Efficacy of physiotherapy in reducing pain in subjects with temporomandibular disorders: a systematic review with network meta-analysis
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Objective
Temporomandibular disorders are common conditions in the general population. Several therapeutic approaches are available, but there is no consensus on the most effective, particularly in physiotherapy. The objective of this review is to assess the effect of manual therapy and therapeutic exercise in reducing pain in patients with temporomandibular disorders.
Data sources
Four databases (MEDLINE, PEDro, EMBASE, CINAHL) were searched up to March 2025.
Review methods
We included randomized controlled trials evaluating the effects of manual therapy and/or therapeutic exercise in individuals with temporomandibular disorders, compared to any other rehabilitation treatment, with pain intensity as the primary outcome. The methodological quality was assessed using the PEDro scale. A network meta-analysis was performed to compare the effect of different rehabilitative approaches.
Results
25 randomised clinical trials for a total of 1,540 people were included. The main comparisons were: manual therapy and/or therapeutic exercise vs no treatment or placebo, occlusal splint, and instrumental physiotherapy. In most studies, manual therapy and therapeutic exercise were more effective than controls in reducing pain. However, the network meta-analysis indicated that multimodal treatments were the most effective. The methodological quality of the included studies ranged from 3 to 9 points.
Conclusion
manual therapy and therapeutic exercise are effective strategies for reducing pain in subjects with temporomandibular disorders and should be used as first-line interventions before more invasive treatments; the combination of dry needling and manual therapy appears to be the most effective approach. Nonetheless, the variability in study quality suggests that further high-quality research is needed to confirm these findings.
