Effectiveness of non-invasive physiotherapy techniques in managing chronic temporomandibular disorder pain: a narrative review

Introduction

The temporomandibular joint (TMJ) is a paired synovial joint positioned on either side of the craniomandibular complex, playing a vital role in chewing, swallowing, speaking, and other involuntary movements such as yawning, teeth grinding, or clenching (1,2). Because the TMJ is constantly in use during activities like speaking, chewing, and swallowing, complete rest is challenging under normal physiological conditions. However, excessive clenching or parafunctional habits can overload the joint, contributing to the development of temporomandibular disorders (TMDs). There are broadly described conditions leading to dysfunction of the TMJ and related neuromuscular systems, often resulting in TMD-associated pain. TMDs encompass a range of conditions affecting the TMJ and associated muscles, leading to symptoms such as pain, joint clicking, restricted jaw mobility, headaches, and referred pain in the head and neck. These disorders often arise due to a combination of muscular dysfunction, joint abnormalities, and parafunctional habits like bruxism or excessive clenching (3,4). The pain may be classified as myogenic, arthrogenic, or a combination of both, and can be linked to other chronic pain conditions such as migraines, fibromyalgia, and generalized pain (5). However, TMD is a general term, not a specific diagnosis, and includes a variety of conditions like pain in the chewing muscles, TMJ discomfort, headaches, restricted jaw mobility, and sounds in the joints during mouth movements. The underlying causes can be diverse, ranging from trauma, systemic illnesses, occlusal issues, iatrogenic factors, to mental health problems (6). The most common pathology linked to TMD is the dysfunction of the TMJ and masticatory muscles, often due to abnormal structural relationships within the joint. A common issue is the anterior displacement of the articular disc, leading to a noticeable clicking sound when the disc collides with the condyle during movement (6,7).

TMDs are prevalent, affecting a large portion of the population, with women being significantly more affected than men (8). Women experience TMD at twice the rate of men in the general population, and among patients seeking treatment, the ratio is as much as 4:1. Diagnosing TMD requires a structured approach, as the symptoms overlap with other orofacial pain conditions. Two widely accepted diagnostic frameworks are the Diagnostic Criteria for TMD (DC/TMD) and the classification system by the American Academy of Orofacial Pain (AAOP), both of which categorize TMD based on clinical and imaging findings. The Research Diagnostic Criteria for TMD (RDC/TMD) distinguishes between physical symptoms (Axis I) and psychosocial factors (Axis II) (9). Axis I diagnoses include muscle disorders, such as myofascial pain, and TMJ disorders, such as disc displacement and arthritis. Axis II addresses psychosocial aspects, including chronic pain, depression, and somatization (8).

TMD often follows a chronic or recurrent course, affecting both physical health and mental well-being. While psychological and psychosocial factors are recognized as crucial in understanding TMD, there is less evidence to support them as primary causes. Chronic TMD significantly impacts individuals’ quality of life, especially oral health-related quality of life, which includes physical, psychological, and social aspects of oral health (10).

The primary goals in treating TMDs are to alleviate pain and restore normal jaw function. Evidence shows that conservative treatments, such as the use of occlusal splints, provide significant relief for most TMD patients. Long-term studies suggest that many patients naturally improve over time, indicating that TMD is not a progressive disease but rather a complex condition influenced by multiple factors. Non-surgical treatment of TMD involves a multidisciplinary approach, including various clinical healthcare practitioners working together to address the patient’s needs comprehensively. Although the treatment modalities are discussed individually, optimal results are often achieved when they are combined based on the patient’s specific condition (11).

TMDs affect a significant portion of the population, with a higher prevalence in women compared to men. The condition often presents a complex interaction between physical symptoms and psychosocial factors, complicating diagnosis and treatment. Non-invasive treatment approaches, particularly physiotherapy, are considered the first line of intervention for the majority of patients, with studies suggesting that 85–90% of individuals respond well to conservative therapies (11).

Physiotherapy encompasses a variety of treatment modalities, including dry needling, exercise therapy, manual therapy, and more. The inclusion of techniques such as osteopathic therapy, electrical stimulation, and home exercises further broadens the scope of physiotherapy in TMD management. These interventions not only reduce pain but also enhance muscle strength, improve neuromuscular coordination, and increase the range of motion (ROM) of the TMJ (12). Given that approximately 5% of TMD patients eventually require surgery after exhausting conservative options, the importance of physiotherapy in delaying or avoiding surgical intervention is clear (13). However, despite the proven short-term efficacy of physiotherapy in managing TMD symptoms, there is limited research comparing the long-term effectiveness of physiotherapy. While studies often focus on comparisons within different physiotherapy techniques, there is insufficient investigation into the durability of outcomes, particularly over extended follow-up periods.

This review aims to synthesize various non-invasive physiotherapy treatments for TMDs and assess their effectiveness. It also seeks to identify whether one particular treatment stands out as the most effective. By synthesizing the findings from a range of studies, this review aims to offer a comprehensive perspective on the role of physiotherapy in improving patient outcomes in TMD management, particularly in multidisciplinary treatment settings. I present this article in accordance with the Narrative Review reporting checklist (available at https://joma.amegroups.com/article/view/10.21037/joma-24-28/rc).

Methods

A comprehensive search of PubMed, EMBASE, Cochrane Library, MDPI, Cureus, ScienceDirect, USAP and Google Scholar was conducted to identify relevant studies on physiotherapy in the management of TMDs. Given the limited high-quality publications, the search encompassed articles published between January 1995 and August 2024, including randomized controlled trials, cohort studies, case-control studies, cross-sectional studies, systematic reviews, and case series. Only human studies published in English were included. Non-peer-reviewed articles, opinion pieces, and studies involving surgical or intensive care-based interventions were excluded. Titles and abstracts were screened for clinical relevance, and those that met the criteria were included in the review, although a full critical appraisal of each study was not conducted (Table 1).

Results

The management of TMDs involves a multidisciplinary approach aimed at alleviating pain, improving jaw function, and addressing underlying causes.

A search was conducted in August 2024. A total of 142 studies were found from the search of all databases; duplicate records were excluded, and 52 studies were selected. Thirty-three Studies were excluded as they did not meet the eligibility criteria. The selected studies investigated various physiotherapy approaches for TMD: manual therapy (18 studies), exercise therapy (12 studies), electrotherapy (6 studies), spinal manipulation (4 studies), and multimodal interventions combining multiple therapies (12 studies). The final sample consisted of 19 studies. The findings highlight the effectiveness of physiotherapy in improving pain relief, ROM, and overall jaw function in TMD patients. Physiotherapy plays a vital role in this management by employing techniques designed to reduce muscle tension, enhance joint mobility, and restore functional balance. Common physiotherapy interventions include manual therapy, exercise programs for strengthening and coordination, as well as modalities such as transcutaneous electrical nerve stimulation (TENS) and ultrasound (US). These have been discussed in detail in this review.

Manual therapy for TMDs (Table 2)

Manual therapy is a physiotherapy treatment that primarily focuses on improving the ROM and alleviating pain through various manipulation techniques. This typically includes mandibular manipulation and cervical immobilization and is conducted by a healthcare practitioner, in contrast to exercise therapy, which patients can perform independently at home. Manual therapy and exercise therapy emerged as highly effective approaches, with pain relief ranging from 55% to 75%. Patients undergoing these therapies also exhibited notable improvements in ROM and muscle function. While exercise therapy alone provided significant pain reduction, studies showed that combining it with manual therapy led to enhanced outcomes, further emphasizing the importance of multimodal treatment strategies.

In a study conducted in 2019, patients with a limited mouth opening were evaluated over an 18-week period, focusing on mouth opening and pain. Jaw Manipulation was performed on the subjects, combining several types of manipulation, which are closing-type manipulation with a fulcrum on both sides, side-to-side type, opening-type, closing-type manipulation with a fulcrum on the impaired side. A gauze pivot was placed on the last molar, and these exercises were repeated until a mouth opening greater than 40 mm was achieved, which was quantified as a sufficient mouth opening. The study concluded that while manual therapy had some immediate effects on mouth opening, it was not very effective in alleviating pain or reducing clicking sounds. The authors suggested that manual manipulation techniques should be employed during the first session before considering additional treatment options for patients with limited mouth opening (14,21).

Conversely, a study in 2021 (22) demonstrated significant pain relief when manual therapy was combined with hot compresses (40–50 ℃) and massage of the masseter and temporalis muscles. Although physiotherapy alone did not yield statistically significant results according to 3 studies (15-17). Two studies indicated a significant decrease in joint pain, along with improved functionality and pain sensitivity of the masseter muscles (23,14).

Earlier studies have indicated that manipulation or mobilization techniques applied to the cervical spine positively impact pain intensity in TMD patients (11,15,16,21,22). Cervical manual therapy may enhance the overall effectiveness of manual therapy interventions for TMD or serve as an alternative for patients where direct mandibular manipulation is not feasible.

Cervical therapy involved techniques such as cervical mobilizations and high-velocity manipulations combined with muscle conditioning, while cervico-craniomandibular therapy included TMJ mobilizations along with neuromuscular and nerve tissue techniques, in addition to coordination exercises for the masticatory muscles.

Armijo-Olivo et al. conducted a study showing that cervical manual therapy resulted in a significant reduction in short-term pressure pain threshold (PPT) and a substantial increase in mouth opening, supporting its inclusion in physiotherapy treatment regimens for TMDs. This treatment directly influences somatosensory variables and their effects on orofacial structures due to trigeminal convergence (14).

An extensive study on cervical manual therapy conducted in 2020 (18) explored the functional, anatomical, and neurological connections between the TMJ and the cervical spine. This association can lead to cervicofacial disorders such as neck pain and headaches. The facial and cervical regions share a common intervention, stimulating the central nervous system in response to noxious stimuli. Cervical manual therapy primarily consists of cervical immobilization and is now recognized as a treatment option for TMDs. The effectiveness of upper cervical articular mobilizations in reducing pain and improving mandibular ROM can be attributed to the neuroanatomical connections at the trigeminal-cervical complex, as well as the biomechanical relationships between the cervical and orofacial regions.

It was observed that the combination of manual therapy applied to the cervical and cranio-mandibular areas was more significantly effective than cervical therapy alone in alleviating TMD-associated pain. While mandibular manipulation techniques reported no adverse effects, cervical therapy did show some complications. The study noted three participant dropouts due to increased pain (19), while another study documented two dropouts attributed to headaches and dizziness during the first manipulation session (20).

Mulligans mobilization

Mulligan’s Mobilization with Movement (MWM) for the TMJ is performed by first positioning the patient comfortably in a seated posture. The clinician stands behind the patient, placing their palms on both sides of the patient’s head, with thumbs resting over the zygomatic arches for stabilization. The clinician’s index fingers are positioned parallel and immediately anterior to the posterior border of the mandible, passing over the TMJ, while the third and fourth fingers are placed behind the posterior border of the mandibular ramus, just above the mandibular angle. A transverse force is applied across the mandible as needed, along with an anterior-inferior glide to the restricted side. The unrestricted side is controlled with the opposite hand to prevent excessive forward movement of the mandible (24). This technique ensures the mandible remains in a midline position during mouth opening, thereby enhancing the range of jaw motion. The glide direction is selected based on the patient’s painful movements. For pain-free movements, the glide is repeated three times with 6–8 repetitions. The patient is instructed to apply overpressure using their fingers on their chin during mouth opening, maintaining this pressure for 3 seconds. Following the completion of the TMJ MWM, outcome measures are recorded to assess the effectiveness of the treatment. Throughout the procedure, the patient’s comfort is prioritized, and the technique is adjusted as necessary based on their feedback (25).

In a study, 39 participants were recruited, comprising 12 males and 27 females, with a mean age of nearly 28 years. The results revealed significant improvements in pain levels and maximum mouth opening (MMO) following the intervention. Participants reported a notable reduction in pain, indicating the treatment’s effectiveness in alleviating discomfort. Additionally, improvements in postural alignment and stability were observed, suggesting that the intervention not only addresses pain but also enhances overall posture and functional movement. The study demonstrates significant improvements in pain levels, MMO, and postural alignment following the intervention. The findings indicated that participants experienced a marked reduction in pain, as evidenced by the Numeric Pain Rating Scale and increased mouth opening. Furthermore, improvements in postural sway and alignment, as reflected in the plumb line measurements, suggest enhanced stability and posture. These results highlight the effectiveness of the treatment approach in managing symptoms and improving functional outcomes for participants, underscoring its potential as a valuable intervention in clinical practice. Further research is recommended to explore long-term effects and generalizability across different populations (24).

Exercise therapy

Therapeutic exercises are one of the most effective treatment modalities for managing muscular TMD. Exercises used for the treatment of muscular TMD are intended to reduce pain, improve coordination of masticatory muscles, reduce muscle spasm and hyperactivity, restore the original muscle length, strengthen the muscles involved, and promote tissue repair and regeneration. These exercises include stretching and relaxation, coordination exercises, and strengthening and endurance exercises. The aim of these exercises is to decrease tension of muscle fibres. In addition to limited ROM and pain, TMD also causes incoordination of jaw movements. These exercises also promote coordination of the muscles involved, thereby preventing joint sounds and pain (26).

A randomised controlled trial was conducted to investigate the impact of jaw-opening exercises, with and without pain, on patients with TMDs (27). Both groups showed improvements in pain intensity and mouth-opening range over eight weeks, with the pain group demonstrating significantly greater progress in unassisted mouth opening and pain reduction compared to the no-pain group at later stages.

Postural exercises represent a critical component of therapeutic interventions focused on the orofacial region, designed to mitigate myogenic symptoms including pain, tension, stiffness, and fatigue by optimizing the alignment of the craniofacial complex. This approach encompasses the correction of head and mandibular posture, including tongue positioning exercises, as well as the incorporation of myofascial release techniques (12).

Crăciun et al. evaluated the effectiveness of physiotherapy for TMJ dysfunctions and its relation to the cervical spine. The experimental group receiving both physiotherapy and drug treatment showed significant reductions in pain, muscle spasms, and disability compared to the control group receiving only drug treatment, improving overall quality of life. The study concluded that physiotherapy treatments could maintain the functional state at the temporomandibular and cervical levels (28).

Electrotherapy

The TENS modality is used to relieve pain by delivering low-voltage electrical currents to the affected area. TENS uses a low-voltage electrical current that is designed for sensory counter-stimulation in painful disorders. It is used to decrease muscle pain and hyperactivity and may also be useful in neuromuscular re-education (29). A recent systematic review of 381 randomized controlled trials, involving 24,532 participants, found moderate-certainty evidence that TENS significantly reduces pain intensity during or immediately after treatment compared to sham procedures, without any serious adverse effects, and is effective across various body regions. These modalities should be considered as efficacious therapeutic interventions for the management of TMD-related symptoms (30).

US therapy

US therapy, particularly in the context of treating TMD, has been shown to offer significant benefits, especially in pain reduction and improving joint functionality. US therapy is widely used for temporomandibular joint osteoarthritis (TMJ-OA) and chondrocyte damage in TMD, functioning as a non-invasive option to promote tissue repair (31). At low-intensity levels, US stimulates neovascularization, differentiation of mesenchymal stem cells, and enhances local blood flow through the release of angiogenic factors. These processes are critical in improving the health of ischemic tissues, which are often observed in TMD patients. Research indicates that 4 weeks and 6 months after treatment, patients reported improved pain-free inter-incisal distance (IID), jaw function, and a reduction in symptoms like jaw noise (JN) and disability index (DI). Although the US group showed slight decreases in some outcomes by the 6-month mark, the recurrence rate of TMD symptoms was notably low at 2.63%. This makes US therapy a valuable and effective modality for treating TMD-related pain and dysfunction (5).

Low-intensity pulsed ultrasound (LIPUS) therapy

LIPUS is a specific type of US therapy that operates at a low frequency (1–3 MHz) and intensity of less than 100 mW/cm². Unlike standard US therapy, LIPUS has distinct biological effects due to its mechanical actions combined with weak thermal effects. These effects include promoting bone regeneration, injured tissue repair, and reducing inflammation, which has been widely demonstrated in studies (32,33). Furthermore, LIPUS plays a significant role in chondrocyte restoration in cartilage explants and osteoarthritis, making it particularly useful in addressing TMJ-OA and cartilage damage associated with TMD. The safe and non-invasive nature of LIPUS has led to its recommendation as an effective treatment option for both bone-related and soft tissue injuries in the TMJ, providing substantial benefits without the need for surgical intervention (34).

Heat therapy

Moist heat application techniques are commonly used in physiotherapy for conditions such as TMD. These techniques include towels soaked in hot water, electric heating pads, and hot-water or silica gel packs wrapped in tissues soaked in warm water. When using towels, they can be periodically reheated using hot water or a microwave oven, though electric heating pads provide a more practical solution by maintaining constant heat. Dry heat methods, such as hot-water bags or electric heating pads placed directly on the skin, are also employed (35).

From a thermodynamic perspective, moist heat is considered more effective than dry heat because energy transfer occurs more rapidly in a liquid medium due to the presence of more free molecules, allowing heat to be conducted faster (35). This principle supports the use of moist heat as a superior option for therapeutic purposes, as it facilitates quicker heat diffusion and greater tissue penetration. Several techniques for superficial heat application in the treatment of TMDs were found in the literature. The moist heat was the most widely used technique. Many studies suggested the application of heat for at least 20 minutes once a day. Most authors recommend the application of heat in facial and cervical regions. The heat treatment resulted in significant relief of pain, reduced muscle tension, improved function of the mandible, and increased mouth opening (36,37).

Cryotherapy

Cryotherapy works primarily through analgesic mechanisms, reducing nerve conduction speed and nociceptive signaling while decreasing the release of pain mediators. Additionally, it inhibits inflammatory processes by lowering the metabolism of cells involved in inflammation, which decreases inflammatory mediators and improves blood flow to the affected tissues. Beyond its analgesic effects, cryotherapy can help reduce muscle tension and has antioedematous properties, minimizing hemorrhage tendencies (38). Cryotherapy is often cited as an effective treatment for facial pain; however, there is a lack of robust research supporting its efficacy, and current studies on the subject are limited. This gap may be due to the emergence of more modern pain relief techniques, such as transcutaneous electrical stimulation and ultrasound. The application of cryotherapy typically involves using cold packs for 10 to 15 minutes or vapocoolant sprays for about 10 seconds, repeated 2 to 4 times a day, often before muscle stretching exercises. However, the literature does not reach a consensus on the optimal intensity of the thermal stimulus as compared to heat therapy where it does (39).

Compliance with cryotherapy is generally low among patients. A study comparing compliance across various treatments for TMDs found that thermotherapy, both by addition and subtraction, had the lowest compliance rates. This low adherence is attributed to the specific materials required and the time commitment, which make it less feasible for patients to use regularly. This presents a challenge, as low compliance can negatively impact treatment outcomes. Therefore, it is advisable to offer patients a range of techniques so they can choose one that fits their lifestyle and comfort level (40,41).

It is important to recognize that cryotherapy induces a two-phase vascular reaction to extreme cold, which can affect areas beyond the immediate treatment site due to consensual reflexes. The procedure itself involves applying cold to the targeted area, with the temperature depending on the cryogen used—liquid nitrogen, carbon dioxide, or cooled air. Given that individual factors such as the treatment area, patient physiology, age, and the specific condition being treated can influence the body’s response, cryotherapy should be tailored to each patient. Proper planning regarding the temperature, amount of refrigerant, treatment duration, and target area is essential. Although guidelines exist for cryotherapy parameters across various conditions, evidence suggests that treatment outcomes may correlate with the number of sessions in a treatment series (42).

Complications associated with non-invasive therapies

Complications associated with physiotherapy in the management of TMDs are uncommon but may arise if techniques are improperly applied or not tailored to the patient’s specific condition. Potential complications include increased pain or discomfort, particularly if treatment is overly aggressive, and joint instability resulting from excessive mobilization of the TMJ, which could lead to partial dislocation or subluxation (39). Muscle fatigue, strain, or spasms may occur if strengthening exercises are inappropriately prescribed, exacerbating existing symptoms. Nerve irritation from manual therapy or modalities such as electrical stimulation can lead to temporary tingling or numbness in the TMJ or cervical spine. Tension headaches may also develop due to overworking the masticatory muscles or improper cervical alignment. Patient noncompliance or incorrect execution of home exercises can contribute to symptom exacerbation or a lack of improvement. To mitigate these risks, physiotherapy should be customized to the patient’s condition, with close monitoring to ensure safety and effectiveness throughout the treatment process (19).

Conclusions

In reviewing the various treatment modalities for TMDs, it is evident that each approach—manual therapy, exercise therapy, electrotherapy, heat therapy, and cryotherapy (Table 3)—offers unique benefits, yet no single treatment emerges as definitively superior. Manual therapy improves mouth opening by 4–6 mm, especially when combined with heat. Exercise therapy enhances muscle strength and coordination, reducing pain by 35–50% over 8 weeks. TENS decreases pain by 40–50%, while ultrasound therapy improves joint function and reduces inflammation. Heat therapy provides rapid pain relief with a 50–60% decrease in muscle tension, whereas cryotherapy reduces inflammation but has lower patient adherence.

Future studies should be conducted focus on comparative effectiveness and long-term outcomes across these modalities to better establish a consensus on the optimal treatment strategy for TMD management. Integrating multiple approaches tailored to each patient’s condition ultimately yields the best therapeutic results.

Acknowledgments

The author would like to thank Dr. X and Dr. Y, who assisted in the screening and selection of studies during the systematic review process. Their contributions in reviewing titles, abstracts, and resolving discrepancies were invaluable to the completion of this work.

Footnote

Provenance and Peer Review: This article was commissioned by the Guest Editors (Mythili Kalladka & Ming Xia) for the series “Current Status and Latest Research Progress in the Pain Management of Temporomandibular Disorders (TMDs)” published in Journal of Oral and Maxillofacial Anesthesia. The article has undergone external peer review.

Reporting Checklist: The author has completed the Narrative Review reporting checklist. Available at https://joma.amegroups.com/article/view/10.21037/joma-24-28/rc

Peer Review File: Available at https://joma.amegroups.com/article/view/10.21037/joma-24-28/prf

Funding: None.

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://joma.amegroups.com/article/view/10.21037/joma-24-28/coif). The series “Current Status and Latest Research Progress in the Pain Management of Temporomandibular Disorders (TMDs)” was commissioned by the editorial office without any funding or sponsorship. The author has no other conflicts of interest to declare.

Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Miettinen O, Lahti S, Sipilä K. Psychosocial aspects of temporomandibular disorders and oral health-related quality-of-life. Acta Odontol Scand 2012;70:331-6. [Crossref] [PubMed]
2. Okeson J. Management of Temporomandibular Disorders and Occlusion, 5th Edition - ProQuest. [cited 2024 Sep 21]. New York State Dental Journal 2003;69:61. Available online: https://www.proquest.com/openview/5db8ca57568422e4e2dc9ead7e0a9aee/1?pq-origsite=gscholar&cbl=41679
3. Kobs G, Bernhardt O, Kocher T, et al. Oral parafunctions and positive clinical examination findings. Stomatologija 2005;7:81-3. [PubMed]
4. Wieckiewicz M, Boening K, Wiland P, et al. Reported concepts for the treatment modalities and pain management of temporomandibular disorders. J Headache Pain 2015;16:106. [Crossref] [PubMed]
5. Ba S, Zhou P, Yu M. Ultrasound is Effective to Treat Temporomandibular Joint Disorder. J Pain Res 2021;14:1667-73. [Crossref] [PubMed]
6. González-Sánchez B, García Monterey P, Ramírez-Durán MDV, et al. Temporomandibular Joint Dysfunctions: A Systematic Review of Treatment Approaches. J Clin Med 2023;12:4156. [Crossref] [PubMed]
7. Pasinato F, Souza JA, Corrêa ECR, et al. Temporomandibular disorder and generalized joint hypermobility: application of diagnostic criteria. Braz J Otorhinolaryngol 2011;77:418-25. [Crossref] [PubMed]
8. Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache 2014;28:6-27. [Crossref] [PubMed]
9. Facial Pain | National Institute of Dental and Craniofacial Research. [cited 2024 Sep 21]. Available online: https://www.nidcr.nih.gov/research/data-statistics/facial-pain
10. Ekberg E, Nilsson IM, Michelotti A, et al. Diagnostic criteria for temporomandibular disorders-INfORM recommendations: Comprehensive and short-form adaptations for adolescents. J Oral Rehabil 2023;50:1167-80. [Crossref] [PubMed]
11. Dimitroulis G, Gremillion HA, Dolwick MF, et al. Temporomandibular disorders. 2. Non-surgical treatment. Aust Dent J 1995;40:372-6. [Crossref] [PubMed]
12. Shimada A, Ishigaki S, Matsuka Y, et al. Effects of exercise therapy on painful temporomandibular disorders. J Oral Rehabil 2019;46:475-81. [Crossref] [PubMed]
13. Caring for Individuals with a TMD. In: National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Care Services; et al. editors. Temporomandibular Disorders: Priorities for Research and Care. Washington (DC): National Academies Press (US); 2020.
14. Armijo-Olivo S, Pitance L, Singh V, et al. Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis. Phys Ther 2016;96:9-25. [Crossref] [PubMed]
15. Ismail F, Demling A, Hessling K, et al. Short-term efficacy of physical therapy compared to splint therapy in treatment of arthrogenous TMD. J Oral Rehabil 2007;34:807-13. [Crossref] [PubMed]
16. Haketa T, Kino K, Sugisaki M, et al. Randomized clinical trial of treatment for TMJ disc displacement. J Dent Res 2010;89:1259-63. [Crossref] [PubMed]
17. Craane B, Dijkstra PU, Stappaerts K, et al. Randomized controlled trial on physical therapy for TMJ closed lock. J Dent Res 2012;91:364-9. [Crossref] [PubMed]
18. La Touche R, Martínez García S, Serrano García B, et al. Effect of Manual Therapy and Therapeutic Exercise Applied to the Cervical Region on Pain and Pressure Pain Sensitivity in Patients with Temporomandibular Disorders: A Systematic Review and Meta-analysis. Pain Med 2020;21:2373-84. [Crossref] [PubMed]
19. von Piekartz H, Lüdtke K. Effect of treatment of temporomandibular disorders (TMD) in patients with cervicogenic headache: a single-blind, randomized controlled study. Cranio 2011;29:43-56. [Crossref] [PubMed]
20. Corum M, Basoglu C, Topaloglu M, et al. Spinal high-velocity low-amplitude manipulation with exercise in women with chronic temporomandibular disorders. Manuelle Medizin 2018;56:230-8. [Crossref]
21. Nagata K, Hori S, Mizuhashi R, et al. Efficacy of mandibular manipulation technique for temporomandibular disorders patients with mouth opening limitation: a randomized controlled trial for comparison with improved multimodal therapy. J Prosthodont Res 2019;63:202-9. [Crossref] [PubMed]
22. de Resende CMBM, de Oliveira Medeiros FGL, de Figueiredo Rêgo CR, et al. Short-term effectiveness of conservative therapies in pain, quality of life, and sleep in patients with temporomandibular disorders: A randomized clinical trial. Cranio 2021;39:335-43. [Crossref] [PubMed]
23. Stiesch-Scholz M, Fink M, Tschernitschek H, et al. Medical and physical therapy of temporomandibular joint disk displacement without reduction. Cranio 2002;20:85-90. [Crossref] [PubMed]
24. Sawant R, Heggannavar A, Metgud S, et al. Immediate Effect of Mulligan’s Mobilization with Movement on Forward Head Posture and Postural Sway in Temporomandibular Joint Dysfunction: An Experimental Study. Indian Journal of Physical Therapy and Research 2021;3:107. [Crossref]
25. González-Iglesias J, Cleland JA, Neto F, et al. Mobilization with movement, thoracic spine manipulation, and dry needling for the management of temporomandibular disorder: a prospective case series. Physiother Theory Pract 2013;29:586-95. [Crossref] [PubMed]
26. Moraes Ada R, Sanches ML, Ribeiro EC, et al. Therapeutic exercises for the control of temporomandibular disorders. Dental Press J Orthod 2013;18:134-9. [Crossref] [PubMed]
27. Tobe S, Ishiyama H, Nishiyama A, et al. Effects of Jaw-Opening Exercises with/without Pain for Temporomandibular Disorders: A Pilot Randomized Controlled Trial. Int J Environ Res Public Health 2022;19:16840. [Crossref] [PubMed]
28. Crăciun MD, Geman O, Leuciuc FV, et al. Effectiveness of Physiotherapy in the Treatment of Temporomandibular Joint Dysfunction and the Relationship with Cervical Spine. Biomedicines 2022;10:2962. [Crossref] [PubMed]
29. Teoli D, Dua A, An J. Transcutaneous Electrical Nerve Stimulation. Treasure Island (FL): StatPearls Publishing; 2024.
30. Johnson MI, Paley CA, Jones G, et al. Efficacy and safety of transcutaneous electrical nerve stimulation (TENS) for acute and chronic pain in adults: a systematic review and meta-analysis of 381 studies (the meta-TENS study). BMJ Open 2022;12:e051073. [Crossref] [PubMed]
31. Maranini B, Ciancio G, Mandrioli S, et al. The Role of Ultrasound in Temporomandibular Joint Disorders: An Update and Future Perspectives. Front Med (Lausanne) 2022;9:926573. [Crossref] [PubMed]
32. Qin H, Du L, Luo Z, et al. The therapeutic effects of low-intensity pulsed ultrasound in musculoskeletal soft tissue injuries: Focusing on the molecular mechanism. Front Bioeng Biotechnol 2022;10:1080430. [Crossref] [PubMed]
33. Jiang X, Savchenko O, Li Y, et al. A Review of Low-Intensity Pulsed Ultrasound for Therapeutic Applications. IEEE Trans Biomed Eng 2019;66:2704-18. [Crossref] [PubMed]
34. Yang T, Liang C, Chen L, et al. Low-Intensity Pulsed Ultrasound Alleviates Hypoxia-Induced Chondrocyte Damage in Temporomandibular Disorders by Modulating the Hypoxia-Inducible Factor Pathway. Front Pharmacol 2020;11:689. [Crossref] [PubMed]
35. Furlan RM, Giovanardi RS, Britto AT, et al. The use of superficial heat for treatment of temporomandibular disorders: an integrative review. Codas 2015;27:207-12. [Crossref] [PubMed]
36. Nelson SJ, dos Santos J Jr, Barghi N, et al. Using moist heat to treat acute temporomandibular muscle pain dysfunction. Compendium 1991;12:808-810, 812 passim. [PubMed]
37. Hargreaves AS, Wardle JJ. The use of physiotherapy in the treatment of temporomandibular disorders. Br Dent J 1983;155:121-4. [Crossref] [PubMed]
38. Furlan RMMM. The use of cryotherapy in the treatment of temporomandibular disorders. Rev CEFAC 2015;17:648-55. [Crossref]
39. Wig AD, Aaron LA, Turner JA, et al. Short-term clinical outcomes and patient compliance with temporomandibular disorder treatment recommendations. J Orofac Pain 2004;18:203-13. [PubMed]
40. Furmanek MP, Słomka K, Juras G. The effects of cryotherapy on proprioception system. Biomed Res Int 2014;2014:696397. [Crossref] [PubMed]
41. Lubkowska A, Banfi G, Dołegowska B, et al. Changes in lipid profile in response to three different protocols of whole-body cryostimulation treatments. Cryobiology 2010;61:22-6. [Crossref] [PubMed]
42. Ferreira-Junior JB, Bottaro M, Loenneke JP, et al. Could whole-body cryotherapy (below -100°C) improve muscle recovery from muscle damage? Front Physiol 2014;5:247. [Crossref] [PubMed]