Effects of manual therapy in the treatment of temporomandibular dysfunction - a review of the literature

Abstract

Background: The term temporomandibular dysfunction (TMD) applies to functional changes related to temporomandibular joint (TMJ) and it is associated to masticatory structures. The main symptoms are pain in the TMJ region and / or the masticatory musculature. Objective: to perform a systematic review on the effects of manual therapy in the treatment of TMD. Methods: We analyzed 231 articles from the databases of Bireme, BVS, Lilacs, MedLine, PEDro, Pubmed and, Scielo. Of these, only 30 were selected for the elaboration of the article and 6 were used for the qualitative synthesis. Studies of controlled clinical trials of high methodological quality and high clinical relevance on the PEDro scale were included, which used the same evaluation measures, VAS (visual analogic scale), PPT (pressure pain threshold) and maximum mouth opening (MMO), and only one treatment technique comparing the control group with placebo. Result: The studies presented positive results for pain in VAS, PPT and MMO; however, there are significant differences depending on the technique. Myofascial release has a strong efficacy in reducing the symptoms of acute pain in the long term, but does not show clinically significant changes in mouth opening amplitude and MMO. Mobilization / manipulation presents significant changes in MMO, significantly improving the efficacy of mouth range of motion in the treatment of the short-term pain symptom, however does not sustain in the long term. Conclusion: The tool for the individual treatment of patients is based on the symptoms addressed, significantly improving the effectiveness of the range of motion of the mouth in the treatment of joint mobilization / manipulation, and treatment of pain by myofascial release.

Effects of Orthopedic Manual Therapy on Pain Sensitization in Patients With Chronic Musculoskeletal Pain

“…A list of excluded articles ( n = 26) with reasons can be found in the supplementary material (Appendix S2, Supplemental Digital Content 3, http://links.lww.com/PHM/C14). Overall, 29 SRs (with or without MA) were included in the qualitative synthesis, 26,27,46–72 whereas four MAs were included in the quantitative synthesis 26,70–72 . A flowchart of the selection process was created according to PRISMA guidelines (supplementary material, Fig.…”

“…According to the type of intervention, joint mobilization (passive mobilization or mobilization with movement) was the most commonly used technique in the intervention group, 27,46,47,52,53,57–60,63,69,71 followed by joint manipulation 49,51,54–56,61,67,68,70 and neurodynamic mobilization 48,62 . Finally, six reviews included studies with a combination of previous approaches 26,50,64–66,72 …”

“…In terms of the control group, sham techniques were the most commonly used control, 26,27,47–49,51,61,62,65,69,70 followed by manual contact, 46,50,52,57–60,63,66,71 other forms of OMT, 54–56 detuned ultrasound, 64,67,72 usual care, 53 or no control group 68 …”

“…The most pain sensitivity measured outcome was PPT, assessed in all SRs but one, 27,46–72 followed by TS 26,48,62 and CPM 26 …”

Efectividad de la terapia manual en trastornos temporomandibulares. Revisión de literatura

“…Las mismas técnicas aplicadas en tejidos blandos seleccionados pueden también ser usadas para mejorar la movilidad y función de tejidos y músculos. Generalmente la terapia manual tiene diferentes efectos biológicos positivos como mejorar la circulación, reducir espasmos musculares, relajar músculos circundantes a la articulación, realinear los tejidos suaves, eliminar adherencias, incrementar el rango de movimiento y disminuir el dolor 18,19 .…”