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

Background: 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. Objective: 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. Methods: 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). Results: 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). Conclusion: 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.