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The Physical Therapy Board 
of Craniofacial & Cervical Therapeutics
HomeCertification Development

Development of the Examination

Development of the examination has been guided by Measurement Research Associates, an independent psychometric testing service for the dental and medical profession. Annual review and updating is performed according to statistical analysis, clinical and scientific advances and to ensure parity with the specialty certification examination requirements of the APTA. Each successful candidate is designated as a "Certified Cervical and Temporomandibular Therapist" (CCTT) with name, practice location and contact information posted within the PTBCCT website ( for those seeking a qualified physical therapist within this specialized field.






  1. The examination blueprint and study guide that follows outlines the specific content areas of knowledge that are included in the examination.
  2. A few sample questions are provided and presented in the exact same format as those included in the examination.
  3. A suggested reading list of books and journal articles for review are included. Please note that the PTBCCT does not endorse any of the specific texts nor state that the list is entirely comprehensive. Furthermore, the list does not in any manner represent that questions on the examination have been taken directly from these sources.



Subject Areas Consist of the Following Categories: Items Percentage
1. Temporomandibular & Cervical Anatomy 17 15%
2. Temporomandibular & Cervical Biomechanics 23 21%
3. Management of Cervical Spine Disorders 6 5%
4. Dental Terminology 5 5%
5. Epidemiology of Cervical & Temporomandibular Disorders 5 5%
6. Oral Appliances 5 5%
7. Evaluation and Differential Dx. Of TMD & Orofacial Pain 18 16%
8. Temporomandibular Joint Surgery 6 5%
9. Management of TMD & Orofacial Pain 13 12%
10. Evaluation & Differential DX. of Cervical Spine Disorders 12 11%



Recommended For Review


Please note that the following textbooks, chapters, course manuals and journal publications represent the references that were submitted by the examination development team of physical therapists, dentists and oral surgeons in support of each test item.


Textbooks and Chapters


  1. Atlas of Human Anatomy. Frank Netter, M.D., Ciba-Geigy Corp., 1995. Plate 16
  2. Berkowitz BKB & Moxham BJ: (1988). A Textbook of Head and Neck Anatomy. London, Yearbook Medical Publishers.
  3. Grieves Modern Manual Therapy – Vertebral Column (2nd Edition)
  4. Temporomandibular Disorders, Eds. Kaplan A, & Assael L, WB Chapters 8 & 9
  5. Kendall F, McCreary E, Provance P, Muscles;  Testing and Function,  1993
  6. Rocabado M, Iglarsh ZA, Musculoskeletal Approach to Maxillofacial Pain, 1991
  7. Dental Clinics of North America; Temporomandibular Disorders and Orofacial Pain. Guest Editor Henry Gremillion.  Vol 51 (1), 2007.
  8. Kraus SL (ed); Clinics in Physical Therapy, Temporomandibular Disorders, ed 2.  New York, Churchill Livingstone, 1994.
  9. Okeson, Management of TMD and Occlusion, 5th edition, 2003.
  10. Okeson: Orofacial Pain: Guidelines for Assessment, Diagnosis and Management Chicago, Quintessence. 1996
  11. Okeson. Bell’s Orofacial Pains. 6th Edition, 2005, Chapters 7-9, 12-13. Quintessence
  12. Physical Therapy of the Cervical and Thoracic Spine, Grant, Churchill Livingstone, 1994.
  13. Travell J, Simons D, Myofascial Pain and Dysfunction, The Trigger Point Manual, 1999. Williams & Wilkins.
  14. Porterfield J, DeRosa C, Mechanical Neck Pain, 1995.
  15. Pertes R, Gross S:Clinical Management of Temporomandibular Disorders and Orofacial Pain. Qunitessence, 1995.
  16. Foreman and Croft (eds.) Cervical Acceleration/Deceleration Syndromes. Baltimore: Williams and Wilkins, 1998.
  17. Fonseca RJ, editor. Oral & Maxillofacial Surgery; Temporomandibular Disorders,vol 4. 1st edition Philadelphia: W.B. Saunders Company. 2000.
  18. Management of Syndromes Related to Herniated Discs; Hanley, E Chapter 9. In; Essentials of the Spine, Ed Weinstein J, Rydevik B, Sonntag V, Raven Press. 1995
  19. Mannheimer, JS (1995). Overview of physical therapy modalites and procedures. In Pertes RA & Gross SG ( eds ). Clinical Management of Temporomandibular Disorders and Orofacial Pain. Chicago. Quintessence.
  20. Boissonnault, WG (ed): Examination in Physical Therapy Practice. Screening for Medical Disease. 2nd edition, Churchill Livingstone, Philadelphia, Pa.1995.
  21. Magee, DJ: Orthopedic Physical Assessment. 4th edition, Saunders, Philadelphia, Pa. 2002.
  22. Boissonnault, WG : Primary Care for the Physical Therapist. Examination and Triage. Elsevier Saunders, St. Louis, Mo. 2005.
  23. Erkonen WE. Radiology 101: The Basics and Fundamentals of Imaging. Philadelphia, PA. Lippincott, Williams and Wilkins; 1998.
  24. McKinnis, LN. Fundamentals of Orthopedic Radiology. Philadelphia, PA: F.A. Davis Company; 1997.
  25. Essentials of the Spine. Editors; Weinstein JN, Rydevik BL, Sonntag VKH, Raven Press, NY, 1995.
  26. Rosenblatt MA. Ocular pain. In Jacobson AL & Donlon WC (eds.) Headache and Facial Pain. New York, Raven Press pp. 169-219, 1990.
  27. Role of Splint Therapy in Treatment of Temporomandibular Disorders;  Sollecito, T  Vol 4, Chapter 9 pp145   In; Oral and Maxillofacial Surgery; Ed.  Fonseca R.
  28. Kaplan & Assael. Temporomandibular Disorders: Diagnosis and Treatment. Saunders, Philadelphia, 1991.
  29. Kraus SL. Temporomandibular disorders. 2nd. Edition. Clinics in Physical Therapy, Churchill Livingstone, 1994.
  30. Ryan R, editors. Evaluation, treatment and prevention of musculoskeletal disorders, vol . 1- Spine. 4th edition. Chaska (MN). The Saunders Group, Inc. 2004 p. 173-210.
  31. De Leeuw R. (ed). Orofacial Pain: Guidelines for Assessment, Diagnosis and Management. 4th ed. of the American Academy of Orofacial Pain. Quintessence Books, Chicago, 2008.
  32. Mannheimer JS, Kraus SL,  Hesse, JR & Visscher  C.  Chapter 9: Cervicogenic Mechanisms of Orofacial Pain and Headaches.  Guidelines for Assessment, Diagnosis and Management  In: De Leeuw, R. (ed). Quintessence Books, Chicago, 2008.


Course Manuals

  1. CTI:  Jeffrey Ellis
  2. Rocabado M. Course Manual for Advanced Upper Quarter. 1984
  3. Rocabado M., Northeast Seminars Course manual for R3.  Pathophysiology of  the Craniovertebral Joints (1990)

Journal Articles

  1. Leuwer R, Schubert R, Kucinski T, et al. The muscular compliance of the auditory tube: a model-based survey.Laryngoscope.112:1791-1795,  2002.
  2. De Wijer, J. Rob J. de Leeuw, Michel H. Steenks, et al: Temporomandibular and cervical spine disorders: self-reported signs and symptoms. Spine 21:1638, 1996.
  3. Bailey DR. Sleep disorders: Overview and relationship to orofacial pain. Dental Clinics of No Am.41(2): 189-209, 1997.
  4. Carlson CR, Okeson JP, Falace DA, et al: Reduction of pain and EMG activity in the masseter region by trapezius trigger point injection. Pain 55: 397-400, 1993.
  5. Eriksen W, et al, Job characteristics as predictors of neck pain, Journal of Occupational and Environmental Medicine  41 (10): 893-902,1999.
  6. Heir GM: Differentiation of orofacial pain related to lyme disease from other dental and facial pain disorders. Dental Clinics of No Am. 41(2), 243-258, 1997.
  7. Dvorak J & Panjabi MM. Functional Anatomy of the Alar Ligaments. Spine Vol 12, No 2, 1987.
  8. Mannheimer JS & Montalbano R. Postoperative management for surgical procedures to the temporomandibular joint. Orthopedic Physical Therapy Clinics of No Am. 11(2): 235-261, 2002.
  9. Mohl, N. Head Posture and its Role in Occlusion. New York State Dental Journal, Vol 47, 1976.
  10. Rantanen J, Thorsson O, Wollmer P, et al. Effects of therapeutic ultrasound on the regeneration of skeletal myofibers after experimental muscle injury. Am Sports Med 27(1):54-59, 1999.
  11. Danielle AWM, Geert JMG, et al. Ultrasound therapy for musculoskeletal disorders: a systematic review. Pain 81:, 1999.
  12. Rocabado, M. Journal of Craniomandibular Disorders: Facial & Oral Pain Vol.3, (2): 75 – 82, 1989.
  13. Schmitt HP. Anatomical structure of the cervical spine with reference to the pathology of manipulation complications. J Man Med 6: 93-101, 1991.
  14. Greenman PE. Principles of manipulation of the cervical spine. J Man Med 6, 106-113, 1991.
  15. Steiger HJ. The anatomy of headache. J Man Med. 3: 15-17, 1987.
  16. Pollmann W, Keodel M & pfaffenrath V. Headache and the cervical spine: A critical review. Cephalgia 17(8): 801-816, 1997.
  17. Okeson JP & Falace DA: Nonodontogenic toothache. Dental Clinics of No Am 41(2), 367-383, 1997.
  18. Wazen JJ: Referred otalgia. Otolaryngologic Clinics of No Am. 22(6), 1205-1215, 1989.
  19. De Leeuw R, Boerin, G, Stegenga B, et al. Clinical Signs of TMJ Osteoarthrosis and Internal Derangement 30 years After Nonsurgical Treatment. J Orofac Pain. 8(1): 18-24, 1994.
  20. Svensson and Graven-Nielson. Craniofacial Muscle Pain: Review of Mechanisms and Clinical Manifestations. J Orofac Pain. 15(2):117-45, 2001.
  21. Levine HL. Otorhinolaryngologic causes of headache. In Diamond S (ed). Headache. Medical Clinics of No Am. 75: 677-692, 1991.
  22. Murray GM, Phanachet I, Uchida S et al. The role of the human lateral pterygoid muscle in the control of horizontal jaw movements. J Orofacial Pain 15(4): 279-305, 2001.
  23. Eriksen W, et al, Job characteristics as predictors of neck pain, Journal of Occupational and Environmental Medicine; 41 (10): 893-902, 1999.
  24. Ekberg EC & Nilner M. Treatment outcome of short and long-term appliance therapy in patients with TMD of myogenous origin and tension-type headache. J Oral Rehab. 33: 713-721, 2006.
  25. Linton SJ. A review of psychological risk factors in neck and back pain. Spine. 25: 1148-1156, 2000.
  26. Shhati-Chafai-Leuwer S, Wenzel S, Bschorer R, et al. Pathophysiology of the eustachian tube- relevant new aspects for the head and neck surgeon. Craniomaxillofac Surg, 34: 351-354, 2006.





1. The following reflex has strong validity regarding lesions affecting the upper motor neurons often associated with cervical myelopathy. This reflex, if positive, may denote spinal cord compression or intracranial pathology that should be fully evaluated by a radiologic work-up. A positive reflex sign is present if the patient’s index finger and thumb flex while the clinician snaps / flicks their middle finger. The name of this reflex is?


A. Upper Babinski Reflex

B. Hoffman’s Reflex

C. Torg-Pavlov Reflex

D. Sugarman’s Reflex


2. Eagles Syndrome is craniofacial pain produced by active cervical rotation compressing sensitive cervical spine structures against the elongation of which of the following processes?


A. Zygomatic process

B. Styloid process

C. Uncinate process

D. Mastoid process


3. Which of the following groups of cranial nerves travel with the spinal tract of trigeminal?


A. Olfactory, facial, oculomotor, vagus, and abducens

B. Facial, vagus, glossophayngeal, optic, and trochlear

C. Vagus, spinal accessory, facial, hypoglossal, and glossophyarngeal

D. Glossopharyngeal, vagus, acoustic, trochear, and oculomotor


4. In an MRI of the temporomandibular joint taken in the sagittal plane, the part of the temporomandibular disk that is located just behind the posterior band is the?


A. Bilaminar zone

B. Epimysium

C. Lateral pterygoid muscle

D. Temporomandibular ligament


5. A patient complains of sensibility loss of the skin of the temporal region and around the ear. Moreover, propriosepsis of the temporomandibular joint is affected. Which nerve is most probably affected?


A. Auriculotemporal

B. Spinal Accessory

C. Supraorbital

D. Facial


6. A physical therapist is manually palpating the area between the lateral border of the trapezius muscle and the posterior border of the sternocleidomastoid muscle, one centimeter below the suboccipital bone. Which muscular structure is she palpating?


A. Oblique Capitis Superior

B. Rectus Capitis Anterior

C. Rectus Capitis Lateralis

D.Splenius Capitis


7. In a patient presenting with posterior cranial rotation, the lateral cervical X-ray would likely disclose:


A. Narrowing of the C5-C6 interspace

B. Advanced degenerative joint disease

C. Multiple disc herniations

D. Decreased distance between the occiput and C1


8. A patient has a diagnosis of a displaced disc without reduction of the right temporomandibular joint. Which clinical sign would most likely be expected upon functional examination?


A. A deflection upon protrusive movement to the left

B. A deviation of the mandible throughout opening and closing

C. An intermediate “click” with opening and closing

D. A restriction of lateral movement to the left


9. A patient has an active mouth opening of 57 mm, a left deviation on opening, a clicking sound at the end of opening and at the beginning of closing, laterotrusion to the left side of 13 mm, and to the right side of 10 mm. She has no history of trauma. What is the most likely diagnosis?


A. Anterior disk displacement with reduction of the left temporomandibular joint

B. Anterior disk displacement with reduction of the right temporomandibular joint

C. Hypermobility of the left temporomandibular joint

D. Hypermobility of the right temporomandibular joint


10. A female patient complains of recurring headaches manifesting in attacks lasting one to two days. It has a unilateral character, a pulsating quality, and is associated with nausea, photophobia, and phonophobia. What type of headache is she suffering from?


A. Cervicogenic headache

B. Cluster headache

C. Migraine

D. Tension-type headache


11. A 60 year old female patient is sent to a physical therapist for treatment of myofascial jaw pain. On examination, tenderness of the masticatory muscles to palpation is found on both sides. In addition, with mandibular range-of-motion movements, the patient winces and complains of electric shock-like pains in her left cheek and upper jaw. In addition to myofascial pain, the most likely diagnosis is:


A. Atypical odontalgia

B. Glossopharyngeal neuralgia

C. Paroxysmal hemicrania

D. Trigeminal neuralgia



Answer Key: 1. ( b), 2. (b), 3. (c), 4. (a), 5. (a), 6. (d), 7. (d), 8. (d), 9. (d), 10. (c), 11. (d).