Asquini Giacomo, Pisacane Giulia, Maselli Filippo, Mourad Firas, Bizzarri Paolo, Balli Edoardo, Bagnoli Cecilia, Manzari Anna, Pernici Marco, Giusti Andrea, Falla Deborah
Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK.
Department of Human Neurosciences, University of Roma "La Sapienza", Rome, Italy.
J Oral Rehabil. 2025 Sep;52(9):1505-1517. doi: 10.1111/joor.14021. Epub 2025 May 25.
Evidence supports the use of exercise for patients with temporomandibular disorders (TMDs). However, previous studies have mainly focused on combined treatment strategies or undefined exercise modalities.
This systematic review aims to evaluate the effectiveness of Resistance Training (RT) as a standalone treatment for managing pain and improving neuromuscular performance in individuals with TMDs.
This systematic review followed a pre-established and published protocol, which was registered with PROSPERO (CRD42023476269). The literature search was conducted from March 1st 2024 to March 31st 2024 via the following electronic databases: MEDLINE (OVID interface), EMBASE (OVID interface), SCOPUS, Web of Science, PubMed, and Cochrane Central Register of Controlled Trials (CENTRAL). Randomised controlled trials or nonrandomised studies of interventions were included when they compared the effect of RT targeting masticatory muscles on pain, neuromuscular performance, and maximum mouth opening in patients with TMDs versus other treatment modalities. Two independent reviewers screened articles for inclusion, extracted data, assessed the risk of bias using the revised Cochrane risk of bias tool for randomised trials and evaluated the overall quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluations approach.
From an initial 2177 articles, only three met the inclusion criteria and involved 108 participants. All the included studies demonstrated a decrease in pain intensity and an improvement in neuromuscular performance following RT, even if the superiority of RT over other interventions remains uncertain. However, the combination of moderate risk of bias, significant heterogeneity and small sample sizes resulted in a very low quality of evidence.
Clinicians managing patients with TMDs should consider RT as an effective, conservative option in conjunction with other treatment modalities. Future methodologically robust studies with large sample sizes and clearly defined exercise protocols are needed to investigate the role of RT for reducing TMD-related pain by increasing load tolerance and addressing potential bruxism-related muscle overload.
有证据支持运动疗法可用于颞下颌关节紊乱症（TMD）患者。然而，以往的研究主要集中在联合治疗策略或未明确的运动方式上。
本系统评价旨在评估抗阻训练（RT）作为一种独立治疗方法，对TMD患者疼痛管理和神经肌肉功能改善的有效性。
本系统评价遵循预先制定并发表的方案，该方案已在国际前瞻性系统评价注册库（PROSPERO，注册号：CRD42023476269）注册。于2024年3月1日至3月31日通过以下电子数据库进行文献检索：MEDLINE（OVID界面）、EMBASE（OVID界面）、SCOPUS、科学引文索引（Web of Science）、PubMed和Cochrane对照试验中心注册库（CENTRAL）。当比较针对咀嚼肌的RT对TMD患者疼痛、神经肌肉功能和最大开口度的影响与其他治疗方式时，纳入随机对照试验或非随机干预研究。两名独立评审员筛选纳入文章、提取数据，使用修订后的Cochrane随机试验偏倚风险工具评估偏倚风险，并使用推荐分级、评估、制定与评价（GRADE）方法评估证据的总体质量。
从最初的2177篇文章中，仅有3篇符合纳入标准，共涉及108名参与者。所有纳入研究均表明，RT后疼痛强度降低，神经肌肉功能改善，尽管RT相对于其他干预措施的优越性仍不确定。然而，由于偏倚风险为中度、显著异质性和样本量较小，导致证据质量非常低。
治疗TMD患者的临床医生应将RT视为一种有效的保守选择，并结合其他治疗方式。未来需要开展方法学严谨、样本量大且运动方案明确的研究，以探讨RT通过提高负荷耐受性和解决潜在的磨牙症相关肌肉过载来减轻TMD相关疼痛的作用。
