Efficacy of Manual Therapy in Temporomandibular Joint Disorders and Its Medium-and Long-Term Effects on Pain and Maximum Mouth Opening: A Systematic Review and Meta-Analysis

Abstract

The aim of this study was to conduct a systematic review of the medium- and long-term efficacy of manual therapy for temporomandibular joint disorders, alone or in combination with therapeutic exercise. Information was compiled from the PubMed, SCOPUS, Cochrane, SciELO and PEDro databases. The inclusion criteria were established: randomized controlled trials only; participants must present any kind of temporomandibular disorder; the treatments must include manual therapy in at least one of the experimental groups; a minimum of 3 months of follow-up; pain must be one of the primary or secondary outcomes; and the article must be available in English, Spanish, Italian, Portuguese or French. Six documents that fulfilled all the criteria were obtained for analysis, two of them considered low quality and four considered high quality. A significant improvement in pain and mouth opening compared to baseline was observed after manual therapy treatment. Manual therapy seems to be an effective treatment for temporomandibular disorders in the medium term, although the effect appears to decrease over time. However, when complemented with therapeutic exercise, these effects can be maintained in the long term. This review underlines the importance of manual therapy and therapeutic exercise for the medium- and long-term treatment of temporomandibular joint disorders in daily practice.

Rehabilitation of unilateral peripheral facial paralysis in Guillain-Barré: a case study

“…As observed by Miranda et al (2015) 17 , Mr. N.J. likewise developed compensatory mechanisms to contract the masseter in an effort to potentialize the The intervention included hand therapy techniques, soft tissue mobilization, and exercises, adapted to the patient's needs 26,28 . He was also instructed how to perform the exercises at the ward; they consisted of postural exercises, following the method suggested by Rocabado 29 (joint at rest; controlled mandibular opening; TMJ stabilization; stabilized head flexion; cervical retraction; shoulder/scapular girdle retraction) [26][27][28]30 .…”

“…The following exercises were made to gain mobility: TMJ physiological mobility (intraoral technique for opening, closure, protrusion, retrusion, laterotrusion, and mediotrusion); bilateral and unilateral longitudinal-caudal accessory mobilization (extraoral and intraoral technique, respectively), unilateral inward and outward transverse mobilization (extraoral and intraoral technique, respectively) and unilateral posteriorinferior and antero-posterior mobilization (extraoral techniques); and longitudinal-caudal accessory mobilization combined with active mandibular opening and closure 24,[26][27][28] .…”

“…The following techniques were used to optimize the mandibular movement coordination: more selective muscle activation techniques (contraction/relaxation and eccentric control of mandibular opening and closure); and controlled mandibular opening, closure, protrusion, retrusion, and laterality exercises with selfpalpation in both TMJs [26][27][28]30 .…”

“…As previously mentioned, he was given therapeutic recommendations of postural exercises to perform at the ward (six repetitions of each exercise, twice a day), which, according to Rocabado 29 , aimed at joint distraction by eliminating the compression, restoring physiological joint rest, mobilizing the soft tissues, and, whenever possible, improving the condyle-disc-glenoid fossa relationship 27,28 .…”

“…The physical therapy intervention for left TMJ dysfunction aimed to ease the pain, reeducate TMJ mobility, and improve the cervical and scapular girdle posture [26][27][28] .…”