Evaluation of Short-Term Effectiveness of Orthopedic Manual Therapy in Signs and Symptoms of Myofascial Pain: A Controlled Clinical Trial.

  • Sheilaha Vivanco-Coke Faculty of Dentistry, University of Chile, Santiago, Chile.
  • Antonio Jiménez-Silva Orthodontics and Dentofacial Orthopedics, Faculty of Dentistry, Andrés Bello University, Santiago, Chile.
  • Felipe Rios-Quiñinao Arturo Prat University, Victoria, Chile
  • Raúl Frugone-Zambra Institute of Multidisciplinary Research in Science and Technology, University of La Serena, Chile. Los Andes University, Santiago, Chile.
  • Julio Tobar-Reyes Faculty of Dentistry, University of Chile, Santiago, Chile.


To evaluate the short-term effectiveness of orthopedic manual therapy (OMT) in signs and symptoms of myofascial pain (MFP) in young adults. Materials and Methods: An experimental controlled clinical study was performed in young adults between 19 and 24 years old. Thirty-one patients with MFP according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were divided into two groups. Group A: Orthopedic Manual Therapy (n=16; 10 females, 6 males; 21.6 ± 1.70 years old), and Group B: Control group (n=15; 10 females, 5 males; 20.9 ± 2.00 years old). The participants of group A were treated for a period of 6 weeks; Six therapeutic interventions were performed. Degree of dysfunction (Helkimo index), pain level (VAS scale), and range of mandibular movements (opening and lateral movements) were taken at baseline (T0) and immediately at post-treatment (T1). The data were analyzed with chi-square test and t-test; p<0.05 was considered significant. Result: After the OMT, there were no significant changes in diagnosis of MFP according to RDC/TMD (p=0.41); however, there was a statistically significant improvement in the Helkimo index (p=0.0083) and the level of pain according to the VAS scale (p=0.0004). Mandibular movements did not show significant differences (p>0.05). Conclusion: This study suggested that a 6-week period of OMT treatment has a clinically significant effect in pain level and degree of dysfunction in patients with MFP. A longer follow-up study is required to better assess the effects of manual therapy.


1. RKG de L. Orofacial pain: Guidelines for assessment, diagnosis and management. Hannover Park (IL): Quintessence, Editorial International. 2013.
2. Chisnoiu AM, Picos AM, Popa S, Chisnoiu PD, Lascu L, Picos A, Chisnoiu R. Factors involved in the etiology of temporomandibular disorders - a literature review. Clujul Med. 2015;88:473–8.
3. Melis M, Di Giosia M. The role of genetic factors in the etiology of temporomandibular disorders: a review. Cranio. 2016;34:43–51.
4. Koutris M, Lobbezoo F, Sümer NC, Atiş ES, Türker KS, Naeije M. Is myofascial pain in temporomandibular disorder patients a manifestation of delayed-onset muscle soreness? Clin J Pain. 2013;29:712–6.
5. Michelotti A, Iodice G, Vollaro S, Steenks MH, Farella M. Evaluation of the short-term effectiveness of education versus an occlusal splint for the treatment of myofascial pain of the jaw muscles. J Am Dent Assoc. 2012;143:47–53.
6. Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord. 1992;6:301-55.
7. Peck PC, Goulet JP, Lobbezoo F, Schiffman EL, Alstergren P, Anderson GC, de Leeuw R, Jensen R, Michelotti A, Ohrbach R, Petersson A, List T. Expanding the taxonomy of the diagnostic criteria for temporomandibular disorders. J Oral Rehabil. 2014; 41:2–23.
8. Manfredini D, Guarda-Nardini L, Winocur E, Piccotti F, Ahlberg J, Lobbezoo F. Research diagnostic criteria for temporomandibular disorders: a systematic review of axis I epidemiologic findings. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;112:453–62. 9. Slade GD, Bair E, Greenspan JD, Dubner R, Fillingim RB, Diatchenko L, Maixner W, Knott C, Ohrbach R. Signs and symptoms of first-onset TMD and sociodemographic predictors of its development: the OPPERA prospective cohort study. J Pain. 2013;14(12 Suppl):T20-32-3.
10. Xia P, Wang X, Lin Q, Cheng K, Li X. Effectiveness of ultrasound therapy for myofascial pain syndrome: a systematic review and meta-analysis. J Pain Res. 2017;10:545–55.
11. De la Torre Canales G, Manfredini D, Grillo CM, Guarda-Nardini L, Machado Gonçalves L, Rizzatti Barbosa CM. Therapeutic effectiveness of a combined counseling plus stabilization appliance treatment for myofascial pain of the jaw muscles: A pilot study. CRANIO®. 2017;4;35:180–6.
12. de Leeuw R, Boering G, Stegenga B, de Bont LG. Clinical signs of TMJ osteoarthrosis and internal derangement 30 years after nonsurgical treatment. J Orofac Pain. 1994;8:18–24.
13. Kuzmanovic Pficer J, Dodic S, Lazic V, Trajkovic G, Milic N, Milicic B. Occlusal stabilization splint for patients with temporomandibular disorders: Meta-analysis of short and long term effects. PLoS One. 2017;12:e0171296.
14. Calixtre LB, Moreira RFC, Franchini GH, Alburquerque-Sendín F, Oliveira AB. Manual therapy for the management of pain and limited range of motion in subjects with signs and symptoms of temporomandibular disorder: a systematic review of randomised controlled trials. J Oral Rehabil. 2015; 42:847–61.
15. Pecos-Martin D, Ponce-Castro MJ, Jiménez-Rejano JJ, Nunez-Nagy S, Calvo-Lobo C, Gallego-Izquierdo T. Immediate effects of variable durations of pressure release technique on latent myofascial trigger points of the levator scapulae: a double-blinded randomised clinical trial. Acupunct Med. 2019;37:141–50.

16. Bialosky JE, Bishop MD, Price DD, Robinson ME, George SZ. The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Man Ther. 2009;14:531–8.
17. Simons D, Travell J SL. Dolor y disfunción miofascial. El manual de los puntos gatillo. 2th Ed. Panamericana.
18. Perreault A, Kelln B, Hertel J, Pugh K, Saliba S. Short-Term Effects of Strain Counterstrain in Reducing Pain in Upper Trapezius Tender Points. Athl Train Sport Heal Care. 2009;1:214–21.
19. LH J. Strain and Counterstrain. Am Acad Osteopat. 1981;
20. Begovic H, Zhou G-Q, Schuster S, Zheng Y-P. The neuromotor effects of transverse friction massage. Man Ther. 2016;26:70–6
21. Helkimo M. Studies on function and dysfunction of the masticatory system. 3. Analyses of anamnestic and clinical recordings of dysfunction with the aid of indices. Sven Tandlak Tidskr. 1974;67:165–81.
22. Frugone-Zambra R, Brevis D, Delgado R, Frugone-Zaror C, Gary A, Martinolli M, Bortolini Sergio MD. Essential oils effect (ping-on) on temporalis muscle pain in patients with headaches attributed to temporomandibular disorders. Int J Med Sci Clin Invent. 2018;5:3959–65.
23. Heredia-Rizo AM, Oliva-Pascual-Vaca A, Rodríguez-Blanco C, Piña-Pozo F, Luque-Carrasco A, Herrera-Monge P. Immediate changes in masticatory mechanosensitivity, mouth opening, and head posture after myofascial techniques in pain-free healthy participants: a randomized controlled trial. J Manipulative Physiol Ther. 2013;36:310–8.
24. Gomes CAF de P, Politti F, Andrade DV, de Sousa DFM, Herpich CM, Dibai-Filho AV, de Oliveira Gonzalez T, Biasotto-Gonzalez DA. Effects of massage therapy and occlusal splint therapy on mandibular range of motion in individuals with temporomandibular disorder: a randomized clinical trial. J Manipulative Physiol Ther. 37:164–9.
25. Kalamir A, Bonello R, Graham P, Vitiello AL, Pollard H. Intraoral myofascial therapy for chronic myogenous temporomandibular disorder: a randomized controlled trial. J Manipulative Physiol Ther. 2012;35:26–37.
26. Guarda-Nardini L, Stecco A, Stecco C, Masiero S, Manfredini D. Myofascial pain of the jaw muscles: comparison of short-term effectiveness of botulinum toxin injections and fascial manipulation technique. Cranio. 2012;30:95–102.
27. Majlesi J UH. Effect of treatment on trigger points. Curr Pain Headache Rep. 2010;14:353–60.
28. Desai MJ, Saini VSS. Myofascial pain syndrome: a treatment review. Pain Ther. 2013;2:21–36.
29. Barão VAR, Gallo AKG, Zuim PRJ, Garcia AR, Assunção WG. Effect of occlusal splint treatment on the temperature of different muscles in patients with TMD. J Prosthodont Res. 2011;55:19–23.
30. Mense S. Nociception from skeletal muscle in relation to clinical muscle pain. Pain. 1993;54:241–89.
31. Hou C-R, Tsai L-C, Cheng K-F, Chung K-C, Hong C-Z. Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Arch Phys Med Rehabil. 2002;83:1406–14.
32. Barbero M, Schneebeli A, Koetsier E, Maino P. Myofascial pain syndrome and trigger points: evaluation and treatment in patients with musculoskeletal pain. Curr Opin Support Palliat Care. 2019;13:270–6.
33. Jiménez-Silva A, Peña-Durán C, Tobar-Reyes J, Frugone-Zambra R. Sleep and awake bruxism in adults and its relationship with temporomandibular disorders: A systematic review from 2003 to 2014. Acta Odontol Scand. 2017;75:36–58.
How to Cite
VIVANCO-COKE, Sheilaha et al. Evaluation of Short-Term Effectiveness of Orthopedic Manual Therapy in Signs and Symptoms of Myofascial Pain: A Controlled Clinical Trial.. Journal of Oral Research, [S.l.], v. 9, n. 2, p. 121-128, apr. 2020. ISSN 0719-2479. Available at: <https://joralres.com/index.php/JOR/article/view/joralres.2020.019>. Date accessed: 03 aug. 2021. doi: https://doi.org/10.17126/joralres.2020.019.