Discussion
TMJ hypomobility, TMD, TMDs, masseter muscle, pain, TMJ, TMJ disorders, muscle pain, mandibular movements
TMJ
This study determined the analgesic and myorelaxant efficacy of MT and self-therapy treatments in female patients with TMDs. The bioelectrical function of the masseter muscles and the evaluation of mandibular movements in patients with and without TMDs were also scrutinized.When analyzing the bioelectrical function of the masseter muscle at rest and exercise, the study’s authors observed a significant difference between the control group and those with TMDs (In the treatment of patients with TMDs, an interdisciplinary treatment team consisting of, among others, an Orofacial Pain-trained dentist/pain physician specializing in TMJ treatment (prosthetics specialist, orthodontist), physiotherapist, psychologist and psychiatrist is key. When prescribing treatment, the first therapy recommended for a patient with pain and impaired joint function is MT combined with self-therapy and supplemented with behavioral therapy. Calixtre et al., in a systematic review of RCTs about studies on the effectiveness of MT in patients with TMDs, indicated that soft tissue therapy treatments applied to the masticatory muscles are even more effective than controls but as effective as botulinum toxin injections [As can be seen from the study, each of the prescribed forms of physiotherapy altered the bioelectrical function of the masseter muscles, the range of mandibular mobility and the intensity of pain. Analyzing the individual parameters studied in relation to the proposed forms of therapy, it can be concluded that there were significant differences between the study groups.Both massage, PIR and self-therapy led to a decrease in bioelectrical signals of the masseter muscle at rest as well as in exercise. When analyzing this parameter, the authors observed that no significant difference was obtained at the first time point between the TMM_TE, PIT_TE, and TE groups (Ariji et al. conducted an ultrasound study of masseter muscle features as an indicator to assess the effectiveness of massage. After the massage, the thickness of the muscle on the symptomatic side decreased significantly, the anechoic areas decreased by 85%, and the pain intensity decreased with it. According to their study, the thickness of the masseter muscle and the presence of anechoic areas may be related to the therapeutic efficacy of muscle pain [We also noticed that the MT forms used effectively reduced the patients’ pain intensity. Notably, a significant difference between the therapies occurred at the second time point (after the 4th treatment). This analgesic effect may occur due to MT pain modulation via activating low-threshold Aβ fibers pathway. This inhibits nociceptive stimuli from Aδ and C supply fibers [When assessing the analgesic effect of MT, the authors observed that, again, the most effective form of pain management was massage combined with autotherapy, which was superior to the other two treatment groups (According to a study by Rodrigez Blanco et al., the PIR technique of the masseter muscle proved to be a more effective method than the tension/counter-tension technique in patients with pain and limited mandibular visitation [As shown in a study by Gomes et al. comparing the therapeutic effect of massage and splinting in an RCT in patients with TMDs, massage therapy on the masticatory muscles and the use of an occlusal splint leads to an increase in mandibular ROM similar to that in an asymptomatic comparison group in relation to maximum active mouth opening and right and left movement in TMD patients [Another parameter assessed in this study was TMJ range of motion, which was significantly different in TMDs patients compared to healthy controls (Statistical analysis showed no significant difference in MMO between the groups at first and second-time endpoints (A study by Toucker et al. on the evaluation of MT and therapeutic exercises showed that, when combined, both forms of therapy yield clinically significant effects on both pain and pain-free maximal mouth opening in TMD patients [Herrera-Valencia et al., in their meta-analysis consisting of six papers on the effectiveness of MT in the treatment of TMDs, found that significant improvements in pain and MMO were observed after manual treatment compared to baseline values. According to their analysis, MT appears to be an effective treatment for TMJ disorders in the mid-term, although the effect seems to diminish over time. However, when combined with therapeutic exercise, these effects may persist for a long time [According to Byra et al., the PT procedure used, including MT and masticatory muscle exercises, improves TMJ range of motion and reduces pain in patients with TMJ hypomobility. Significant improvements in TMJ mobility were achieved, with an average increase of 6.6 mm (The research carried out quite clearly demonstrated the superiority of the synergism of MT methods and therapeutic exercises over monotherapy (self-therapy), at very high significance (