Efficacy of manual therapy by different healthcare professionals on pain and function in temporomandibular disorders: a systematic review of randomized controlled trials.

BACKGROUND

Manual therapy is widely used in temporomandibular joint disorders (TMD), but its effectiveness across different professional practices and techniques remains unclear. This systematic review of randomized controlled trials (RCTs) aims to evaluate the efficacy of manual therapy in alleviating pain and improving functional recovery in patients with different TMD subtypes, considering the roles of various healthcare professionals.

METHODS

A systematic search was conducted across PubMed, Scopus, Cochrane and Web of Science to identify RCTs presenting participants with a diagnosis of TMD, manual therapies as interventions; other therapeutic modalities, placebo, or sham therapy as comparisons; pain intensity and maximum mouth opening (MMO) as outcomes.

RESULTS

From 561 initial records, 18 RCTs met the inclusion criteria and were included in the analysis. Overall, manual therapy was associated with reductions in pain and improvements in MMO across different professional background and techniques. However, the certainty of evidence was limited, and effects were predominantly observed in the short term. Physiotherapists in rehabilitation settings showed the most consistent outcomes, particularly documented in Brazil. Chiropractic approaches were common in Australia, USA, and England, while Japan focused on intra-oral manipulations by dental and maxillofacial specialists. Italy, Spain, Greece and Turkey stand out for their interdisciplinary approach independently by chiropractors, physiotherapists, or osteopaths in TMD management.

CONCLUSIONS

This systematic review suggests that manual therapy may be associated with short-term improvements. Variability in techniques, professional settings, and study designs precludes firm conclusions regarding long-term effectiveness or superiority of specific approaches. Physiotherapy manipulation emerged as the most used technique. Further research should explore long-term outcomes and multiprofessional collaboration.