Spinal high-velocity low-amplitude manipulation with exercise in women with chronic temporomandibular disorders: A randomized controlled trial comparing to patient education

Manual therapy was effective in reducing pain immediately after treatment, independent of the professional category.

“Manual therapy was found to be effective in reducing pain immediately after treatment, independent of the professional category (Table 2).”

Manual therapy was effective across all professional categories, with significant reductions in pain and improvements in maximum mouth opening.

“Manual therapy was effective across all professional categories, with significant reductions in pain [21–25] and improvements in MMO [21–26].”

In this systematic review, most studies applied Axis I criteria, while a subset incorporated both Axis I and II.

“In this systematic review, most studies applied Axis I criteria [22,25,27,30,35], while a subset incorporated both Axis I and II [21,33] to identify TMD subtypes most responsive to manual therapy.”

Medical doctors and oral health professionals achieved positive outcomes using HVLA, myofascial release, and intraoral manipulation techniques.

“Medical doctors and oral health professionals achieved positive outcomes using HVLA, myofascial release, and intraoral manipulation techniques [21,34,36].”

For Axis I temporomandibular disorders, positive outcomes were reported with upper cervical HVLA techniques, likely due to interruption of nociceptive signaling via trigemino-cervical convergence mechanisms.

“For Axis I TMD, positive outcomes were reported with upper cervical HVLA techniques, likely due to interruption of the nociceptive signaling via trigemino-cervical convergence mechanisms [21,25,27].”

Five of the eight included trials demonstrated selection bias, and all included trials demonstrated similar degrees of performance bias.

“Five of the 8 included trials40, 41, 42,45,46 demonstrated selection bias, and all demonstrated similar degrees of performance bias.”

No blinded randomized controlled trials were included, specifically Corum 2018 and Guarda-Nardini 2012.

“No blinded RCTs:Corum 2018 [21], Guarda-Nardini 2012 [33]”

Treatment targets differed, with some studies focusing solely on masticatory muscles while others included cervical or upper-cervical spine structures.

“Treatment targets also differed, with some studies focusing solely on masticatory muscles [24,28] while others including cervical or upper-cervical spine structures [21].”

Comparator groups varied widely, including sham or no-treatment control, standard care, splint therapy, and pharmacological treatments.

“Comparator groups varied widely, including sham or no-treatment control [23,27], standard care [21], splint therapy [25,29,32] and pharmacological treatments [38].”

HVLA techniques applied to the jaw and cervical spine demonstrated efficacy in reducing pain and improving maximum mouth opening.

“HVLA techniques applied to the jaw [24,29,31] and cervical spine [21,23,25–27] demonstrated efficacy in reducing pain and improving MMO.”

Osteopathic interventions and physician-led treatments were effective when compared to education- or sham-controls.

“Osteopathic interventions [24] and physician-led treatments [21] were effective when compared to education- or sham- controls.”

Physiotherapists consistently achieved significant outcomes in pain reductions and maximum mouth opening improvement.

“Physiotherapists consistently achieved significant outcomes in pain reductions [21–23] and MMO improvement [21,22,26].”

Several studies emphasized that manual therapy was performed by professionals with specialized training, reinforcing the notion that clinical expertise is critical to achieving effective results.

“Several studies [21,22,25,26,29,31,34] emphasized that manual therapy was performed by professionals with specialized training, reinforcing the notion that clinical expertise is critical to achieving effective results.”