Intra-oral myofascial therapy versus education and self-care in the treatment of chronic, myogenous temporomandibular disorder: a randomised, clinical trial
Open accessAbstract
BACKGROUND: Myogenous temporomandibular disorders (TMD) are considered to be a common musculoskeletal condition. No studies exist comparing intra-oral myofascial therapies to education, self-care and exercise (ESC) for TMD. This study evaluated short-term differences in pain and mouth opening range between intra-oral myofascial therapy (IMT) and an ESC program. METHODS: Forty-six participants with chronic myogenous TMD (as assessed according to the Research Diagnostic Criteria Axis 1 procedure) were consecutively block randomised into either an IMT group or an ESC group. Each group received two sessions per week (for five weeks) of either IMT or short talks on the anatomy, physiology and biomechanics of the jaw plus instruction and supervision of self-care exercises. The sessions were conducted at the first author's jaw pain and chiropractic clinic in Sydney, Australia. Primary outcome measures included pain at rest, upon opening and clenching, using an eleven point ordinal self reported pain scale. A secondary outcome measure consisted of maximum voluntary opening range in millimetres. Data were analysed using linear models for means and logistic regression for responder analysis. RESULTS: After adjusting for baseline, the IMT group had significantly lower average pain for all primary outcomes at 6 weeks compared to the ESC group (p < 0.001). These differences were not clinically significant but the IMT group had significantly higher odds of a clinically significant change (p < 0.045). There was no significant difference in opening range between the IMT and ESC groups. Both groups achieved statistically significant decreases in all three pain measures at six weeks (p ≤ 0.05), but only the IMT group achieved clinically significant changes of 2 or more points. CONCLUSION: This study showed evidence of superiority of IMT compared to ESC over the short-term but not at clinically significant levels. Positive changes over time for both IMT and ESC protocols were noted. A longer term, multi-centre study is warranted. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12610000508077.
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Myofascial release, performed by physiotherapists, chiropractors and dental nurses, showed significant improvements in both pain and function.
“Myofascial release, performed by physiotherapists, chiropractors and dental nurse, showed significant improvements in both pain and function [22,34,35].”
From Efficacy of manual therapy by different healthcare professionals on pain and function in temporomandibular disorders: a systematic review of randomized controlled trials (2026) · cites this paper as [35]
The Results (Primary outcomes; Secondary outcome, page not supplied) report significant pain reductions with intra-oral myofascial therapy and a statistically significant increase in opening range from baseline, a measure of jaw function. The opening-range improvement was not clinically significant or significantly different from education and self-care. The Methods (Study team, page not supplied) say one practitioner performed the interventions; the paper does not establish the claimed range of providers, particularly dental nurses. (LLM, conf=0.88)
Experimental — accuracy not yet measuredDunning et al. and Kalamir et al. observed improvements within six weeks, confirming the short-term efficacy of manual therapy.
“Similarly, Dunning et al. [25] and Kalamir et al. [35] observed improvements within six weeks, confirming the short-term efficacy of manual therapy.”
From Efficacy of manual therapy by different healthcare professionals on pain and function in temporomandibular disorders: a systematic review of randomized controlled trials (2026) · cites this paper as [35]
The Results (Secondary outcome; page not provided) report significant pain reductions at six weeks, with clinically significant reductions in the intra-oral myofascial therapy group. But the Discussion says the difference from education and self-care was not clinically significant and that other factors might explain the added improvement. Thus the six-week improvement is supported, while “confirming” the short-term efficacy of manual therapy overstates this trial’s finding. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIntra-oral myofascial therapy demonstrated pain relief and significant myorelaxant effects.
“Intra-oral myofascial therapy also demonstrated pain relief and significant myorelaxant effects [30,35].”
From Efficacy of manual therapy by different healthcare professionals on pain and function in temporomandibular disorders: a systematic review of randomized controlled trials (2026) · cites this paper as [35]
The Results (Primary outcomes and Secondary outcome; page unavailable) report significant pain reductions with intra-oral myofascial therapy. The Methods (Outcome measures; page unavailable) list pain and jaw-opening measures, but no measure of muscle relaxation; the paper does not demonstrate a significant myorelaxant effect of the therapy. (LLM, conf=0.89)
Experimental — accuracy not yet measuredIn 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.”
From Efficacy of manual therapy by different healthcare professionals on pain and function in temporomandibular disorders: a systematic review of randomized controlled trials (2026) · cites this paper as [35]
Methods > Subjects says the trial used both the physical and psychosocial RDC axes to select participants with myogenous TMD and exclude those with severe depression or somatisation. This supports citing the trial as one that incorporated both axes, but it did not compare TMD subtypes to identify which were most responsive to manual therapy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredMyofascial manipulations and trigger point releases were particularly effective in reducing subjective pain perception.
“Myofascial manipulations [28,30,33] and trigger point releases [34,35] were particularly effective in reducing subjective pain perception.”
Axis I subtypes, particularly myofascial temporomandibular disorder, responded well to manual therapy interventions.
“Axis I subtypes, particularly myofascial TMD, responded well to manual therapy interventions [28–30,33–35].”
Twenty-one of the studies used the RDC/TMD established by Dworkin and LeResche to classify patients as having TMD.
“Twenty-one of the studies 57-76 used the RDC/TMD established by Dworkin and LeResche 27 to classify the patients as having TMD.”
From Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis (2016) · cites this paper as [64]
Four studies looked at MT techniques for people with myogenous TMD.
“Four studies 64,65,77,81 looked at MT techniques, such as facial manipulation versus botulinum toxin 81 or intraoral myofascial therapy versus waiting list, and self-care education and exercises for people with myogenous TMD.64,65,77”
From Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis (2016) · cites this paper as [64]
When pooling the results from 3 of these studies, MT significantly reduced pain at 4 to 6 weeks of treatment compared with botulinum toxin or waiting list, approaching a clinically relevant value.
“When pooling the results from 3 of these studies based on similar outcomes and diagnoses and comparing similar interventions regarding MT, 64,65,81 we found that MT significantly reduced pain at 4 to 6 weeks of treatment compared with botulinum toxin or waiting list, approaching a clinically relevant value.”
From Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis (2016) · cites this paper as [64]
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- Authors
- Kalamir, A., Graham, P. L., Vitiello, A. L., Bonello, R., & Pollard, H.
- Affiliations
- Macquarie University (AU)
- Health Sciences University (GB)
- Australian Catholic University (AU)
- Corresponding author
- Kalamir, Allan
- Venue
- Chiropractic & Manual Therapies
- Published
- 2013-06-05
- Volume
- 21
- Issue
- 1
- Pages
- 17-17
- ISSN
- 1746-1340 (ISSN-L)
- 2045-709X
- PMC
- PMC3706243
- OpenAlex
- W2118894173
- Cited by
- 76
- References
- 61
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 15 · 2023: 6 · 2022: 5 · 2021: 9 · 2020: 8 · 2019: 7 · 2018: 2 · 2017: 2 · 2016: 3 · 2015: 5 · 2014: 2 · 2012: 1
- FWCI
- 5.44
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Chiropractic & Manual Therapies (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Bank (Australian Catholic University) (submittedVersion)
- 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 › Dentistry › Orthodontics › Orthodontics and Dentofacial Orthopedics
- Keywords
- myogenous temporomandibular disorders, jaw pain, mouth opening range, jaw biomechanics
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