Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis

Armijo‐Olivo, Susan; Pitance, Laurent; Singh, Vandana; Neto, Francisco Rosa; Thie, Norman M.R.; Michelotti, Ambrosina

doi:10.2522/ptj.20140548

Cited by 290 publications

(337 citation statements)

References 91 publications

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“…Therapeutic jaw exercises are a commonly used treatment in TMD cases and aims to attain relaxation in tender/sore jaw muscles and to optimise jaw function . There are some randomized controlled trials (RCTs) that have shown that jaw exercises can be effective in the treatment of masticatory myofascial pain, but due to small sample sizes in published studies and limited numbers of RCTs, there is a great uncertainty about the effectiveness of exercises in the management of TMD …”

Section: Introductionmentioning

confidence: 99%

Patients’ experiences of therapeutic jaw exercises in the treatment of masticatory myofascial pain—A postal questionnaire study

Lindfors

Magnusson

Ernberg

2019

J of Oral Rehabilitation

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Background The most common non‐dental pain in the orofacial region is pain associated with temporomandibular disorders (TMD), and jaw exercises are a common treatment in these cases. Since masticatory myofascial pain has components of an affective and cognitive nature, knowledge about the patients’ experiences of the condition and treatment is important. Objective The aim was to study the patients’ experiences of jaw exercises in the treatment of masticatory myofascial pain. Methods A questionnaire, containing 24 statements that should be answered according to a five‐item verbal Likert scale, was sent to 150 consecutive patients with masticatory myofascial pain according to the Research Diagnostic Criteria for TMD after they had been treated with jaw exercises for 3‐12 months. Results The response rate was 73% (n = 109), and 79% of the responders were women. 71% of the patients reported that it was easier to remember the jaw exercises if they put them in conjunction with an already established routine. Before examination, 49% of the patients suspected serious disease behind their symptoms, but these concerns were greatly relieved by the information provided. As a result, 78% reported that information about the underlying cause of their symptoms made them more involved in the treatment. Finally, 72% of the respondents reported that the jaw exercises were effective in reducing their symptoms. Conclusions Information about the cause of the symptoms and the treatment is important to reassure and make the patient involved in the treatment. Most patients report that jaw exercises are an effective treatment and they appreciated to have tools to tackle the problems themselves if the symptoms should return.

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Section: Introductionmentioning

confidence: 99%

Patients’ experiences of therapeutic jaw exercises in the treatment of masticatory myofascial pain—A postal questionnaire study

Lindfors

Magnusson

Ernberg

2019

J of Oral Rehabilitation

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“…The results showed significant mandibular function improvement and decreased self‐reported pain score. Although systematic reviews and meta‐analysis observed two major issues on the majority of studies involving exercises, they did not report interventions sufficiently to be reproducible, and co‐interventions were also not controlled . The current study isolated the exercise intervention and controlled all parameters involved in the prescription, with relevant changes in pain.…”

Section: Discussionmentioning

confidence: 92%

“…Conservative interventions for subjects with TMD including exercises, joint mobilisation, splints and combinations of some of these techniques are often applied as primary choice for care . Low to moderate level of evidence shows positive effects for improving symptoms of muscular TMD when using posture correction exercises for patients with myofascial pain . There was also a trend to favour exercise therapy (general jaw exercises alone or combined with neck exercises in myogenous TMD) for pain free maximum opening and pain intensity when compared with a control group, with a moderate pooled effect size .…”

Section: Introductionmentioning

confidence: 99%

“…Low to moderate level of evidence shows positive effects for improving symptoms of muscular TMD when using posture correction exercises for patients with myofascial pain . There was also a trend to favour exercise therapy (general jaw exercises alone or combined with neck exercises in myogenous TMD) for pain free maximum opening and pain intensity when compared with a control group, with a moderate pooled effect size . However, the exercise programmes were not often assessed alone, but in association to other therapies as part of a conservative treatment protocol .…”

Section: Introductionmentioning

confidence: 99%

“…There was also a trend to favour exercise therapy (general jaw exercises alone or combined with neck exercises in myogenous TMD) for pain free maximum opening and pain intensity when compared with a control group, with a moderate pooled effect size . However, the exercise programmes were not often assessed alone, but in association to other therapies as part of a conservative treatment protocol . A review with meta‐analysis analysed the effectiveness of manual therapy and therapeutic exercise for TMD .…”

Section: Introductionmentioning

confidence: 99%

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Effects of 8 weeks of masticatory muscles focused endurance exercises on women with oro‐facial pain and temporomandibular disorders: A placebo randomised controlled trial

Barbosa

Tahara

Ferreira

et al. 2019

J of Oral Rehabilitation

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Background Exercises are used to treat temporomandibular disorders (TMD), but they are often assessed with other therapies. Local endurance exercises may alter the resistance to fatigue and pain. Objective To assess the effects of an 8‐week protocol of local endurance exercises of masticatory muscles on muscle excitation, force response, perceived pain and over muscle efficiency. Design Randomised controlled trial. Setting Ambulatory care. Subjects In a placebo randomised controlled trial, 46 women with TMD and oro‐facial pain were randomised into intervention group and placebo group. The intervention group received a protocol of biting endurance exercises, controlled by biofeedback. The placebo group received a placebo (simulated laser therapy). Main Outcome Measures The primary outcomes were collected at baseline, 4 weeks and 8 weeks. Pain was assessed through visual analogue scale (VAS) and pressure pain thresholds (PPT). Bite force was collected by a load cell synchronised with surface electromyography of masticatory muscles, bilaterally. Results Pain scores decreased for both groups, but the intervention group showed lower values at 8 weeks. No differences were noted between groups for PPT, but the results increased for both overtime. Time until fatigue and muscle efficiency were higher in the intervention group vs placebo group in both within‐ and between‐subject analysis. Force increased from 4 to 8 weeks in the PG, without differences between groups. Temporal muscle excitation was higher on 8 weeks compared with baseline for the intervention group, without differences between groups. Conclusion Eight‐week exercise protocol of muscle endurance alleviates the pain and improves the resistance to fatigue and muscle efficiency in TMD subjects.

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Manual Therapy for Patients With Radiation-Associated Trismus After Head and Neck Cancer

McMillan

Barbon

Cardoso

et al. 2022

JAMA Otolaryngol Head Neck Surg

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IMPORTANCETrismus is highly prevalent in head and neck cancer (HNC) survivorship. Current standards for trismus treatment include various stretch-based exercise protocols as a primary and single treatment modality with limited evidence regarding the role of manual therapy (MT) for this indication.OBJECTIVE To assess the effect size and associations of response to MT to increase oral opening in the setting of radiation-associated trismus. DESIGN, SETTING, AND PARTICIPANTS This retrospective case series was conducted at the University of Texas MD Anderson Cancer Center between 2016 and March 2020 (before COVID-19 interruption) and included 49 disease-free survivors of HNC who were referred for treatment of radiation-associated trismus. INTERVENTION Intraoral MT (including or excluding external head and neck) targeting the muscles of mastication. MAIN OUTCOMES AND MEASURES Maximum interincisal opening (MIO) before and after the initial MT session compared with serial MT sessions. Covariates were examined to determine the association with response to MT for trismus. RESULTS A total of 49 survivors of HNC (13 women [27%]; 24 [49%] 64 years or younger; 25 [51%] 65 years or older; mean [range] of 6.6 [0-33] years postradiotherapy were included, 9 [18.4%] of whom underwent a single MT session; 40 [81.6%] who underwent multiple sessions [mean, 6; median (range), 3 (2-48)]). The MIO improved after a single session by a mean (SD) of 4.1 (1.9) mm (0.45 effect size) and after serial MT sessions by a mean (SD) of 6.4 (4.8) mm with an effect size of 0.7. No covariates were found to be clinically meaningfully associated with MIO improvement following MT. CONCLUSIONS AND RELEVANCEThe findings of this case series study suggest that MT improved MIO with a medium to large effect size in survivors of HNC with radiationassociated trismus. The results suggest that the largest increase in oral opening was achieved after the initial treatment and although gains were more modest, oral opening continued to improve with serial treatment. Covariates were not associated with MT response, suggesting that patients with clinical features often considered treatment refractory (eg, advanced disease, multiple lines of oncology treatment, Ն5 years posttreatment) may benefit from treatment with MT. Manual therapy may be a beneficial frontline or adjuvant treatment when combined with traditional stretching therapy. A clinically meaningful increase in oral opening has the potential to improve swallow function, speech, pain, and quality of life.

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Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis

Abstract: No high-quality evidence was found, indicating that there is great uncertainty about the effectiveness of exercise and MT for treatment of TMD.

Cited by 290 publications

References 91 publications

Patients’ experiences of therapeutic jaw exercises in the treatment of masticatory myofascial pain—A postal questionnaire study

Patients’ experiences of therapeutic jaw exercises in the treatment of masticatory myofascial pain—A postal questionnaire study

Effects of 8 weeks of masticatory muscles focused endurance exercises on women with oro‐facial pain and temporomandibular disorders: A placebo randomised controlled trial

Manual Therapy for Patients With Radiation-Associated Trismus After Head and Neck Cancer

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