Temporomandibular joint (TMJ) dysfunction encompasses a range of conditions affecting the
jaw joint and surrounding muscles, often resulting in pain, restricted movement, and
functional impairment. Temporomandibular disorder (TMD) can be categorized as
intra-articular, affecting structures within the temporomandibular joint (TMJ), or
extra-articular, involving surrounding muscles and structures. Intra-articular TMD
includes conditions like disc displacement, osteoarthritis, or subluxation, while
extra-articular TMD manifests as muscle pain or dysfunction, such as myofascial pain
syndrome.
Reduced mouth opening or limited mandibular range of motion, is a condition characterized
by restricted movement of the TMJ resulting in diminished ability to open the mouth. It
can arise from various etiologies including trauma, inflammation, muscle dysfunction, or
surgical interventions affecting the masticatory muscles or TMJ. Trismus may manifest
acutely or chronically and can significantly impair oral functions such as eating,
speaking, and oral hygiene maintenance. Assessment typically involves measurement of
maximal inter-incisal opening (MIO) using standardized methods, with normal values
varying depending on age, gender, and population.
The Maximal Mouth Opening (MMO) generalized reference range is from 42 to 60 mm.
Patients diagnosed with myofascial temporomandibular disorder (TMD) commonly present
myofascial trigger points (MTrPs) located in both the neck and masticatory muscles. These
trigger points are believed to be integral to the development and expression of
myofascial TMD symptoms. MTrPs represent hypersensitive sites within taut bands of
skeletal muscle or muscle fascia. Their activation can lead to a range of sensory, motor,
neurological, and autonomic symptoms, contributing significantly to the clinical
presentation of myofascial TMD. Among the various treatment modalities, myofascial
massage therapy and dry needling have gained attention for their potential efficacy in
managing TMJ dysfunction, particularly in addressing the associated muscular component.
Myofascial massage therapy targets the fascia, the connective tissue surrounding muscles,
aiming to release tension, improve blood flow, and restore mobility. Massage therapy can
help break down trigger points through several mechanisms. Firstly, it increases blood
flow to the affected area, which helps deliver oxygen and nutrients while removing waste
products, aiding in tissue repair. It can also disrupt the tight muscle fibers and
release tension, allowing the muscle to relax and the trigger point to dissipate.
Additionally, massage stimulates the nervous system, promoting the release of endorphins
and other natural pain-relieving chemicals, which can help alleviate discomfort
associated with trigger points. Lastly, the pressure and manipulation applied during
massage can physically break down adhesions and knots within the muscle tissue, helping
to release the trigger point.In the context of TMJ dysfunction, myofascial massage may
involve techniques such as effleurage, petrissage, and trigger point therapy to alleviate
muscle tightness, reduce pain, and enhance jaw function.
This approach focuses on manual manipulation of soft tissues to promote relaxation and
alleviate muscular imbalances contributing to TMJ symptoms. Dry needling involves the
insertion of thin needles into trigger points or areas of muscular tension to elicit a
therapeutic response. Unlike acupuncture, which follows traditional Chinese medicine
principles, dry needling targets specific muscular trigger points rather than meridian
pathways.
In the context of TMJ dysfunction, dry needling aims to deactivate hyperirritable trigger
points, reduce muscle tension, and alleviate pain by promoting local blood flow and
releasing endogenous opioids. The recent systematic review emphasized the necessity for
conducting larger trials with a decreased risk of bias to thoroughly evaluate the impact
of dry needling on myofascial temporomandibular disorder (TMD). This recommendation stems
from the observation of both the low quality of evidence and the heightened risk of bias
evident in certain studies included in the review.
While both myofascial massage therapy and dry needling target muscular dysfunction
associated with TMJ disorders, they differ in their mechanisms of action and application.
Myofascial massage therapy relies on manual manipulation techniques to directly address
muscle tension and fascial restrictions, promoting relaxation and improved tissue
mobility. In contrast, dry needling involves the precise insertion of needles into
trigger points to stimulate neuromuscular responses and induce therapeutic effects, such
as pain relief and muscle relaxation. Dry needling is a common intervention in clinical
practice nowadays, but its effectiveness compared to other conservative treatment
modalities, such as manual therapy, remains unclear.
In a 2022 network meta-analysis (NMA), which evaluated the effectiveness of twelve
different treatment modalities for patients with myofascial temporomandibular disorder
(TMD), manual therapy emerged as the most effective treatment option. Nevertheless, the
authors advised a careful interpretation of the findings, citing study limitations and a
paucity of robust evidence.
According to a systematic review published in 2023, it was concluded that no significant
differences in terms of pain reduction was observed between dry needling and manual
therapy in patients with myofascial TMD. High variability was observed in available
literature for methods of application of these interventions.
Despite growing interest in myofascial massage therapy and dry needling for TMJ
dysfunction, there remains a gap in the literature regarding direct comparisons of their
efficacy, safety, and long-term outcomes. While individual studies have investigated the
effects of each modality separately, few studies have directly compared their
effectiveness in improving TMJ symptoms and functional outcomes. Additionally, factors
such as treatment protocols, patient characteristics, and practitioner expertise may
influence treatment outcomes and complicate direct comparisons between myofascial massage
therapy and dry needling.
This lack of comparative randomized clinical trials between dry needling and myofascial
massage therapy limits determine which technique of the two is better. So, the available
literature has only made indirect comparisons and therefore, the current study aims to
find the comparative effectiveness of myofascial massage therapy and dry needling for TMJ
dysfunction. The findings will help inform evidence-based management strategies for TMJ
dysfunction.