Effects of Core Strengthening Exercises for Treating TMD

November 7, 2025 updated by: Margaret Miller, Loyola University

A Randomized Trial Analyzing the Effects of Core Strengthening Exercises in Physical Therapy for Treating Temporomandibular Joint Dysfunction

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.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

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.

Study Type

Interventional

Enrollment (Estimated)

50

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Who Can Participate (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.

Who Cannot Participate (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.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: 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.
Behavioral: 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.
Other Names:
  • Shirley Sahrmann Core Stability Protocol
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.
Other Names:
  • Rocabado 6x6 Exercises
Active Comparator: 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.
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.
Other Names:
  • Rocabado 6x6 Exercises

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
TMD Pain (e.g., Visual Analog Scale/Numeric Pain Rating)
Time Frame: Baseline and post-intervention (6 PT sessions), assessed up to 6 weeks
Baseline and post-intervention (6 PT sessions), assessed up to 6 weeks

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Neck Disability Index (NDI)
Time Frame: Baseline and post-intervention (6 PT sessions), assessed up to 6 weeks
This measure evaluates how neck pain affects a person's ability to perform everyday activities. It uses the Neck Disability Index (NDI), a questionnaire scored from 0% to 100%, where 0% means no disability and 100% represents complete disability in daily life.
Baseline and post-intervention (6 PT sessions), assessed up to 6 weeks
Compliance with Home Exercise Program (HEP)
Time Frame: Throughout the 6-week intervention period (daily tracking, summarized at post-intervention)
Assessed via participant-completed exercise diaries, tracking adherence to prescribed daily exercises.
Throughout the 6-week intervention period (daily tracking, summarized at post-intervention)
Functional Measures from TMJ Scale
Time Frame: Baseline and post-intervention (6 PT sessions), assessed up to 6 weeks
This measure objectively evaluates jaw movement and functional performance, including mobility, deviation, and deflection. It uses the Temporomandibular Disorder (TMD) Dysfunction Scale, which consists of 10 questions scored from 0 to 4. The total score is converted to a percentage, where higher percentages reflect greater levels of dysfunction or disability.
Baseline and post-intervention (6 PT sessions), assessed up to 6 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Loyola University

Collaborators

Loyola University Chicago

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

November 1, 2025

Primary Completion (Estimated)

December 1, 2026

Study Completion (Estimated)

January 31, 2027

Study Registration Dates

First Submitted

October 30, 2025

First Submitted That Met QC Criteria

November 7, 2025

First Posted (Actual)

November 10, 2025

Study Record Updates

Last Update Posted (Actual)

November 10, 2025

Last Update Submitted That Met QC Criteria

November 7, 2025

Last Verified

October 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 219911

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Clinical Trials on Myofascial Pain

Clinical Trials on Experimental: Group 1: Core Strengthening

Search Similar Trials

Sponsors and Collaborators

Medical Conditions

Drug Interventions

CROs by country

CROs in Italy

Conditions

Rare Diseases

Drug Interventions

Dietary Supplements

Sponsor/Collaborators

Locations

Subscribe