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Cited by 33Temporomandibular Joint DisordersMyofascial pain diagnosis and treatmentMuscle activation and electromyography studies

Evaluation of the efficacy of manual soft tissue therapy and therapeutic exercises in patients with pain and limited mobility TMJ: a randomized control trial (RCT)

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Gębska, Magdalena, Dalewski, Bartosz, Pałka, Łukasz, Kołodziej, Łukasz·2023·Head & Face Medicine
DOI 10.1186/s13005-023-00385-yPMC PMC10486124
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Abstract

Summary: The limited number of randomized controlled trials (RCTs) comparing the efficacy of soft tissue manual therapy and self-therapy interventions prompted the authors to focus on the analgesic and myorelaxant use of massage, post-isometric muscle relaxation (PIR) and therapeutic exercise in TMD patients. Objectives: To evaluate the effectiveness of soft tissue therapy and therapeutic exercises in female patients with pain, increased masseter muscle tension and limited mandibular mobility. Material and methods: The study was conducted on a group of 82 women (G1) with the Ib disorder diagnosed in DC/TMD (Ib—myofascial pain with restricted mobility). The control group (G2) consisted of 104 women without diagnosed TMDs (normal reference values for TMJ ROM and masseter muscle sEMG bioelectric activity). Diagnostic procedures were performed in both groups (sEMG of the masseter muscles at baseline and during exercise, measurement of TMJ mobility, assessment of pain intensity—NRS scale). The G1 group was randomly divided into 3 therapeutic groups in which the therapy was carried out for 10 days: therapeutic exercises (TE), manual therapy – massage and therapeutic exercises (MTM_TE), manual therapy – PIR and therapeutic exercises (MTPIR_TE). Each time after therapy, the intensity of pain and TMJ mobility were assessed. Sealed, opaque envelopes were used for randomization. After 5 and 10 days of therapy, bilateral sEMG signals of the masseter muscles were acquired. Results: Massage, PIR and self-therapy led to a decrease in sEMG at rest as well as in exercise. After day 6 of therapy, the groups obtained a significant difference (p = 0.0001). Each of the proposed forms of therapy showed a minimal clinically significant difference (MID) in the sEMG parameter at the endpoint, with the most considerable difference in the MTM_TE group. The forms of MT used were effective in reducing the patients’ pain intensity; however, a significant difference between therapies occurred after 4 treatments (p = 0.0001). Analyzing the MID between methods, it was observed that self-therapy had an analgesic effect only after 8 treatments, while PIR after 3 and massage after 1 treatment. After day 7, the mean pain score in the MTM_TE group was 0.889 and in the TMPIR_TE group was 3.44 on the NRS scale. In terms of MMO, a significant difference was obtained between monotherapy and each form of TM, i.e. massage (p = 0.0001) and PIR (p = 0.0001). Analyzing mandibular lateral movements, the authors got a significant difference in the proposed MT forms, of which massage treatments exceeded the effectiveness of PIR. Conclusions: Soft tissue manual therapy and therapeutic exercise are simple and safe interventions that can potentially benefit patients with myogenic TMDs, with massage showing better analgesic effects than PIR.

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  • Fascial manipulations and massage, administered by physiotherapists, demonstrated efficacy in reducing myogenic temporomandibular disorder symptoms.

    “Fascial Manipulations and massage, administered by physiotherapists, demonstrated efficacy in reducing myogenic TMD symptoms [28,30,32,33].”

    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 [30]

    The Results and Conclusions (page unavailable) report reduced pain in patients with TMD after massage combined with therapeutic exercises or self-therapy. The paper lists fascial therapy among soft-tissue techniques, but its trial tested massage and post-isometric relaxation, not fascial manipulation; it therefore does not establish the claimed efficacy of fascial manipulation. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Intra-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 [30]

    The Discussion reports that manual therapy reduced pain and that massage and other treatments decreased masseter-muscle bioelectrical activity, with significant differences between treatment groups after five sessions. The Conclusions also report a significant analgesic effect for massage combined with self-therapy. The paper does not establish that the treatment producing these effects was intra-oral myofascial therapy; its mention of an intra-oral procedure in Materials and methods concerns a dental examination. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • 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].”

    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 [30]

    The Material and methods section (page unavailable) identifies participants as 82 women with one myofascial TMD subtype—DC/TMD Ib—and describes manual therapy combined with exercises. The Conclusions (page unavailable) report pain relief and improved mobility, but the trial does not establish a response across Axis I subtypes generally or to manual therapy alone. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Myofascial 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.”

    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 [30]

    The Results and Discussion (page unavailable) report that manual therapy reduced patients’ pain ratings, with massage plus therapeutic exercises outperforming the other treatments. The trial tested massage and post-isometric relaxation, not a distinct trigger-point-release intervention, so it does not establish that trigger-point releases were particularly effective. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • 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.”

    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 [30]

    The Abstract’s Material and methods section (page unavailable) says the trial enrolled women diagnosed with DC/TMD Ib, supporting the claim that it identified a TMD subtype. It does not say that the trial applied both Axis I and Axis II criteria; searches for Axis II and psychosocial assessment found no such procedure in our copy. The trial also cannot establish how many studies in the citing systematic review used each set of criteria. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

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Cited by

Sorted by citations

Authors
Gębska, M., Dalewski, B., Pałka, Ł., & Kołodziej, Ł.
Affiliations
  • Pomeranian Medical University (PL)
  • Processus d'Activation Sélective par Transfert d'Énergie Uni-électronique ou Radiatif (FR)
Corresponding author
Pałka, Łukasz
ORCID
Venue
Head & Face Medicine
Publisher
Springer Science and Business Media LLC
Published
2023-09-08
Volume
19
Issue
1
Pages
42-42
ISSN
1746-160X (ISSN-L)
DOI
10.1186/s13005-023-00385-y
PMC
PMC10486124
OpenAlex
W4386563755
Cited by
33
References
6
Citations by year
2026: 10 · 2025: 12 · 2024: 9 · 2023: 2
FWCI
9.59
Type
journal article
Language
en
Open access
Licence
Locations
  • Head & Face Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
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
  • Physical Sciences › Engineering › Biomedical Engineering › Muscle activation and electromyography studies
Keywords
temporomandibular disorders, massage, post-isometric relaxation, exercise therapy, surface electromyography, pain intensity, self-therapy, women, analgesic effect, myorelaxation, treatment efficacy comparison
MeSH terms
Female, Humans, Mandible, Pain, Temporomandibular Joint, Therapy, Soft Tissue

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