Information - Cervico-Cranio-Mandibular Academy

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Why Cervical-Cranio-Mandibular (CCM) is a complex?

The main role of the neck is to carry the head in order to serve its main functions such as sight, hearing, mastication (including taste) and correct its position in space according to the various demands and surrounding (proprioception). This major role connects the neck-head-face and jaw into one major functional complex in which its components are inter-related and affect each other. Additionally, the modern neuroanatomy research demonstrates that there is a strong neural sensory connection between the various parts of this complex, such that noxious stimuli in a specific region (such as the right side of the upper neck) can easily lead to pain presentation in another region (around the right eye in this example) and vice versa.

In my PhD research project that was done at Tel Aviv University we characterized upper cervical spine musculoskeletal pain and related performance parameters, as well as assess the prevalence/incidence of cervicogenic headache among patients with Temporomandibular Disorders (TMD). The trend we observed was clear and demonstrated significant specific upper neck impairments in patients with painful TMD, where over a third of them were diagnosed with Cervicogenic Headache versus 5% in the general population.

These findings, also supported elsewhere in the literature, have led to the understanding that the ideal management of this population, for us physiotherapists, requires understanding of the whole Cervical-Cranio-Mandibular complex.

Should I specialize in treating people with CCM pain and dysfunction?

To date, more than 25% of the adult population report significant pain somewhere in the Cervico-Cranio-Mandibular (CCM) complex, which is of a musculoskeletal nature, which commonly becomes chronic, second in its prevalence to Chronic Low Back Pain (LBP). Hence, rehabilitation of the CCM complex in this population is highly relevant for physiotherapists and other health professionals especially as unfortunately, these patients are hardly referred to physiotherapy. Whatever the reason may be for this unfortunate approach, now is the time to introduce change and demonstrate the effectiveness of physiotherapy management in the field of Cervico-Cranio-Mandibular complex pain. Certification and expertise in the management of CCM pain will help you widen your scope of practice and help more patients, who many times suffer from mismanagement.

Is PT effective for people with CCM disorders?

There is vast evidence also of strong quality (such as systematic reviews and meta analyses) to demonstrate the effectiveness of physiotherapy interventions (manual therapy and exercise) as first line treatment for people with CCM disorders (neck pain, cervicogenic headache, TMD). This is similar to the role of physiotherapy management of non-musculoskeletal headache/orofacial pain (e.g., migraine or Tension Type Headache (TTH)) which is recognized complementary clinical practice as part of a multidisciplinary team (including for example neurologist, psychologist, physicians etc.).

Which courses are offered for Physiotherapists?

Cervical-Cranio-Mandibular Therapeutics

A 48 hours comprehensive course, consisting of three independents modules, that can also be taken individually. No previous experience needed.

Module 1: Cranio-Mandibular therapeutics(16 hours)
Module 2: Cervico-Brachial therapeutics(16 hours)
Module 3: Cranio-Cervical therapeutics(16 hours)

Dry Needling for Orofacial Pain & Headache (9 hours)

In this one-day workshop participants will learn and practice safe and effective dry needling approaches for the most commonly involved myofascial structures in patients with orofacial pain (mainly TMD) and headaches (cervicogenic, tension type and migraine).

E-learnings modules

Available during COVID-19 times and consist of a lecture and a number of clinical practical tutorials, as listed below. These e-learning modules are to be taken together and cannot be separated.

Headache & Orofacial pain in musculoskeletal practice (Background and introduction ((lecture)
Cranio-Mandibular therapeutics (video tutorials with online supervised practice)

When is your next course?

Please visit This following link for all course dates and venues.

Why Cervical-Cranio-Mandibular (CCM) complex?

Therefore, the ideal rehabilitation of this region should also incorporate physiotherapy, which requires understanding of the whole Cervical-Cranio-Mandibular complex

How do Physiotherapists treat patients with Cervical-Cranio-Mandibular disorders?

One of the fortes of physiotherapists is the qualification and practice of stringent, thorough and comprehensive clinical assessment (and clinical reasoning) of various conditions and dysfunctions of patients and all related comorbidities and contributing factors such as one’s functional abilities, muscular performance, pain parameters, one’s perspective and belief system. For the last two decades the physiotherapy profession has progressed greatly and is under continuous development in evidence informed clinical guidelines and practice, and in setting strong foundation for further research such as by developing valid and reliable tools for clinical and subjective assessment of patients’ progression. Physiotherapy related research has also contributed greatly to the understanding of the relationship between the regions in the cervico-cranio-mandibular complex. In addition, there is emerging evidence as to the contribution and effectiveness of physiotherapy in the management of CCM related disorders, which have been published also in dentistry related journals.

The modern physiotherapist will perform a comprehensive assessment of the patient and will set measurable, meaningful, and realistic goals for the patient’s management based on their findings and clinical reasoning.

The following case study demonstrates a modern physiotherapist approach:

Patient seeks care with a CCM qualified physiotherapist with a main complaint left jaw pain while chewing bread or other firm food, with a VAS of 7/10. He expresses his concerns about this pain worrying him that it will prevent him from enjoying his son’s wedding next month.

In his assessment the physiotherapist finds mouth opening range of motion of 32 mm pain free and 41 mm with pain and intra-oral bruxism signs. In specific upper neck mobility test a limitation to the left is noticed. In specific assessment of the deep neck flexors a relative weakness is present.

The main goal of the treatment is pain free chewing of solid food to achieve with a month (by the wedding of the patient’s son). Intermediate goals are to increase and develop the patient’s awareness of clenching during the day and his ADL, reduce overall pain and specifically where palpated in left masticatory muscles and provide re-assurance by educating the patient as to good expected prognosis. In addition, there is room to train the deep neck flexors muscles and improve the mobility of his upper neck to the left side. Objective and subjective assessment are to be used throughout the treatment program until full recovery and are to be shared with the patient.

In the case described above, the goals stated were achieved within 4 weeks, of one session per week of 30 minutes long, and the patient has fully recovered and was able to attend his son’s wedding pain and worry free.

Is PT effective for people with CCM disorders?

There is vast evidence also of strong quality (such as systematic reviews and meta analyses) to demonstrate the effectiveness of physiotherapy interventions (manual therapy and exercise) as first line treatment for people with CCM disorders (neck pain, cervicogenic headache, TMD) (references). This is similar to the role of physiotherapy management of non-musculoskeletal headache/orofacial pain (e.g., migraine or Tension Type Headache (TTH)) which is recognized complementary clinical practice as part of a multidisciplinary team (including for example neurologist, psychologist, physicians etc.).

How can dentists and physiotherapists collaborate in the management of CCM patients?

Similarly, to other chronic pain conditions, CCM is best managed by a multidisciplinary team guided by the biopsychosocial model. CCM certified physiotherapists and dentists are the first line of therapy for individuals with cervico-cranio-mandibular pain. The role of a CCM certified dentist is primarily to detect and screen these patients as well as offer oral appliance as necessary, and the role of the CCM certified physiotherapist is to manage the rehabilitation of that patient. This unique collaboration between these CCM certified clinicians is imperative for best care practice for patients with CCM disorders, as also supported by the science.

Which courses are offered for Dentists?

We offer 2 courses designed especially for dentists

Orofacial pain for dentists (16 hours) (link) קורס חדש צריך לקפוץ לעמוד קורסים של רופאי שיניים

In this 2 days’ course, participants will learn an effective evidence informed assessment & practical dry needling therapy for patients with TMD’s and other forms of orofacial pain

Dry Needling for Orofacial Pain & Headache (9 hours) (link) קורס חדש צריך לקפוץ לעמוד קורסים של רופאי שיניים

A one-day workshop for dentists who use dry needling in their scope of practice who wish to expand their knowledge in the application of dry needling in orofacial pain and headache presentation.

When is your next course for dentists?

Please visit This following link for all course dates and venues.

What is the connection between the neck-head-face and jaw?

There is a close relationship between our neck, head, face, and jaw. A common example of this relationship is the fact that a few days of neck pain are likely to cause a headache, or a few days of headache are likely to be followed by neck pain. The main cause for this is a unique pain processing mechanism of which both the face and the upper neck regions send pain signals to the brain via the same pathways, so it is as if the brain cannot differentiate at times as to which region is responsible for that pain presentation, and the end result is pain in both regions.

In addition, the upper neck and face structures have a functional and mechanical connection. For example, you might have noticed that while yawning you might have extended you r neck backwards automatically. This in fact, is a kind of a supportive movement to enable the jaw to move further downwards and by that to open your mouth freely.

These examples above may explain why many patients who present with neck pain also complain of headaches, facial and jaw pain, and vice versa, all of which are well supported by the most up to date evidence.

This is why, us clinicians should address the neck-head-jaw region as a one clinical unit: The Cervical-Cranio-Mandibular (CCM) complex.

What are the common CCM complex problems treated by Physiotherapists?

Neck pain (locally or remote to the shoulder blades & arms)
Headaches with neck involvement (as identified in clinical assessment)
Temporomandibular Joint Disorders (TMJ) (Jaw pain originating from masticatory muscles, joint pain, click and locks)
Orofacial pain (non-muscular facial pain)
Dizziness with neck involvement (as identified in clinical assessment)

What does physiotherapy treatment entail?

Personal patient-therapist connection: I strongly believe that a close and personal patient-therapist connection is vital for a successful rehabilitation process. This connection helps in promoting existing and new healthy behavior patterns by encouraging and empowering the patient’s sense of self worthiness and ability.

Manual Therapy: Human touch is a great tool for establishing a healthy connection between people. Hands on manual therapeutic techniques that mobilize and release joints, soft tissue and other tissues, play a major role in my treatment sessions, as they promote various physiological aspects in the healing process such as in the brain and nervous system.

Dry needling: Dry needling is a western approach of needling for musculoskeletal pain disorders. The effectiveness of dry needling for various myofascial pain syndromes is well supported by research, as well as for CCM related pain presentations. Dry needling is not a stand-alone treatment and is a great adjunct tool to manual therapy.

Taping: Taping is another adjunct tool for supporting the musculoskeletal system and assisting the body in the natural healing and different recovery stages. …… A support of the either rigid or elastic (Kinesiotape) application may assist the patient’s awareness as to movements that may be dangerous or even limit that movement in order to protect the region injured.

Therapeutic Exercise and education: Movement is the key to life and eventually there is no substitute for physical activity. Manual therapy, dry needling and taping are passive tools cannot train your muscles unfortunately, as they only provide a temporary answer to your pain and dysfunction. The body-mind-soul modifications that occur after an injury or within painful presentations can best be restored by an addition of individually tailored physical activity program (therapeutic exercise). Physical activity has been proposed and clinically proven as the optimal ‘medicine’ for many musculoskeletal and other health related conditions.

Is the physiotherapy treatment you offer based on science?

I am clinician, lecturer and researcher – in that order. Scientific research is an important part of the triangle that includes the patient (your world and narrative), the therapist (and his expertise) and science (evidence based/ informed practice). In my opinion, the ideal clinical practice relies on the science but remains flexible enough and modifies it all based on the patient in hand and according to the circumstances.

How long will it take until I feel an improvement?

Of course, it is very individual but most patients with Cervical-Cranio-Mandibular problem (that are orthopedically related/ musculoskeletal) tend to improve well withing 4-6 weekly visits (usually of 30-50 min). Important to note is that a positive response to treatment is vital for confirming that the problem is indeed of a musculoskeletal origin. If you do not improve within that timeframe you are likely to be referred for further medical investigations.

Having said that, a chronic CCM pain condition (> 12 months), as with other chronic problems, may take longer to improve and prognosis is based on the each individual case.

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