Physiotherapy in the Management of Painful Temporomandibular Disorders: A Critical Narrative Review

Abstract

Painful temporomandibular disorders (TMD) are a common cause of orofacial pain involving the masticatory muscles, temporomandibular joints, or both. Physiotherapy is widely used, but the effectiveness of individual interventions and their added value over active care remain uncertain. This review aimed to critically examine physiotherapy for painful TMD in adults, focusing on clinical presentation, comparative effectiveness and function. Targeted PubMed and Google Scholar searches covered English-language publications since January 2010. Supplementary searches and reference-list screening were also used. Guidelines, systematic reviews, meta-analyses and relevant controlled studies were synthesised narratively. Exercise and selected manual therapy techniques may reduce pain; exercise may also improve maximum mouth opening. However, physiotherapy has not consistently provided additional benefit over education and self-management. Cervical rehabilitation may reduce short-term pain in adults with myogenous TMD, although evidence is heterogeneous and effects on mandibular function remain uncertain. Photobiomodulation and transcutaneous electrical nerve stimulation may provide short-term relief compared with control conditions, although their added benefit over active care remains uncertain. TMD-specific evidence for dry needling is sparse, with broader orofacial-pain evidence of low-to-very-low certainty. Evidence for intra-articular TMD is limited, and consistent additional benefit over education or other conservative care has not been established. Physiotherapy may have a role in conservative management when tailored to clinical diagnosis, symptoms and functional limitations. Evidence is less certain for adjunctive modalities and benefits beyond active care. Further high-quality studies should identify interventions providing clinically meaningful, sustained improvements in specific TMD presentations.