Effects of manual therapy and splint therapy on patients with temporomandibular disorders: a randomized clinical trial

Myogenic temporomandibular disorders (TMDs) are prevalent and costly conditions; yet, the most effective treatment protocol remains a subject of debate. Although treatments such as splint therapy are frequently used, a recent meta-analysis suggested that insufficient evidence exists to support its efficacy. Conversely, physical therapy, specifically manual therapy for the neck and jaw, shows promising results in managing TMD symptoms.

This study compared the effectiveness of a combined manual therapy and splint protocol against that of splint therapy alone in patients diagnosed with myogenic TMDs.

A randomized clinical trial was conducted with 38 participants (12 men and 26 women, mean age = 42.3 ), who were divided in a control group (splint therapy alone) and an experimental group (splint therapy + manual therapy). The outcome measures included pain intensity according to the numeric pain rating scale and functional indices such as the Fonseca Anamnestic Index, Helkimo Clinical Dysfunction Index, Neck Disability Index, and Headache Impact Test. Assessments were performed before and one month after treatment completion.

Both groups showed improvements in all variables, but the experimental group demonstrated significantly greater improvements across all metrics (p < .001). Large effect sizes were observed for the Fonseca Anamnestic Index, pain intensity, and Neck Disability Index, with a number needed to treat of 1.9.

The addition of manual therapy to splint therapy yielded superior outcomes in terms of pain reduction and functional improvement for patients with myogenic TMDs. These findings suggest that manual therapy should be a primary therapeutic modality alongside splint therapy.