Efficacy of musculoskeletal manual approach in the treatment of temporomandibular joint disorder: A systematic review with meta-analysis

Man Ther. 2016 Feb:21:10-7. doi: 10.1016/j.math.2015.06.009. Epub 2015 Jun 25.


Background: Temporomandibular joint disorder (TMD) requires a complex diagnostic and therapeutic approach, which usually involves a multidisciplinary management. Among these treatments, musculoskeletal manual techniques are used to improve health and healing.

Objectives: To assess the effectiveness of musculoskeletal manual approach in temporomandibular joint disorder patients.

Design: A systematic review with meta-analysis.

Methods: During August 2014 a systematic review of relevant databases (PubMed, The Cochrane Library, PEDro and ISI web of knowledge) was performed to identify controlled clinical trials without date restriction and restricted to the English language. Clinical outcomes were pain and range of motion focalized in temporomandibular joint. The mean difference (MD) or standard mean difference (SMD) with 95% confidence intervals (CIs) and overall effect size were calculated at every post treatment. The PEDro scale was used to demonstrate the quality of the included studies.

Results/findings: From the 308 articles identified by the search strategy, 8 articles met the inclusion criteria. The meta-analysis showed a significant difference (p < 0.0001) and large effect on active mouth opening (SMD, 0.83; 95% CI, 0.42 to 1.25) and on pain during active mouth opening (MD, 1.69; 95% CI, 1.09 to 2.30) in favor of musculoskeletal manual techniques when compared to other conservative treatments for TMD.

Conclusions: Musculoskeletal manual approaches are effective for treating TMD. In the short term, there is a larger effect regarding the latter when compared to other conservative treatments for TMD.

Keywords: Manual therapy; Pain; Range of motion; Temporomandibular joint disorder.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Male
  • Middle Aged
  • Musculoskeletal Manipulations / methods*
  • Range of Motion, Articular
  • Temporomandibular Joint / physiopathology*
  • Temporomandibular Joint Disorders / diagnosis*
  • Temporomandibular Joint Disorders / therapy*
  • Young Adult