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20 November 2022

Effectiveness of physiotherapy in myalgia of the masticatory muscles

Lara Figini

Temporo-mandibular disorders (TMD) are common chronic musculoskeletal pain conditions in which the temporomandibular joint (TMJ), chewing muscles, or both, cause pain and functional limitations of jaw movement. TMDs have a prevalence of 5% –12% and the symptoms and clinical signs are pain, arthralgia, disc displacement with reduction (DDwR), disc displacement without reduction (DDwoR) and degenerative joint disease.  

Physiotherapy should be considered as an initial approach to improve muscle coordination, relax tense muscles, increase muscle strength, and reduce joint and muscle pain, thereby restoring functional jaw movement.  

Pain is the most common and disabling symptom for patients with TMD. Although pain is successfully reduced in the natural course of the disease in most patients, pain persists for a long time in a considerable number of patients. Initial conservative treatments are considered the norm and have priority. First, non-invasive therapies such as counseling, cognitive-behavioral therapy and physiotherapy should be adopted, followed by occlusal plaque therapy and, finally, pharmacological treatment with NSAIDs or corticosteroids.  

Materials and methods

In a study published in the Journal of Oral Rehabilitation in October 2022, the authors investigated the immediate healing effects of physiotherapy in patients with masticatory muscle myalgia.  

Fifty-nine patients with masticatory muscle myalgia were included in the study.  

Physiotherapists performed the treatment based on therapeutic exercises — stretching the painful masseter or cervical muscles along the direction of muscle contraction — in 10 traction cycles, each lasting 10 seconds. The patient's maximum painless distance and degree of mouth opening and pain (VAS value) before and immediately after physiotherapy were compared using the Wilcoxon signed rank test. The Mann-Whitney U test was used for the subgroup.  


Mouth opening was increased from 41 (IQR 38–43) to 46 (IQR 43–48) mm immediately after physiotherapy and pain reduction dropped from 48 (IQR 31–56) to 21 (IQR 10 –56).  

None of the patients experienced exacerbation of pain or reduced mouth opening after physiotherapy. No differences in mouth opening distance were observed based on gender, painful side, painful site and therapist.  

Pain reduction was greater in patients with unilateral pain (26, IQR 12–39) than in those with bilateral pain (13, IQR 5–25) (p = .019). There were no differences in the variation in the degree of pain depending on the sex, the painful site and the therapist (p> .05 for all).  


From the data of this study, exercise therapy immediately enlarged the mouth opening distance and reduced myalgia. The authors said that it therefore could be helpful in managing masticatory muscle myalgia.

Kohei Sakaguchi, Nozomu Taguchi, Rina Kobayashi, Kei Taguchi, Kei Okada, Fumie Kinoshita, Hideharu Hibi. "Immediate curative effects of exercise therapy in patients with myalgia of the masticatory muscles." J Oral Rehabil. 2022 Oct; 49: 937-943. https://doi.org/10.1111/joor.13355

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