Manual Therapy for Temporomandibular Joint Disorders

#027 – Manual Therapy for Temporomandibular Joint Disorders

Estimated reading time: 1 minute, 33 seconds*

The effect of manual therapy for temporomandibular joint disorders

? Problem

  • The classification of temporomandibular joint disorders (TMD) can be complex.
  • Disc displacement is the most common cause of pain in TMD, it can be disc displacement reduction and disc displacement without reduction.
  • without reduction is what causes pain and mouth opening limitation.
  • Physiotherapy treatments might include:
    • Transcutaneous electrical nerve stimulation (TENS), lasers, massage therapy, joint mobilization and therapeutic exercise (TE).
  • The effect of manual therapy (MT) and exercise (TE) is only investigated for the short and medium term.

??‍♀️ Investigated

  • Therefore, the main objective of this study was to conduct a systematic review and meta-analysis of the medium- and long-term efficacy of MT for TMD, alone or in combination with TE.

Outcome measures

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  • VAS (6 studies).
  • Active Maximal Mouth Opening (MMO) (6 studies).
  • Passive MMO. (2 studies).
  • Pain pressure threshold (PPT) (2 studies).


304 participant from 6 RCTs (2 low quality and 4 high quality)

?Effect of manual therapy (MT) on TMJ pain:

  • MT alone decreased TMJ pain in the short and medium term.
    • Note: other techniques also had similar effect.
  • In the long term, the effect of manual therapy diminish over time.
  • But, if therapeutic exercise was added, the effect of MT on pain is maintained.

?Effect of manual therapy (MT) on maximal mouth opening (MMO):

  • Short-term, manipulative therapy with TE caused a significant increase in MMO compared to TE only.
  • The medium-term results from treatment with MT and TE showed benefits.
  • Treatment with MT on the TMJ seemed to lose its impact on MMO after 6 months.
  • MT on the cervical region is suggested to have no effect on MMO.


  • Manual therapy is effective for TMD in the midterm.
  • To sustain that effect for the long term, therapeutic exercise should be added.

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*Calculation is based on the average reading speed that around 200 words per minute (wpm)

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