~20 min/day) is provided with printed and video instructions.

Intervention Type: BEHAVIORAL

Group 2: Standard TMD PT

Participants receive standard TMD PT including jaw exercises (Rocabado 6x6), manual therapy for TMJ and cervical spine, soft tissue mobilization, neuromuscular re-education to improve jaw mechanics, and education on jaw positioning, diet/chewing modifications, and parafunctional habits. A home exercise program is provided as part of treatment.

Intervention Type: BEHAVIORAL

Other Intervention Names

Shirley Sahrmann Core Stability Protocol; Rocabado 6x6 Exercises

Eligibility Criteria

Inclusion Criteria

Adults between 18 and 70 years old.

Have had jaw pain or problems with the jaw joint (TMD) in the last 30 days.

Able and willing to attend at least six physical therapy sessions over three months.

Speak English or have access to a qualified interpreter.

Able to safely do physical exercises.

Exclusion Criteria

Recently had surgery on the jaw, teeth, or spine (within the last 3 months).

Recently had head or neck injuries or certain neurological problems (such as dizziness, double vision, trouble swallowing, or sudden falls).

Are pregnant or become pregnant during the study.

Currently doing physical therapy for other movement problems that could affect the study.

Have had lower back or pelvic health issues in the last 3 months.

Currently receiving chemotherapy or radiation for cancer in the head, neck, pelvis, spine, or hip.

Wear dentures or cannot safely perform exercises.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 80 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Loyola University Chicago

OTHER

Sponsor Role: collaborator

Loyola University

OTHER

Sponsor Role: lead

Responsible Party

Margaret Miller

MD

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

Loyola University Medical Center

Maywood, Illinois, United States

Countries

United States

Facility Contacts

Dr. Margaret Miller, MD

Role: primary

Dr. Margaret Miller, MD

Role: backup

Other Identifiers

219911

Identifier Type: -

Identifier Source: org_study_id