Effects of Core Strengthening Exercises for Treating TMD

NCT07226505 | Not Yet Recruiting

• 1 other identifier: 219911
• Study Type: interventional
• Target: 50
• Locations: 1 country
• Sites: 1

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.

Conditions

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

Keywords

Core strengthening; physical therapy; RCT

Outcome Measures

Primary Outcomes (1)

• TMD Pain (e.g., Visual Analog Scale/Numeric Pain Rating)

  Baseline and post-intervention (6 PT sessions), assessed up to 6 weeks

Secondary Outcomes (3)

• Neck Disability Index (NDI)

  Baseline and post-intervention (6 PT sessions), assessed up to 6 weeks

• Compliance with Home Exercise Program (HEP)

  Throughout the 6-week intervention period (daily tracking, summarized at post-intervention)

• Functional Measures from TMJ Scale

  Baseline and post-intervention (6 PT sessions), assessed up to 6 weeks

Study Arms (2)

Group 1: Core Strengthening + Standard TMD Physical Therapy

EXPERIMENTAL

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.

Behavioral: Experimental: Group 1: Core Strengthening; Behavioral: Group 2: Standard TMD PT

Group 2: Standard TMD Physical Therapy

ACTIVE COMPARATOR

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.

Behavioral: Group 2: Standard TMD PT

Interventions

Experimental: Group 1: Core Strengthening 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.

Also known as: Shirley Sahrmann Core Stability Protocol

Group 1: Core Strengthening + Standard TMD Physical Therapy

Group 2: Standard TMD PT 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.

Also known as: Rocabado 6x6 Exercises

Group 1: Core Strengthening + Standard TMD Physical Therapy; Group 2: Standard TMD Physical Therapy

Eligibility Criteria

• Age: 18 Years - 80 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• 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.

You may not qualify if:

• 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.

Sponsors & Collaborators

• Loyola University: lead
• Loyola University Chicago: collaborator

Study Sites (1)

Loyola University Medical Center

Maywood, Illinois, 60153, United States

Location

MeSH Terms

Conditions

Temporomandibular Joint Disorders

Condition Hierarchy (Ancestors)

Craniomandibular Disorders; Mandibular Diseases; Jaw Diseases; Musculoskeletal Diseases; Joint Diseases; Muscular Diseases; Stomatognathic Diseases

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Masking Details: Single-blinded (evaluating PT blinded)
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: MD

Study Record Dates

• First Submitted: October 30, 2025
• First Posted: November 10, 2025
• Study Start: November 1, 2025
• Primary Completion (Estimated): December 1, 2026
• Study Completion (Estimated): January 31, 2027
• Last Updated: November 10, 2025

Record last verified: 2025-10

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)