Joint Mobilization

Rita Chiaramonte et al. (2026) · The Journal of manual & manipulative therapy

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.

Salma Bouqartacha et al. (2026) · Chiropractic & manual therapies

This randomized mechanistic cross-over trial with 89 adults explored how two hands-on neck treatments differ right after they are delivered. Chronic neck pain, defined here as pain lasting at least 12 weeks, is one of the leading causes of disability worldwide. Spinal manipulation (SM) is a single quick, shallow thrust applied to a joint, and spinal mobilization (Smob) is a slower, repeated rocking pressure on the same area. Both are recommended in clinical guidelines, but they are often lumped together, so little was known about how their effects on pain, movement and muscle activity compare. Participants were aged 18 to 65, with an average of 35 years, and 65% were women. They were recruited in Zurich, Switzerland, and Trois-Rivieres, Canada. Each person attended two sessions three days apart, receiving SM in one and Smob in the other in random order. SM was one thrust to the most painful neck joint while lying face up, and Smob was 30 seconds of repeated pressure on the same level while lying face down. Pain was rated from 0 to 10, and neck movement, tenderness to pressure, grip strength and muscle electrical activity were measured before and after. Pain dropped by 0.79 points after SM and 0.37 points after Smob, a gap of 0.41 points (p = 0.002), which stayed below the 1.3 points considered clinically meaningful. Neck movement improved after both treatments, by about 4.6 degrees after SM and 3.7 degrees after Smob in bending forward and back, with no difference between them. Neck muscles responded more strongly during SM, with activity in the sternocleidomastoid about six times higher (0.144 versus 0.023). Tenderness and grip strength changed inconsistently, and the grip decrease of 1.13 kg was far under the 6 kg detectable change. Participants' own global impression of change favored SM (p < 0.001) but also stayed below the clinical threshold. Upper trapezius activity was likewise higher during SM (0.083 versus 0.024). No serious adverse events were reported. The authors state that statistically significant differences did not reach clinical significance, so the trial cannot support conclusions about which treatment works better in practice. Only immediate effects after one session were measured, many outcomes were tested, participants could tell the treatments apart, and baseline disability was mostly mild to moderate. Clinician training also differed between sites. The authors propose that future trials examine several sessions of each treatment, since a multi-session or combined approach may reach clinical relevance.

Luis González-Gómez et al. (2025) · European journal of pain (London, England)

This systematic review and meta-analysis asked a practical question for people with chronic low back pain (CLBP, pain lasting more than three months): if you had to choose between exercise therapy and hands-on manual therapy alone, which works better? Clinical guidelines actually recommend combining both approaches with psychological support, but in real clinics, people often receive just one or the other, so the researchers pooled every trial that tested exercise against manual therapy head-to-head, without either being combined with the other. After a comprehensive search of five research databases, the researchers found six qualifying randomized trials, covering 743 people with CLBP total, published between 2007 and 2022. The exercise treatments ranged from general aerobic and strengthening exercise to specific 'motor control' exercises that retrain deep core muscles; the manual therapies ranged from joint mobilization and massage to formal osteopathic and chiropractic spinal manipulation. The researchers combined the trial results statistically and also checked whether results changed depending on how long people had been followed up, and whether patient characteristics like age or sex explained some of the differences. Overall, there was no clear winner. For pain relief, exercise and manual therapy performed about the same across all six trials, though when two trials involving chiropractic or osteopathic-style manipulation were set aside, manual therapy showed a small edge in the first three months. For disability (how much back pain limits a person's daily activities), the two treatments were also similar in the short and medium term, but exercise therapy showed a small advantage after six months or longer. Neither treatment stood out for physical function, based on the two trials that measured it. Notably, trials with more women in them tended to show exercise working somewhat better for disability but manual therapy working somewhat better for pain, and older participants tended to respond somewhat better to exercise for pain — though these are patterns across studies, not conclusions about any one person. The researchers rate the overall quality of this evidence as very low, mainly because there are still very few well-designed trials that isolate exercise from manual therapy without mixing the two, and the studies used inconsistent doses and often didn't fully describe what patients actually received. Their bottom line is that picking exercise or manual therapy alone is not clearly better-supported than the other, and that combining exercise, manual therapy, and psychological support, as major clinical guidelines already recommend, remains the better-evidenced path rather than choosing one alone.

Pamela M Rist et al. (2020) · Cephalalgia : an international journal of headache

This pilot randomized controlled trial with 61 adult women explored whether adding multimodal chiropractic care to enhanced usual care could feasibly be delivered to people with episodic migraine, and whether it might reduce how often migraines occurred. Multimodal chiropractic care combines several hands-on techniques — spinal manipulation (adjusting joint movement in the spine), joint mobilization, soft-tissue release, and posture correction — rather than spinal manipulation alone, the approach most prior migraine trials tested. Enhanced usual care meant continuing regular medical treatment plus migraine education materials and regular phone check-ins, giving both groups comparable attention from the study team. Participants were women ages 21 to 55 (average 36) having 4 to 13 migraine days a month, randomly assigned to receive up to 10 individualized chiropractic sessions over 14 weeks (29 women) or enhanced usual care alone (32 women). Chiropractors tailored treatment to each person's diagnosis — myofascial pain, spinal misalignment, or jaw dysfunction — drawing from a fixed menu of techniques. Migraine frequency, severity, and disability were tracked through daily logs and standardized questionnaires: the Migraine Disability Assessment (MIDAS), the Headache Impact Test (HIT-6), and a migraine-specific quality-of-life scale, completed at 14 and 18 weeks. Recruitment and safety looked encouraging: of 422 people screened, 61 enrolled over 20 months, 93% completed migraine logs, and no serious side effects occurred, though only 83% of chiropractic-group participants attended enough sessions to meet the study's own adherence goal (versus a target of 85%), so feasibility criteria were narrowly missed. Migraine days dropped substantially more with chiropractic care added, a difference of about 2 fewer migraine days per month than usual care alone (95% confidence interval -3.46 to -0.37, meaning the true benefit is likely real but its exact size is uncertain), and this advantage held up a month after treatment ended. Disability and headache-impact scores (MIDAS and HIT-6) improved significantly more with chiropractic care too. However, migraine severity, duration, medication use, and quality-of-life scores did not differ significantly between groups, and musculoskeletal stiffness was reported more often by the chiropractic group (21% versus 6%). For migraine sufferers seeking non-drug options, these results are promising but preliminary: the size of the migraine-day reduction was similar to what topiramate, propranolol, and erenumab achieve against placebo in prior research. Because participants and chiropractors knew who was receiving treatment, and the chiropractic group received more attention overall, some of the benefit could reflect that extra contact rather than the techniques themselves. The sample was small, all female, and drawn from one clinic, so a larger, multi-site trial is needed before multimodal chiropractic care can be recommended as proven migraine therapy.