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).
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
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
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 |
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.