Efficacy of manual therapy by different healthcare professionals on pain and function in temporomandibular disorders: a systematic review of randomized controlled trials.

The short version

This systematic review of 18 randomized controlled trials explored whether hands-on treatment eases pain and improves jaw movement in adults with temporomandibular disorders (TMD). TMD is a group of conditions affecting the jaw joint, the chewing muscles and nearby tissues, and it is estimated to affect about 31% of adults. Its subtypes include muscle pain (myalgia), disc displacement (the cushioning disc slips out of position, sometimes locking the jaw) and joint pain. Manual therapy covers thrust manipulation, soft-tissue release, massage and intra-oral techniques, delivered by physiotherapists, chiropractors, osteopaths, dentists and physicians. The review asked which techniques help most and whether results differ by profession. Researchers searched four databases through March 2025 and screened 561 records, keeping 18 trials of adults with a clinical TMD diagnosis. Trials compared manual therapy with sham treatment, no treatment, splints, medication, exercise or education. Pain was rated on the visual analogue or numeric rating scale (0 to 10), and maximum mouth opening was measured in millimetres. Risk of bias was checked with the Cochrane tool and certainty with GRADE. Because the trials differed so widely in technique, dose, comparator and follow-up, results were summarized in words rather than pooled statistically. Most trials reported short-term pain reduction and wider mouth opening, but certainty was low to moderate for pain and low for mouth opening. High-velocity low-amplitude (HVLA) thrusts made up 56% of interventions and fascial manipulation with myofascial release made up 37.5%. Dry needling plus upper neck HVLA beat splint therapy, diclofenac and joint mobilization at three months (p < 0.001), and intra-oral therapy kept benefits for one year in chronic jaw-muscle pain. Upper thoracic HVLA showed no significant effect (p > 0.05), and jog manipulation gained only 6.86 mm of mouth opening at first visit with no later group difference. Massage and fascial manipulation by physiotherapists were linked to relief of jaw-muscle symptoms, while chiropractic, osteopathic and dental trials also reported gains. Physiotherapy trials were the most numerous, which the authors attribute to publication volume rather than superior effectiveness. The authors describe manual therapy as associated with short-term benefit and treat professional comparisons as descriptive, since profession was tangled with setting, technique and country. Limitations include small samples, short follow-up, mixed diagnoses, English-only searching and no meta-analysis. Safety findings were not reported in pooled form, and the evidence mostly covers weeks to months rather than years. The authors call for larger trials with longer follow-up and standardized protocols, and they state that manual therapy is best delivered by trained, licensed professionals.

Key findings

• This systematic review synthesized 18 randomized controlled trials (studies that randomly assign people to treatments) of manual therapy, meaning hands-on treatment such as manipulation, massage and release techniques, in adults with temporomandibular disorders (TMD, conditions affecting the jaw joint and chewing muscles).
• Most trials reported short-term reductions in pain and increases in maximum mouth opening (the widest the jaw can open, measured in millimetres), but the certainty of evidence was rated low to moderate for pain and low for mouth opening using the GRADE system (a method for rating confidence in evidence).
• Upper neck thrust manipulation, jaw manipulation, myofascial release, massage, fascial manipulation and intra-oral techniques were each linked to improvement, while thrust manipulation of the upper thoracic (upper back) spine showed no significant effect (p > 0.05).
• The authors state that differences between professions, such as physiotherapists, chiropractors and osteopaths, are descriptive only because profession was entangled with setting, technique and country, and that the long-term effect of manual therapy remains unproven.

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