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FOTO Rehab Outcomes Blog

Manual Approach for Temporomandibular Joint Disorder


This is one diagnosis that I really tend to avoid. I mean, I can appreciate that clinicians can help patients with temporomandibular joint pain. What I am not able to do is settle my fear and anxiety associated with sticking my fingers in a mouth with teeth! You see, I grew up on a farm. From my perspective, teeth are dangerous!

Since FOTO now has the Jaw Functional Limitation Scale available, I thought some of you might be interested in the effectiveness of manual therapy for jaw problems. It appears including a manual approach is helpful for these patients.

Here's a quick view of the abstract. 


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




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.


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


A systematic review with meta-analysis.


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.


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.


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.

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