Effects of manual therapy in the treatment of temporomandibular dysfunction - a review of the literature
Background: The term temporomandibular dysfunction (TMD) applies to functional changes related to temporomandibular joint (TMJ) and it is associated to masticatory structures. The main symptoms are pain in the TMJ region and / or the masticatory musculature. Objective: to perform a systematic review on the effects of manual therapy in the treatment of TMD. Methods: We analyzed 231 articles from the databases of Bireme, BVS, Lilacs, MedLine, PEDro, Pubmed and, Scielo. Of these, only 30 were selected for the elaboration of the article and 6 were used for the qualitative synthesis. Studies of controlled clinical trials of high methodological quality and high clinical relevance on the PEDro scale were included, which used the same evaluation measures, VAS (visual analogic scale), PPT (pressure pain threshold) and maximum mouth opening (MMO), and only one treatment technique comparing the control group with placebo. Result: The studies presented positive results for pain in VAS, PPT and MMO; however, there are significant differences depending on the technique. Myofascial release has a strong efficacy in reducing the symptoms of acute pain in the long term, but does not show clinically significant changes in mouth opening amplitude and MMO. Mobilization / manipulation presents significant changes in MMO, significantly improving the efficacy of mouth range of motion in the treatment of the short-term pain symptom, however does not sustain in the long term. Conclusion: The tool for the individual treatment of patients is based on the symptoms addressed, significantly improving the effectiveness of the range of motion of the mouth in the treatment of joint mobilization / manipulation, and treatment of pain by myofascial release.
1. Kinote APBM, Monteiro LT, Vieira AAC, Ferreira NMN, Abdon APV. Perfil funcional de pacientes com disfunção temperomandibular em tratamento fisioterápico. Rev BrasPromoç Saúde. 2011;24(4):306-12.
2. Dym H, Israel H. Diagnosis and treatment of temperomandibular disorders. Dental Clinics. 2012;56(1):149-61.
3. Liu F, Steinkeller A. Epidemiology, Diagnosis, and Treatment of Temporomandibular Disorders. Dent Clin North AM. 2013;57(3):465-79.
4. Calixtre LLB, Moreira RFC, Franchini GH, Alburquerque-Sedin F, OLIVEIRA AB. Manual therapy for the management of pain and limited range of motion in subjects with signs and symptoms of temperomandibular disorder: a systematic review of randomized controlled trails. Journal of Oral Rehabilitation. 2015;42:847-61.
5. Gonçalves DADG, Dal Fabro AL, Campos JADB, Bigal ME, Speciali JG. Symptoms of temporomandibular disorders in the population: an epidemiological study. J Orofac Pain. 2010;24:270-8.
6. Kalamir A, Graham PL, Vitiello AL, Bonello R, Pollard H. Inter-oral myofascial therapy versus education and self-care in the treatment of chronic, myogenous temporomandibular disorder: a randomized, clinical trail. Chiropractic Manual therapies. 2013;21(17).
7. Kalamir A, Bonello R, Graham P, Vitiello AL, Pollard H. Intraoral myofascial therapy of croniomyogenous temporomandibular disorder: a randomized controlled trail. Journal Manipulative Physiol. Therapy. 2011;35:26-37.
8. La Touche R, Fernandez-De-Las-Peñas C, Fernández-Carnero J, Escalante K, Ângulo-Díaz-Parreño S, Paris-Alemany A. The effects of manual therapy and exercise directed at the cervical spine on pain and pressure sensitivity in patients with myofascial temporomandibular disorders. Journalof Oral Rehabilitation. 2009;36:644-52.
9. De Freitas DG, Pinheiro IOC, Vantin K, Meinrath NCM, de Carvalho NAA. Os efeitos da desativação dos pontos- gatilho miofasciais, da mobilização articular e do exercício de estabilização cervical em uma paciente com disfunção temperomandibular: um estudo de caso. Fisioter. Mov. 2011;24(1):33-8.
10. Borg-Stein J, Iaccarino MA. Miofascial Syndrome treatment. Phys Med Rehabil Clin. 2014;25:357-74.
11. Graff-Radford SB, Bassiur JP. Temporomandibular disorders and Headaches Neurol Clin. 2014;32:525-37.
12. Özkan F, Çakir Özkan N, Erkorkmaz Ü. Trigger point injection therapy in the management of myofascial temporomandibular pain. Ağri Clinical Trials - Klinik Çalişma. 2011;23(3):119-25.
13. Kalamir A, Pollard H, Vitello AL, Bonello R. Manual therapy for temporomandibular disorders: A review of literature. Journal of Bodywork and Movement Therapies. 2007; 11(1):84-90.
14. American Physical Therapy Association (APTA). Manipulation education manual for physical therapist professional degree programs manipulation. Available at: http://www.Apta.org/uploadedFiles/APTAorg/Educators/Curriculum_Resources/APTA/Manipulation/ ManipulationEducationManual.pdf; [Accessed 13 Apr 2016].
15. Bialosky JE, Bishop MD, Price DD, Robinson ME, George SZ. The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Man Ther. 2009;14:531-8.
16. De Morton NA, The Pedro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Australian Journal of Physiotherapy. 2009; 55(2):129-33.
17. Mansilla FP, Boscá GJJ. Efecto de la manipulación de la charnelaoccipitoatlo- axoidea em la apertura de la boca. Osteopatía Científica. 2008;45-51.
18. La Touche R, Paris-Alemany A, Mannheimer JS, Ângulo-Díaz-Parreño S, Bishop MD, Lopéz-Valverde-Centeno A, Von Piekartz H, FernándezCarnero J. Does mobilization of the upper cervical spine affect pain sensitivity and autonomic nervous system function in patients with cervico-craniofacial pain? A randomized-controlled trail. Clin J Pain. 2012;29(3):205-15
19. Tuncer AB, Ergun N, Tuncer AH, Karahan S. Effectiveness of manual therapy and home physical therapy in patients with temporomandibular disorders: a randomized controlled trail. Journal of Bodywork and Movement Therapies. 2013;17:302-08.
20. Bijur P, Silveer W, Gallagher JE. Reliability of the visual analogue scale for measurement of acute pain. Acad Emerg Med. 2001;8:1153-7.
21. Chesterson LS, Sim J, Wright CC, Foster NE. Inter-rater reliability of algometry in measuring pressure pain thresholds in healthy humans, using multiple raters. Clin J Pain. 2007;23:760-6.
22. Goulet JP, Clark GT, Flack VF, Liu C. The reproducibility of muscle and joint tenderness detection methods and maximum mandibular movement measurement for the temporomandibular system. Orofac Pain. 1998;17-26.
23. Haythornthwaite JA. Impact recommendations for clinical trails: opportunities for the RDC/TMD. J Oral Rehabil. 2010;37:799-806.
24. Kamper SJ, Maher CG, Mackay G. Global rating of change scales: a review of strengths and weaknesses and considerations for design. J Man Manip Ther. 2009;17:163-70.
25. Kamoneski DH, Fonseca CL, De Souza TP, Zamunér AR, De Oliveira Peixoto B, Yi LC. Efeito imediato da manipulação Thrust aplicada na coluna cervical alta sobre a abertura ativa da boca: ensaio clínico randomizado. J Health Sci Inst. 2012;30(3):277-80.
26. Peroni CR, Oliveira AS, Bézin F. Immediate effect of cervical mobilization in temporomandibular disorder patients. Braz J Oral Sci. 2005;4(15):911-8.
27. Catanzariti JF, Debuse T, Duquesnoy B. Cervicalgies Chroniques Et Dysfonctionnement de láppareilmanducateur. Revue du Rhumatisme. 2005;72:1283- 7.
28. Xiaoqiang Z, Shusheng T, Qiangmin H. Understanding of myofascial trigger points. Chinese Medical Journal. 2014;127(24).
29. Lv J, Huang QM, Tang L. The Studies of electrophysiology and histopathology of chronic model of myofascial trigger points in rat. Chin j Sports Med. 2013;32:621-8.
30. Mense S. How do muscle lesions such as latent and active trigger points influence central nociceptive neurons? J Musculoskelet Pain. 2010;18:348-53.