What is the Evidence for Physiotherapy in TMJ/TMD Management?

Temporomandibular disorders (TMD) affect up to one in three adults at some point in their lives, according to UK clinical guidance. That is not a niche problem. It is a widespread, often persistent source of pain that interferes with eating, speaking, sleep, and quality of life. When patients ask, “Does physiotherapy actually help my jaw?” they deserve an answer grounded in evidence, not opinion.

This article explores the current evidence for physiotherapy and rehabilitation in the management of temporomandibular joint (TMJ) disorders, drawing on national guidelines, systematic reviews, and UK-based research. I will focus on what works, why it works, and how clinicians can apply this evidence in practice.

Temporomandibular disorders are rarely caused by a single factor. They sit at the intersection of biomechanics, neuromuscular control, pain processing, and behaviour. Muscle overload, joint dysfunction, postural influences, and central sensitisation can all coexist.

This complexity is precisely why physiotherapy and rehabilitation have become central to modern TMJ care. These approaches are designed to address movement, function, and pain together, rather than chasing a single structural cause.

The Comprehensive Guideline for the Management of Painful Temporomandibular Disorder in Adults published by the Royal College of Surgeons of England places conservative care firmly at the forefront of treatment. Physiotherapy is explicitly recommended as part of first-line, non-invasive management before irreversible interventions are considered.

The guideline emphasises education, self-management strategies, and physical interventions aimed at restoring normal movement and reducing pain. Importantly, it highlights the role of structured clinical assessment in guiding care, ensuring that treatment is appropriate and targeted rather than generic.

A major systematic review and meta-analysis titled The effectiveness of physiotherapy in the management of temporomandibular disorders provides strong support for physiotherapy-based interventions. Across multiple trials, physiotherapy was associated with:

Reduced pain intensity

Improved jaw mobility

Enhanced functional outcomes

Better patient-reported quality of life

Manual therapy, therapeutic exercise, and movement re-education showed the most consistent benefits. These are not marginal gains. For many patients, they represent the difference between persistent daily pain and manageable symptoms.

What stands out to me is the consistency of findings across heterogeneous studies. Despite differences in protocols, the overall message remains clear: physiotherapy and rehabilitation work when they are applied thoughtfully and progressively.

The UK-based survey Physiotherapy in the management of disorders of the temporomandibular joint—perceived effectiveness and access to services adds a crucial real-world dimension. Both clinicians and patients reported high perceived effectiveness of physiotherapy interventions for TMJ disorders.

However, access remains uneven. Many patients experience delays or are never referred at all. This gap between evidence and service provision is striking. It suggests that while physiotherapy is valued, it is still underutilised in TMJ care pathways.

In more complex cases, such as TMJ ankylosis, the role of physiotherapy and rehabilitation becomes even more critical. A recent systematic review and meta-analysis on physiotherapy interventions for TMJ ankylosis demonstrates that structured rehabilitation significantly improves mouth opening and functional outcomes, particularly following surgical management.

Early mobilisation, progressive loading, and long-term adherence to exercise programmes were key factors in success. This reinforces an important principle: physiotherapy is not an optional add-on. It is a determinant of outcome.

High-quality physiotherapy for TMJ disorders typically includes:

Clear explanations of pain mechanisms and jaw function. Fear reduction matters more than many realise.

Targeted techniques addressing the TMJ, cervical spine, and associated musculature.

Graduated exercises to improve control, endurance, and range of motion.

Strategies to reduce parafunctional habits and improve movement efficiency during daily tasks.

Crucially, treatment is individualised. A thorough differential diagnosis ensures that non-TMD causes of facial pain are identified and managed appropriately, avoiding unnecessary or ineffective interventions.

TMJ disorders are often frustrating for patients and clinicians alike. They do not respond well to quick fixes. The evidence consistently shows that physiotherapy and rehabilitation provide meaningful, durable improvements when they are delivered as part of a structured, patient-centred approach.

From national guidelines to meta-analyses and UK survey data, the message is aligned. Conservative, movement-based care should not be an afterthought. It should be foundational.

As clinicians, we owe it to our patients to base our recommendations on what works. And right now, the evidence for physiotherapy in TMJ management is both substantial and compelling.