Efficacy of manipulation and therapeutic exercise applied to the neck region of patients with temporomandibular disorders: A systematic review and meta-analysis.

Abstract

Objective: This study aimed to evaluate comprehensively and quantitatively the efficacy of manipulation and therapeutic exercise acting on the neck region of patients with myogenous temporomandibular joint disorders (TMD) using meta-analysis.

Methods: Randomized controlled trials (RCTs) in regard to this issue were searched in electronic databases. The timeframe was from the starting year of inclusion in each database to 25 December 2024 for all searches. The eligible literature was screened according to the inclusion criteria, and meta-analysis of the eligible studies was performed using Review Manager 5.4. The primary outcome measure was the degree of pain, reported on a visual analog scale (VAS), the numerical pain rating scale (NPRS), biting muscle pressure pain thresholds (PPT) and the maximum mouth opening (MMO). Pooled effect sizes were calculated using random effects models and 95 % confidence interval (95 % CI).

Results: Fourteen RCTs comprising 825 patients were included. Meta-analysis showed that manipulative therapy and therapeutic exercise acting on the neck region had a significant effect in NPRS (SMD = -0.49; 95 % CI = [-0.93, -0.04]; p = 0.03), VAS (SMD = -0.64; 95 % CI = [-1.20, -0.08]; p = 0.002), and PPT (SMD = 0.40; 95 % CI = [0.21, 0.58]; p < 0.0001). No significant effect was observed in improving MMO in patients with TMD (SMD = 0.41; 95 % CI = [-0.45, 1.28]; p = 0.32), but in subgroup analyses based on the type of intervention, manipulative therapy combined with therapeutic neck exercises was effective in improving the MMO in patients with TMD (SMD = 0.45; 95 % CI = [0.12, 0.78]; p < 0.008).

Conclusion: Manipulation and therapeutic exercise in the neck region can effectively improve the maxillofacial pain intensity and muscle-related PPT in patients with TMD. Manipulation alone has a negligible effect on improving MMO, but the combination of manipulation and therapeutic exercise in the neck can effectively improve MMO in patients with myogenous TMD. However, many manipulative treatments and therapeutic exercises can be used for the treatment of TMD with varying effects, and more well-designed large-sample RCTs are needed for further validation.