The effectiveness of manual therapy applied to craniomandibular structures in temporomandibular disorders: a systematic review

Background Manual therapy (MT) and exercise have been extensively used to treat people with musculoskeletal conditions such as temporomandibular disorders (TMD). The evidence regarding their effectiveness provided by early systematic reviews is outdated. Purpose The aim of this study was to summarize evidence from and evaluate the methodological quality of randomized controlled trials that examined the effectiveness of MT and therapeutic exercise interventions compared with other active interventions or standard care for treatment of TMD. Data Sources Electronic data searches of 6 databases were performed, in addition to a manual search. Study Selection Randomized controlled trials involving adults with TMD that compared any type of MT intervention (eg, mobilization, manipulation) or exercise therapy with a placebo intervention, controlled comparison intervention, or standard care were included. The main outcomes of this systematic review were pain, range of motion, and oral function. Forty-eight studies met the inclusion criteria and were analyzed. Data Extraction Data were extracted in duplicate on specific study characteristics. Data Synthesis The overall evidence for this systematic review was considered low. The trials included in this review had unclear or high risk of bias. Thus, the evidence was generally downgraded based on assessments of risk of bias. Most of the effect sizes were low to moderate, with no clear indication of superiority of exercises versus other conservative treatments for TMD. However, MT alone or in combination with exercises at the jaw or cervical level showed promising effects. Limitations Quality of the evidence and heterogeneity of the studies were limitations of the study. Conclusions No high-quality evidence was found, indicating that there is great uncertainty about the effectiveness of exercise and MT for treatment of TMD.

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Manual Therapy in the Treatment of Myofascial Pain Related to Temporomandibular Disorders: A Systematic Review

Journal of Oral & Facial Pain and Headache ◽

10.11607/ofph.2530 ◽

2020 ◽

Vol 34 (2) ◽

pp. 141-148 ◽

Cited By ~ 2

Author(s):

Laércio de Melo ◽

Annie de Medeiros ◽

Maria Campos ◽

Camila de Resende ◽

Gustavo Barbosa ◽

...

Keyword(s):

Systematic Review ◽

Manual Therapy ◽

Temporomandibular Disorders ◽

Myofascial Pain

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Effect of Manual Therapy and Therapeutic Exercise Applied to the Cervical Region on Pain and Pressure Pain Sensitivity in Patients with Temporomandibular Disorders: A Systematic Review and Meta-analysis

Pain Medicine ◽

10.1093/pm/pnaa021 ◽

2020 ◽

Vol 21 (10) ◽

pp. 2373-2384 ◽

Cited By ~ 1

Author(s):

Roy La Touche ◽

Sergio Martínez García ◽

Beatriz Serrano García ◽

Alejandro Proy Acosta ◽

Daniel Adraos Juárez ◽

...

Keyword(s):

Systematic Review ◽

Pain Intensity ◽

Manual Therapy ◽

Temporomandibular Disorders ◽

Randomized Clinical Trials ◽

Clinical Effect ◽

Meta Analysis ◽

Cervical Region ◽

Pressure Pain ◽

Pressure Pain Thresholds

Abstract Objective To assess the effectiveness of cervical manual therapy (MT) on patients with temporomandibular disorders (TMDs) and to compare cervico-craniomandibular MT vs cervical MT. Design Systematic review and meta-analysis (MA). Methods A search in PubMed, EMBASE, PEDro, and Google Scholar was conducted with an end date of February 2019. Two independent reviewers performed the data analysis, assessing the relevance of the randomized clinical trials regarding the studies’ objectives. The qualitative analysis was based on classifying the results into levels of evidence according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Results Regarding cervical MT, MA included three studies and showed statistically significant differences in pain intensity reduction and an increase in masseter pressure pain thresholds (PPTs), with a large clinical effect. In addition, the results showed an increase in temporalis PPT, with a moderate clinical effect. MA included two studies on cervical MT vs cervico-craniomandibular MT interventions and showed statistically significant differences in pain intensity reduction and pain-free maximal mouth opening, with a large clinical effect. Conclusions Cervical MT treatment is more effective in decreasing pain intensity than placebo MT or minimal intervention, with moderate evidence. Cervico-craniomandibular interventions achieved greater short-term reductions in pain intensity and increased pain-free MMO over cervical intervention alone in TMD and headache, with low evidence.

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