Osteopathic manual therapy versus conventional conservative therapy in the treatment of temporomandibular disorders: A randomized controlled trial
Abstract
Objective Temporomandibular disorders (TMD) is a term reflecting chronic, painful, craniofacial conditions usually of unclear etiology with impaired jaw function. The effect of osteopathic manual therapy (OMT) in patients with TMD is largely unknown, and its use in such patients is controversial. Nevertheless, empiric evidence suggests that OMT might be effective in alleviating symptoms. A randomized controlled clinical trial of efficacy was performed to test this hypothesis. Methods We performed a randomized, controlled trial that involved adult patients who had TMD. Patients were randomly divided into two groups: an OMT group (25 patients, 12 males and 13 females, age 40.6+/-11.03) and a conventional conservative therapy (CCT) group (25 patients, 10 males and 15 females, age 38.4+/-15.33). At the first visit (T0), at the end of treatment (after six months, T1) and two months after the end of treatment (T2), all patients were subjected to clinical evaluation. Assessments were performed by subjective pain intensity (visual analogue pain scale, VAS), clinical evaluation (Temporomandibular index) and measurements of the range of maximal mouth opening and lateral movement of the head around its axis. Results Patients in both groups improved during the six months. The OMT group required significantly less medication (non-steroidal medication and muscle relaxants) (P<0.001). Conclusions The two therapeutic modalities had similar clinical results in patients with TMD, even if the use of medication was greater in CCT group. Our findings suggest that OMT is a valid option for the treatment of TMD.
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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).”
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].”
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.”
Jaw HVLA combined with myofascial release yielded significant pain relief and increased maximum mouth opening, both immediately after treatment and at 2 months follow-up.
“Jaw HVLA combined with myofascial release [24,31], yielded significant pain relief and increased MMO, both immediately after treatment and at 2 months follow-up [24].”
HVLA of the cervical spine and of the jaw combined with myofascial release have been studied in Brazil.
“Additionally, HVLA of cervical spine [27] and of the jaw combined with myofascial release [24] have been studied in Brazil (Table 3).”
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].”
Cuccia et al. and DeVocht et al. demonstrated significant improvements at six months, while Kalamir et al. reported sustained efficacy up to one year, particularly in chronic myogenous temporomandibular disorder.
“Cuccia et al. [24] and DeVocht et al. [29] demonstrated significant improvements at six months, while Kalamir et al. [34] reported sustained efficacy up to one year, particularly in chronic myogenous TMD.”
No statistical differences were found between MT targeted to the jaw and jaw exercises plus splint therapy, between cervical chiropractic adjustment and cervical trigger point therapy, upper thoracic manipulation and placebo, or masticatory muscle massage and splint for improving symptoms of patients with mixed TMD.
“However, no statistical differences were found between MT targeted to the jaw and jaw exercises plus splint therapy, 100 between cervical chiropractic adjustment and cervical trigger point therapy, 102 upper thoracic manipulation and placebo, 76 or masticatory muscle mas- sage and splint 104 for improving symptoms of patients with mixed TMD.”
From Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis (2016) · cites this paper as [100]
Cuccia et al. and Raiadurai investigated the use of PIR and MR methods in TMD patients.
“Additionally, Cuccia et al. [45] and Raiadurai [46] investigated the use of PIR [45,46] and MR methods [45] in TMD patients.”
From The Application of Manual Techniques in Masticatory Muscles Relaxation as Adjunctive Therapy in the Treatment of Temporomandibular Joint Disorders (2021) · cites this paper as [45]
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.”
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- Authors
- Cuccia, A. M., Caradonna, C., Annunziata, V., & Caradonna, D.
- Affiliations
- University of Palermo (IT)
- Corresponding author
- Cuccia, A.M.
- ORCID
- Cuccia, A.M.
- Venue
- Journal of Bodywork and Movement Therapies
- Publisher
- Elsevier BV
- Published
- 2010-04
- Volume
- 14
- Issue
- 2
- Pages
- 179-184
- ISSN
- 1360-8592 (ISSN-L)
- OpenAlex
- W2124759819
- Semantic Scholar
- 5dfaeb2f79dfad8e5ff0ca08459e631ceb8ffc5e
- Cited by
- 91
- References
- 38
- Citations by year
- 2026: 2 · 2025: 11 · 2024: 7 · 2023: 8 · 2022: 7 · 2021: 4 · 2020: 9 · 2019: 6 · 2018: 3 · 2017: 5 · 2016: 5 · 2015: 8 · 2014: 3 · 2013: 7 · 2012: 2
- FWCI
- 3.12
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Bodywork and Movement Therapies (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Myofascial pain diagnosis and treatment
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- osteopathic manual therapy, temporomandibular disorders, conservative treatment, jaw pain, pain intensity, mouth opening range, nonsteroidal anti-inflammatory drugs, muscle relaxants, treatment efficacy
- MeSH terms
- Adult, Analysis of Variance, Female, Health Status Indicators, Humans, Male, Middle Aged, Pain Measurement, Temporomandibular Joint Disorders, Range of Motion, Articular, Treatment Outcome, Manipulation, Osteopathic
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