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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).

Head & face medicine
January 1, 1970
Magdalena Gębska et al. (4 authors)
Journal ArticleRandomized Controlled TrialHuman StudyClinical
Study Details

Study Goal

The researchers aimed to evaluate the effectiveness of soft tissue manual therapy (massage) and therapeutic exercises in reducing pain, muscle tension, and improving mandibular mobility in female patients with myofascial pain and restricted mobility.

Results Summary

Massage combined with therapeutic exercises (MTM_TE) showed significant reductions in pain intensity and muscle tension (sEMG activity), with analgesic effects observed after just one treatment. Massage also outperformed post-isometric relaxation (PIR) in improving mandibular mobility and pain relief.

Population

82 women diagnosed with myofascial pain and restricted mobility (DC/TMD Ib disorder).

Effective Dosage

Not specified (therapy administered over 10 days).

Duration

10 days

Interactions

None mentioned

Extracted Claims (16)
InterventionDirectionEndpointPopulationDosageImpactClaim #
massage
decrease
sEMG at rest as well as in exercise
female patients with pain, increased masseter muscle tension and limited mandibular mobility (G1 group)
-
led to a decrease
#1
PIR
decrease
sEMG at rest as well as in exercise
female patients with pain, increased masseter muscle tension and limited mandibular mobility (G1 group)
-
led to a decrease
#2
self-therapy
decrease
sEMG at rest as well as in exercise
female patients with pain, increased masseter muscle tension and limited mandibular mobility (G1 group)
-
led to a decrease
#3
massage, PIR and self-therapy
neutral
-
female patients with pain, increased masseter muscle tension and limited mandibular mobility (G1 group)
p = 0.0001
obtained a significant difference
#4
Each of the proposed forms of therapy
neutral
sEMG parameter at the endpoint
female patients with pain, increased masseter muscle tension and limited mandibular mobility (G1 group)
minimal clinically significant difference (MID)
showed a minimal clinically significant difference (MID)
#5
MTM_TE group therapy
neutral
sEMG parameter at the endpoint
female patients with pain, increased masseter muscle tension and limited mandibular mobility (G1 group)
-
showed the most considerable difference
#6
forms of MT used
decrease
patients' pain intensity
female patients with pain, increased masseter muscle tension and limited mandibular mobility (G1 group)
-
effective in reducing
#7
forms of MT used
neutral
-
female patients with pain, increased masseter muscle tension and limited mandibular mobility (G1 group)
p = 0.0001
significant difference between therapies occurred
#8
self-therapy
decrease
pain intensity
female patients with pain, increased masseter muscle tension and limited mandibular mobility (G1 group)
after 8 treatments
had an analgesic effect
#9
PIR
decrease
pain intensity
female patients with pain, increased masseter muscle tension and limited mandibular mobility (G1 group)
after 3 treatments
had an analgesic effect
#10
massage
decrease
pain intensity
female patients with pain, increased masseter muscle tension and limited mandibular mobility (G1 group)
after 1 treatment
had an analgesic effect
#11
MTM_TE group therapy
neutral
pain intensity on NRS scale
female patients with pain, increased masseter muscle tension and limited mandibular mobility (G1 group)
0.889
mean pain score
#12
TMPIR_TE group therapy
neutral
pain intensity on NRS scale
female patients with pain, increased masseter muscle tension and limited mandibular mobility (G1 group)
3.44
mean pain score
#13
massage
neutral
MMO
female patients with pain, increased masseter muscle tension and limited mandibular mobility (G1 group)
p = 0.0001
significant difference obtained between monotherapy and
#14
PIR
neutral
MMO
female patients with pain, increased masseter muscle tension and limited mandibular mobility (G1 group)
p = 0.0001
significant difference obtained between monotherapy and
#15
massage treatments
neutral
mandibular lateral movements
female patients with pain, increased masseter muscle tension and limited mandibular mobility (G1 group)
-
exceeded the effectiveness of
#16
Abstract

UNLABELLED: 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.

Medical Subject Headings (MeSH)
FemaleHumansMandiblePainTemporomandibular JointTherapy, Soft Tissue
Study Links
Quality Scores
SafetyNot Assessed
Efficacy85/10
Quality80/10
Citation Metrics
Total Citations12
Citations/Year6.0
Relative Citation Ratio7.79
NIH Percentile96.7%
Research Impact Scores
APT Score0.75
Weight Score1.68
Normalized Score0.70
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