Effectiveness of manual therapy, exercise, low-level laser therapy, ultrasound, and transcutaneous electrical nerve stimulation in reducing pain and improving mouth opening in temporomandibular joint disorders: A network meta-analysis of randomized con...

Medicine (Baltimore). 2026 Jun 19;105(25):e49263. doi: 10.1097/MD.0000000000049263.

Effectiveness of manual therapy, exercise, low-level laser therapy, ultrasound, and transcutaneous electrical nerve stimulation in reducing pain and improving mouth opening in temporomandibular joint disorders: A network meta-analysis of randomized controlled trials

ABSTRACT

BACKGROUND: Temporomandibular joint (TMJ) disorders are prevalent musculoskeletal conditions. Common therapies include TMJ manual therapy, TMJ exercise, and modalities such as low-level laser, therapeutic ultrasound, and transcutaneous electrical nerve stimulation (TENS). This study ranked TMJ manual therapy, TMJ exercise, low-level laser therapy, therapeutic ultrasound, and TENS for pain relief and improved maximal mouth opening (MMO) to strengthen evidence for clinical practice.

METHODS: PubMed, Scopus and Ovid MEDLINE were systematically searched from inception to March 2026 for randomized controlled trials evaluating TMJ manual therapy, TMJ exercise, low-level laser therapy, therapeutic ultrasound, and TENS for TMJ disorder. A frequentist network meta-analysis with a random-effects model was performed to compare treatment effects across interventions, with standardized mean differences calculated as the effect size. Treatment rankings were estimated using the surface under the cumulative ranking curve. Publication bias was assessed using funnel plots and Egger test.

RESULTS: This network meta-analysis demonstrated significant pain reduction with therapeutic ultrasound, TMJ manual therapy, TMJ exercise, and low-level laser therapy, and TENS. Therapeutic ultrasound showed the highest probability of providing pain relief, followed by TMJ manual therapy, low-level laser therapy, TMJ exercise, and TENS. For MMO, TMJ manual therapy, low-level laser therapy, therapeutic ultrasound, and TENS showed significant improvements, while TMJ exercise demonstrated a borderline effect. Based on the surface under the cumulative ranking curve rankings, TMJ manual therapy had the highest probability ranking, followed by therapeutic ultrasound.

CONCLUSION: This network meta-analysis suggests that TMJ manual therapy had a higher probability ranking than TMJ exercise for reducing pain and improving MMO. Among physical modalities, therapeutic ultrasound and low-level laser therapy tended to rank higher than TENS. These findings may help inform clinical decision-making in the management of TMJ disorder. Future studies should further investigate the influence of treatment duration and TMJ disorder diagnostic subtypes.

PMID:42332459 | DOI:10.1097/MD.0000000000049263