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Myofascial techniques: What are their effects on joint range of motion and pain? A systematic review and meta-analysis of randomised controlled trials

PainSci » bibliography » Webb et al 2016
Tags: massage, TMJ joint, stretch, manual therapy, treatment, exercise, self-treatment, muscle

Three articles on PainSci cite Webb 2016: 1. Massage Therapy for Bruxism, Jaw Clenching, and TMJ Syndrome2. Does Massage Therapy Work?3. The Complete Guide to Trigger Points & Myofascial Pain

PainSci commentary on Webb 2016: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

A review of nine studies of dubious quality of “myofascial technique” — rubbing and stretching basically — for joint pain and stiffness. Although all the studies showed improved range of motion and reduced pain, most clearly for the jaw, the authors of this review think that there are “a number of threats that challenge the statistical inferences underpinning these findings.” Translation: they think the studies they reviewed are of poor quality and that their conclusions cannot be trusted (garbage in, garbage out). Obviously the science is incomplete, but there are some reasons for optimism here (and it’s not exactly a huge claim that some rubbing and stretching might help a painful, stiff joint).

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: This systematic review aimed to determine the evidence for the effect of a single manually applied myofascial technique (MFT) on joint range of motion (JROM) and pain in non-pathological symptomatic subjects.

METHODS: Authors independently searched the following databases: PEDro; Cochrane Library; NLM PubMed; EMBASE; Academic Search Premier; MEDLINE; Psychology and Behavioural Sciences Collection; PsycINFO; SPORTSDiscus; CINAHL Plus from 2003 to 2015. All randomised controlled trials (RCTs) that used JROM as an outcome measure were identified. RCT quality was independently evaluated using PEDro and Cochrane Risk of Bias tools and all reported outcome data were independently abstracted and presented. If post-intervention central tendencies and variance were reported, these were assessed for heterogeneity with a view to performing a meta-analysis.

RESULTS: Nine RCTs (n = 534) were systematically reviewed and outcome data presented; all trials concluded that MFT increased JROM and reduced pain levels in symptomatic patients. Two RCTs (n = 161) were judged 'moderately' heterogeneous (I(2) = 47.2%; Cochran's Q = 5.69; p = 0.128, df = 3) and meta-analysis using a fixed effects model suggested a 'moderate' effect size of MFTs on jaw opening (ES = 0.578; 95%CI 0.302 to 0.853).

CONCLUSION: Although results reported by each RCT indicate that MFT increases JROM and reduces pain scores, there are a number of threats that challenge the statistical inferences underpinning these findings. Only two trials could be meta-analysed, the results of which suggest that applying MFTs to symptomatic patients diagnosed with latent trigger-points in masseter muscle can increase jaw JROM.

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