Massage Therapy for People with Temporomandibular Disorders

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Massage Therapy for People with Temporomandibular Disorders

Research supports the use of massage therapy as a treatment option for people with jaw pain and temporomandibular disorders.

A Whole Person Approach to Temporomandibular Disorders

Temporomandibular Disorders (TMDs) are a significant source of chronic musculoskeletal pain, affecting a substantial portion of the population, with estimates ranging from 6% to 9% of adults. TMDs encompass a range of conditions causing pain in the jaw, face, and neck, often accompanied by headaches, earaches, and clicking, popping, or crepitus in the temporomandibular joint. Like most musculoskeletal conditions, TMD is influenced by a combination of biological, psychological, social, and environmental factors, and can stem from injuries, overuse, age-related wear and tear, or underlying medical conditions. TMDs can lead to pain, stiffness, weakness, and difficulty with daily activities. Fortunately, various management options are available, including exercise, manual therapy, medication, and lifestyle modifications (Busse et al., 2023; Manfredini et al., 2025).

We often seek a quick fix for musculoskeletal conditions, but these conditions are complex and multifactorial. Pain itself is a multidimensional experience, stemming from a variety of contributing factors.

The Six Pillars of a Massage Treatment Plan

Within a whole person framework for massage therapy there are six components that make up a treatment plan (informed consent and shared decision making, assessment, outcome measurements, education and reassurance, multimodal treatment, ongoing re-evaluation).

Within an evidence-based framework for massage therapy there are six components that make up a treatment plan (informed consent and shared decision making, assessment, outcome measurements, education and reassurance, multimodal treatment, Ongoing reevaluation).

Informed Consent and Shared Decision Making

Informed consent will include a discussion about natural history and the effects of no treatment, as well as the possible risks and benefits of receiving treatment. The therapist and patient will then work together to develop a plan of care based on the individualized goals and needs of the patient. This approach gives people the opportunity to be engaged in their own health through the process of shared decision making.

Assessment

A comprehensive assessment assists the clinician come up with a treatment plan that is best suited to each individual. It may involve a physical assessment and detailed health history intake to gather information about patients' limitations, course of pain and can help identify those with a higher likelihood of red flags (serious underlying pathologies) or yellow flags (prognosis factors for delayed recovery). This may also help establish therapeutic alliance and identify the biological, psychological, social and contextual factors contributing to pain and disability.

  • Red Flags (serious underlying pathologies) - Red flags are signs and symptoms that raise suspicion of serious underlying pathology, if a serious pathology is suspected a clinical decision should be made to refer the patient to an appropriate healthcare practitioner. For the general population there are several red flags to be mindful of such as, substantial motor/sensory loss or progressive neurological deficits, fractures or osteoporosis risk/fragility fracture, acute infection (fever/chills/malaise), joint dislocation, peripheral arterial disease and venous thromboembolism.

  • Yellow Flags (risk factors for delayed recovery) - This assessment process could also include screening questionnaires, such as the Orebro musculoskeletal pain questionnaire or Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) to help identify yellow flags or identify patients at risk of poor prognosis. If the patient develops worsening physical or psychological symptoms consider a referral to counseling or an appropriate healthcare professional for further evaluation.

  • Physical Assessment - A physical assessment could include palpation, observing gait, neurological screening tests, assessing mobility and/or muscle strength. Interpret assessment results in the context of all assessment findings and implement an individualized treatment plan that is based on the assessment findings and goals of the patient.

  • Orthopedic Tests - Clinicians could also incorporate one or more of the following physical assessment tools and interpret assessment results in the context of all other assessment findings.

    • Physiological temporomandibular joint movements

    • Trigger point palpation of the masticatory muscles

    • Trigger point palpation away from the masticatory system

    • Accessory movements

    • Articular palpation

    • Noise detection during movement

    • Manual screening of the cervical spine

    • The Neck Flexor Muscle Endurance Test

Outcome Measurement

Outcome measurements can be used to monitor and evaluate the effectiveness of the treatment plan and adapt care accordingly. This could include incorporating one or more of the following outcome measurements when assessing and monitoring patient progress:

  • Self-Rated Recovery Question

  • Patient-specific Functional Scale

  • Brief Pain Inventory (BPI)

  • Visual Analog Scale (VAS)

  • Numeric Pain Rating Scale (NRS)

  • Jaw Functional Limitation (JFL‐8)

  • Mandibular Function Impairment Questionnaire (MFIQ)

  • Tampa Scale for Kinesiophobia for Temporomandibular disorders (TSK/TMD)

  • Neck Disability Index (NDI)

Education & Reassurance

Focus on the whole person concept of health that addresses biological, psychological, and and social factors and empowers people with shared decision making. This can be used to provide reassurance and facilitate an evidence based understanding of treatment options and encourage the use of healthy coping strategies to help manage symptoms and mental well-being. Reassess the person's status at each visit for new or worsening symptoms, or satisfactory recovery.

Multimodal Treatment

Manual Therapy - Massage therapy is a recommended treatment option for people with temporomandibular Disorder. A recent network meta-analysis of 153 randomized controlled trials (RCTs) found that manual trigger point therapy is one of the most effective treatment options for those with jaw pain and temporomandibular disorders (Busse et al., 2023).

A massage therapy treatment plan should be implemented based on patient-specific assessment findings and patient tolerance. Intra-oral and extra-oral massage can be performed in the clinic or as self-care. Structures to keep in mind while assessing and treating patients suffering from temporomandibular disorders may include neurovascular structures and investing fascia of:

  • Medial Pterygoid

  • Temporalis

  • Masseter

  • Sternocleidomastoid

  • Suprahyoid Muscle Group (digastric, stylohyoid, geniohyoid, and mylohyoid)

  • Infrahyoids Muscle Group (sternohyoid, sternothyroid, thyrohyoid, and omohyoid)

  • Scalene Muscle Group (anterior scalene, middle scalene, and posterior scalene)

  • Upper Cervical Spine (suboccipitals, upper trapezius, splenius cervicis, splenius capitis)

Massage therapy is a clinically-oriented healthcare option that can improve quality of life for patients with a variety of conditions. Acknowledging the multidimensional nature of massage therapy – specific effects, contextual effects, and non-specific effects – paves the way for an evidence-based unified theoretical framework for understanding of how massage therapy works.

Self-Management Strategies - Supported self-management empowers individuals to actively manage their health, often through shared decision-making and skill development to handle symptoms in between visits (Kang et al., 2024). Massage therapists play a dual role: providing hands-on treatment and designing personalized self-management programs. For temporomandibular disorders, simple home-care techniques like self-massage, jaw strengthening and stretching exercises, and specific cranio-cervical and temporomandibular joint exercises have proven beneficial (Busse et al., 2023).

Interdisciplinary Collaboration - A multidisciplinary approach that supports healthy lifestyle factors, such as sleep, stress management, physical activity, and nutrition, can significantly benefit both physical and mental well-being. Massage therapists play a valuable role within this collaborative framework, working alongside medical and allied health professionals.

Ongoing Reevaluation

The therapeutic effects of intra-oral, extra-oral massage, and self-care management of temporomandibular dysfunction has been demonstrated in several randomized control trials and systematic reviews (Arribas-Pascual et al., 2023; Busse et al., 2023). Clinicians should work in partnership with patients to develop a person-centered care plan that considers best available evidence and the patient's goals, values, and preferences. If appropriate, start with multi-modal conservative care (education and reassurance, exercise, manual therapy, hydrotherapy, acupuncture, etc.) and reassess the patient’s status at each visit for new or worsening symptoms, or satisfactory recovery. Then the patient is discharged, treatment is continued, or treatment is escalated based on response to the initial treatment plan, risk/benefit assessment and shared decision making.

The available evidence suggests that the effects of massage Therapy cannot be explained by a single mechanism. Instead, it acts through a complex interplay of interconnected responses. This aligns with the concept of a "whole-person approach," which emphasizes the interconnectedness of biological, psychological, and social factors that contribute to our overall health and well-being.

Key Takeaways

Massage therapy can be used as part of a multidisciplinary approach that supports lifestyle factors (sleep, stress, and physical activity). An integrated multidisciplinary approach can have a positive effect on physical and mental health. Depending on the person’s needs and goals massage therapists are able to incorporate a number of rehabilitation strategies based on patient-specific assessment findings including, but not limited to:

  • Comprehensive assessment and screening for underlying pathologies (red flags & yellow flags)

  • Education and reassurance (person-centered communication, shared decision making, and healthy coping strategies)

  • Manual therapy (soft tissue massage, neural mobilization, joint mobilization)

  • Self-management strategies (mindfulness-based interventions, hydrotherapy, sleep hygiene, and remedial exercise programs incorporating stretching, strengthening, and physical activity)

References and Sources

Whether you're a seasoned massage therapist or a curious newcomer, this massage therapy glossary is here to be your one-stop shop for understanding terms as it relates to massage therapy.

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