The research we rely on
Evidence Library
Every treatment we offer, and the conditions we see, with the published research behind them, graded at its true strength. Each study has a plain-English summary, and a clinician view with the full citation. Where the research does not favour a treatment we use, it is here too.
- Studies
- 87
- Topics
- 15
- Last reviewed
- 28 October 2026
How to read this library
Two questions for every study
How sure is the research?
- Supported by guidelines
Recommended in current clinical guidelines, built on a body of trials.
- Moderate-certainty evidence
Several good-quality studies point the same way; new research could still change the picture.
- Low-certainty or mixed evidence
Some positive results, but studies are small, varied or disagree with each other.
- Early, limited evidence
Very few studies, small pilots or a biological rationale; benefit is not established.
What kind of study is it?
- Clinical guideline
Expert panels weigh all the research and make recommendations.
- Systematic review & meta-analysis
Every relevant trial on a question, found, appraised and pooled.
- Randomised controlled trial
People are allocated to treatments by chance, so the groups can be compared fairly.
- Pilot trial
A small early trial that tests whether a bigger study is worth running.
- Narrative review
An expert summary of the research, without a formal search or pooling.
Higher rungs usually give more reliable answers, but a well-run trial can matter more than a weak review. Summaries here are written only from each study's published abstract and checked a second time against it.
At a glance
The evidence map
Core care
- Jaw exerciseModerate-certainty evidence8 studies
- Manual therapySupported by guidelines7 studies
- Education & self-managementLow-certainty or mixed evidence7 studies
- Stress, habits & pain psychologySupported by guidelines8 studies
- The jaw–neck connectionLow-certainty or mixed evidence6 studies
- MassageLow-certainty or mixed evidence7 studies
Conditions
Foundations
Guidelines & diagnosis
Clinical guidelines and diagnostic criteria that shape how TMD is assessed and managed.
The bottom line
International and UK guidelines support education, self-management, exercises, selected hands-on treatments and cognitive behavioural therapy, a type of talking therapy, for persistent pain linked to temporomandibular disorders (TMD), which affect the jaw joint and surrounding muscles. The international guideline recommends against several treatments, including certain mouth splints, low-level laser therapy and electrical nerve stimulation, with different strengths of recommendation. Standard diagnostic criteria can help identify common painful types of TMD, but are less accurate for some joint disorders. A separate guideline on overgrowth of part of the jaw joint recommends timely diagnosis and mainly surgical treatment, although the supporting research is limited.
At the clinic: Every new patient starts with a full assessment of the jaw, neck and nervous system together, and treatment plans are built on published research, with referral on to dentists, ENT or neurology when another specialist is needed. Technology is used only where the evidence supports it, always inside an assessed plan, and you are told plainly what each option can and cannot do.
Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline
Busse JW et al. · BMJ (Clinical research ed.)
For pain linked to temporomandibular disorders, which affect the jaw joint and surrounding muscles, lasting at least three months, an international guideline strongly recommends cognitive behavioural therapy, a type of talking therapy, selected hands-on treatments, supervised jaw and posture exercises, and usual care such as home exercises, reassurance and education. It makes conditional recommendations against reversible mouth splints, low-level laser therapy and electrical nerve stimulation through the skin, meaning these recommendations are less firm than its strong recommendations.
Management of painful Temporomandibular disorder in adults
Beecroft E et al. · NHS England GIRFT / Royal College of Surgeons of England, Faculty of Dental Surgery
This UK guideline for adults with painful temporomandibular disorders, which affect the jaw joint and surrounding muscles, combines research with expert agreement. It supports education, self-management, exercise, selected hands-on therapies and cognitive behavioural approaches, a form of talking therapy, particularly for pain lasting at least three months. It also explains referral pathways and the roles of primary and specialist care.
Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†
Schiffman E et al. · Journal of oral & facial pain and headache
International experts developed standard criteria for diagnosing temporomandibular disorders, which affect the jaw joint and surrounding muscles. Testing found that the criteria could accurately identify common painful types and one disorder within the jaw joint. Clinicians using the criteria for painful types showed high agreement. Criteria for other common joint disorders were not accurate enough for diagnosis, although they could help with initial screening. The framework also includes questionnaires, with newer ones selected to be shorter and publicly available.
Clinical Practice Guideline: Condylar Hyperplasia of the Mandible—Diagnosis and Treatment
Riechmann M et al. · Deutsches Arzteblatt international
This guideline covers condylar hyperplasia, abnormal growth of the part of the lower jaw that forms the jaw joint. Experts recommend timely diagnosis through a medical history, examination and imaging. Treatment is mainly surgical. Most treatment studies involved small numbers of people and offered low-level evidence.
Recently added (via Consensus)
- González-Sánchez et al. (2023), Journal of Clinical Medicine A review of 15 studies suggested that exercise and hands-on therapy may reduce jaw pain and improve jaw function in people with TMD.
- Armijo-Olivo et al. (2015), Physical Therapy This review found no high-quality evidence for exercise and hands-on therapy for TMD, with no clear evidence that they outperform other conservative treatments.
- Dinsdale et al. (2025), Musculoskeletal science & practice This review suggested that cognitive behavioural therapy, pain education and hands-on therapy may reduce fear of movement and overwhelming worries about pain in adults with TMD.
- Busse et al. (2023), BMJ For TMD pain lasting at least three months, this guideline recommends cognitive behavioural therapy and therapist-assisted jaw movement.
Core care
Jaw exercise
Supervised and home exercise for the jaw muscles and joint.
The bottom line
Research suggests that jaw exercises may help reduce pain and improve mouth opening in people with jaw joint or muscle problems. A large review found moderate-to-high-certainty evidence of pain benefit from supervised jaw exercises and stretching compared with placebo or sham treatment. Other reviews found low-quality or limited evidence, and exercises have not clearly outperformed mouth splints for pain. Findings vary for a jaw that is locked because of a displaced joint disc: one trial found greater improvement in mouth opening with exercises than with a splint, while another found no clear added benefit from physiotherapy alongside advice.
At the clinic: Any jaw exercise programme follows a full assessment of the jaw, neck and nervous system together, with clear goals agreed and reviewed at each visit. You are told plainly what exercise can and cannot do.
Management of chronic pain secondary to temporomandibular disorders: a systematic review and network meta-analysis of randomised trials
Yao L et al. · BMJ (Clinical research ed.)
A large review compared many treatments for long-term jaw pain. Therapist-assisted jaw movement and supervised jaw exercise with stretching were among the treatments that probably helped pain more than placebo, based on moderate-to-high certainty evidence.
Exercise therapy improves pain and mouth opening in temporomandibular disorders: A systematic review with meta-analysis
Idáñez-Robles AM et al. · Clinical rehabilitation
This review pooled 16 randomised trials, meaning studies where people were allocated to groups by chance. It found that exercise therapy reduced jaw pain and improved mouth opening, including when exercise was added to a splint.
Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis
Armijo-Olivo S et al. · Physical therapy
This review of 48 trials of hands-on treatment and exercise for jaw problems rated the evidence as low quality. It found no clear evidence that exercise was better than other non-surgical treatments. Problems with study quality and differences between studies leave considerable uncertainty about the benefits.
Effectiveness of exercise therapy versus occlusal splint therapy for the treatment of painful temporomandibular disorders: a systematic review and meta-analysis
Zhang L et al. · Annals of palliative medicine
This review compared jaw exercises with mouth splints for painful jaw problems across six trials. Neither treatment was clearly better for pain or jaw movement. The authors noted the evidence was limited.
Randomized controlled trial on physical therapy for TMJ closed lock
Craane B et al. · Journal of dental research
This trial involved 49 people with a jaw joint disc that had moved out of place and did not return during opening, causing a closed lock. Adding physiotherapy sessions to advice about jaw habits did not show a clear additional benefit for pain or jaw function over one year. Both groups improved over time.
Randomized clinical trial of treatment for TMJ disc displacement
Haketa T et al. · Journal of dental research
In this trial, 52 people with a jaw joint disc that had moved out of place and did not return during opening were allocated by chance to a mouth splint or jaw-movement exercises they performed themselves. Both groups improved over 8 weeks. Mouth opening improved more with exercise, suggesting a possible advantage for this aspect of jaw function.
Comparison of NSAID therapy alone versus combined NSAID and home exercise therapy in patients with temporomandibular joint osteoarthritis and arthralgia
Erdogan O et al. · Cranio : the journal of craniomandibular practice
In people with jaw joint arthritis and joint pain, adding home exercises to anti-inflammatory tablets improved mouth opening and quality of life more than tablets alone. Pain eased similarly in both groups.
Effectiveness of Ultrasound Therapy, TheraBite Device, Masticatory Muscle Exercises, and Stabilization Splint for the Treatment of Masticatory Myofascial Pain: A Randomized Controlled Trial
Salloum K et al. · Clinical and experimental dental research
This trial allocated 80 adults by chance to jaw muscle exercises, ultrasound treatment, a mouth splint or a jaw-stretching device for persistent jaw muscle pain with limited opening. At four weeks, pain was lower with ultrasound and splints than with exercises. The researchers reported similar effectiveness across the four treatments at five months, although this does not establish that they work equally well.
Core care
Manual therapy
Hands-on joint mobilisation and soft-tissue techniques for the jaw and neck.
The bottom line
Research here mainly concerns jaw pain. An international guideline strongly recommends assisted joint movements and hands-on treatment of tender muscle points for jaw pain lasting at least three months. A large analysis of trials found that these approaches probably improve pain compared with dummy treatments. Other reviews report short-term improvements but highlight weaknesses in the research. In one trial of people with a locked jaw, physiotherapy showed no clear extra benefit over advice. For neck and upper back muscle pain, a review found no clear difference between hands-on treatment and dry needling. Results depend on the condition, treatment and outcome studied.
At the clinic: Every new patient has a full assessment of the jaw, neck and nervous system together, and any hands-on treatment forms part of a plan built on published research. You are told plainly what it can and cannot do, and clear goals are agreed and reviewed at each visit.
Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline
Busse JW et al. · BMJ (Clinical research ed.)
An international guideline on jaw pain lasting at least three months strongly recommends therapist-assisted joint movements and hands-on treatment of tender muscle points compared with dummy treatments. It gives a weaker, conditional recommendation for manipulation, another hands-on joint technique. It also conditionally recommends against several treatments, including low-level laser therapy and removable bite splints.
Management of chronic pain secondary to temporomandibular disorders: a systematic review and network meta-analysis of randomised trials
Yao L et al. · BMJ (Clinical research ed.)
This analysis included 153 trials involving 8713 people with long-standing jaw pain. Participants were allocated to treatments by chance. Therapist-assisted jaw movements and hands-on treatment of tender muscle points probably improved pain compared with dummy treatments.
Effectiveness of physiotherapy for temporomandibular disorders: a systematic review of pain and functional outcomes
Skorupa-Strojna A et al. · Scandinavian journal of pain
This review of 51 recent trials found that physiotherapy, including manual therapy, was generally linked with less pain and better jaw movement in the short term. The studies were varied and often small, which limits how firmly conclusions can be drawn.
Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis
Armijo-Olivo S et al. · Physical therapy
This review of 48 trials found that manual therapy for the jaw or neck, alone or with exercise, showed promising effects. However, no high-quality evidence was found, so there is considerable uncertainty about how well it works.
Randomized controlled trial on physical therapy for TMJ closed lock
Craane B et al. · Journal of dental research
People with a 'locked' jaw were allocated by chance to physiotherapy (joint mobilisation, exercises and massage) or advice alone. Both groups improved over a year, and physiotherapy added no clear extra benefit.
Effectiveness of an 8-week neck exercise training on pain, jaw function, and oral health-related quality of life in women with chronic temporomandibular disorders: a randomized controlled trial
de Oliveira-Souza AIS et al. · Journal of oral & facial pain and headache
In this trial, 54 women with jaw disorders involving muscle pain were allocated by chance to eight weeks of neck exercises, manual therapy or a dummy treatment. Neck exercises improved the effect of oral health on daily life more than manual therapy at the end of treatment and three months later. Results comparing manual therapy with the dummy treatment were not reported.
Comparison of dry needling and trigger point manual therapy in patients with neck and upper back myofascial pain syndrome: a systematic review and meta-analysis
Lew J et al. · The Journal of manual & manipulative therapy
This review compared dry needling, which uses fine needles in muscles, with hands-on treatment of tender muscle points for neck and upper back muscle pain. Both treatments were associated with improvements in pain and function in the short to medium term. No clear difference was found between them, but that does not establish that they work equally well.
Core care
Education & self-management
Understanding the condition, jaw-friendly habits and self-care between visits.
The bottom line
Education, support with changing habits and jaw exercises may help people with jaw pain, but the evidence is mixed. Some reviews found benefits, while others found insufficient evidence to judge whether self-management helps more than other treatments. Counselling may reduce muscle-related jaw pain, and one review found similar improvements in tenderness and mouth opening with counselling and mouth splints. Some studies found no clear extra benefit from adding other treatments. The effects on quality of life and unwanted effects remain insufficiently studied.
At the clinic: Treatment plans at the clinic are built on published research, and you are told plainly what each option, including self-care, can and cannot do. Clear goals are agreed and reviewed at each visit.
Self-Management Therapies for Temporomandibular Disorders-Evidence From Systematic Reviews
Bijelic T et al. · Journal of oral rehabilitation
This review of earlier reviews looked at self-management for jaw pain. It found the research generally suggests benefit from education, habit change and jaw exercises. However, nearly half the reviews said the evidence was not yet strong enough to be sure.
Effectiveness of occlusal splint therapy in the management of temporomandibular disorders: network meta-analysis of randomized controlled trials
Al-Moraissi EA et al. · International journal of oral and maxillofacial surgery
This review combined 48 studies in which people were allocated to treatments by chance. It compared different mouth splints and counselling. For muscle-related jaw pain, moderate-quality evidence suggested that counselling alone, or counselling combined with a hard splint, may reduce pain after treatment compared with a control group. What the control group received was not reported.
Counselling and self-management therapies for temporomandibular disorders: a systematic review
de Freitas RF et al. · Journal of oral rehabilitation
This review of seven randomised studies (where people are allocated to treatments by chance) found counselling and self-care helped jaw muscle tenderness and mouth opening. Results were similar to those seen with mouth splints.
Self-management in temporomandibular disorders: a systematic review of behavioural components
Story WP et al. · Journal of oral rehabilitation
This review looked at the techniques used to support behaviour change in self-management programmes for jaw problems. Across the programmes, a small proportion of the available techniques were used. The authors said more studies are needed to establish whether these programmes work better than no treatment or a placebo, meaning a dummy treatment.
Headache Attributed to Masticatory Myofascial Pain: Clinical Features and Management Outcomes
Costa YM et al. · Journal of oral & facial pain and headache
People with jaw muscle pain and headaches received either advice on changing habits, or the same advice plus a mouth splint. Headaches became less intense and less frequent in both groups, with no clear difference between them.
Randomized controlled trial on physical therapy for TMJ closed lock
Craane B et al. · Journal of dental research
In this study of 49 people with a locked jaw, everyone received detailed advice about avoiding certain jaw and mouth habits. Twenty-three people also received physiotherapy. Pain and jaw function improved in both groups over a year, with no clear extra benefit from physiotherapy. Because everyone received advice, the study could not establish how much the advice itself helped.
Additional effects of therapeutic exercise and education on manual therapy for chronic temporomandibular disorders treatment: a randomized clinical trial
Justribó-Manion C et al. · Physiotherapy theory and practice
In a small study of 34 people with long-standing jaw problems, adding education about pain and exercises to hands-on treatment did not clearly improve jaw- and face-related disability more than hands-on treatment alone. The authors reported possible benefits for fear of movement and distressing thoughts about pain, but differences between the groups were uncertain.
Core care
Stress, habits & pain psychology
Cognitive behavioural approaches, relaxation and biofeedback for persistent jaw pain.
The bottom line
An international guideline strongly recommends cognitive behavioural therapy (CBT), a talking-and-skills approach, with or without relaxation or biofeedback for jaw pain lasting three months or more. It conditionally recommends against relaxation or biofeedback used alone. Research findings vary: one review found evidence of pain relief with CBT, while a Cochrane review found low- to very low-certainty evidence and no clear pain benefit at treatment completion. Small studies suggest behaviour-based approaches may help daytime clenching habits, but pain benefits remain uncertain. For night-time grinding, the benefits of CBT are not well supported.
At the clinic: Every new patient starts with a full assessment of the jaw, neck and nervous system together, and treatment plans are built on published research, with patients told plainly what each option can and cannot do. When something needs another specialist, Krina refers on to dentists, ENT or neurology.
Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline
Busse JW et al. · BMJ (Clinical research ed.)
An international guideline for jaw pain lasting three months or more strongly recommends cognitive behavioural therapy (CBT), a talking-and-skills approach, with or without relaxation or biofeedback. Its recommendations against using relaxation or biofeedback alone are conditional rather than firm rules.
Management of chronic pain secondary to temporomandibular disorders: a systematic review and network meta-analysis of randomised trials
Yao L et al. · BMJ (Clinical research ed.)
This review examined treatments for long-lasting jaw pain. Its combined analysis included 153 trials involving 8,713 people, who were allocated to treatments by chance. Cognitive behavioural therapy (CBT), a talking-and-skills approach, combined with biofeedback or relaxation probably improved pain compared with dummy treatment. CBT alone also showed a pain benefit, with a smaller estimated effect. The evidence for these pain findings was rated high to moderate certainty.
Psychological therapies for temporomandibular disorders (TMDs)
Penlington C et al. · The Cochrane database of systematic reviews
This review examined psychological therapies for painful jaw problems lasting three months or more. Most studies assessed cognitive behavioural therapy (CBT), a talking-and-skills approach. At the end of treatment, there was no clear evidence that CBT reduced pain more than comparison care or other treatments. The studies had important weaknesses, and the evidence was rated low to very low certainty, so further research may change the findings.
Psychological treatments for temporomandibular disorder pain-A systematic review
Christidis N et al. · Journal of oral rehabilitation
This review suggests psychological treatments may reduce jaw pain to a similar extent as standard care. Combining psychological treatment with standard care may offer additional pain relief, but the supporting evidence was rated very low quality.
Management of awake bruxism: a systematic review
Graham DA et al. · BMC oral health
This review examined ways to manage daytime clenching and related jaw habits. It included nine studies involving 165 people, mostly testing behaviour-based approaches. These generally suggested that biofeedback, methods for changing habits, reminder prompts and counselling with self-management may help, but the evidence was limited and study quality varied.
Comparing botulinum toxin and biofeedback therapies for awake bruxism: a randomized clinical trial
Foscaldo TF et al. · BMC oral health
In this small trial, 40 adults with jaw disorders and daytime clenching were allocated by chance to biofeedback, which uses muscle-activity measurements as feedback, or botulinum toxin injections. Some clenching-related behaviours decreased in the biofeedback group compared with its starting measurements. However, neither treatment improved pain or psychological symptoms, and no clear differences were detected between the treatments.
Managements of sleep bruxism in adult: A systematic review
Minakuchi H et al. · The Japanese dental science review
This review of treatments for night-time grinding found that the benefits of cognitive behavioural therapy were not well supported. Biofeedback reduced some measures of grinding, but larger, better-quality studies are needed.
The relationship between psychological factors and temporomandibular disorders: a systematic review and meta-analysis
Saini RS et al. · Head & face medicine
This review of 21 studies found links between jaw disorders and anxiety, depression and stress. These findings do not establish that psychological factors cause jaw disorders or that treating them will reduce jaw pain.
Core care
The jaw–neck connection
How the neck relates to jaw pain, and treatment directed at the cervical spine.
The bottom line
Research links jaw problems with reduced neck movement, neck muscles that tire sooner and greater difficulty because of neck symptoms. Some evidence suggests that hands-on neck treatment or neck exercises may reduce jaw pain. Combining jaw and neck treatment may offer additional short-term benefit, but that evidence is less certain. Physiotherapy may also slightly reduce associated headache pain, although certainty is low to very low. These findings do not establish that neck problems cause jaw pain or that everyone will benefit from neck treatment.
At the clinic: Every new patient starts with a full assessment of the jaw, neck and nervous system together, not the jaw in isolation. Treatment plans are built on published research, and you are told plainly what each option can and cannot do.
Effect of Manual Therapy and Therapeutic Exercise Applied to the Cervical Region on Pain and Pressure Pain Sensitivity in Patients with Temporomandibular Disorders: A Systematic Review and Meta-analysis
La Touche R et al. · Pain medicine (Malden, Mass.)
This review pooled trials of hands-on neck treatment in people with jaw problems. There was moderate-certainty evidence that neck treatment reduced pain more than placebo hands-on treatment or minimal treatment. Combining treatment of the jaw and neck may offer greater short-term pain relief and help people open their mouth further without pain, but this evidence was low certainty.
Cervical musculoskeletal disorders in patients with temporomandibular dysfunction: A systematic review and meta-analysis
de Oliveira-Souza AIS et al. · Journal of bodywork and movement therapies
This review compared people with and without jaw problems. Those with jaw problems tended to have weaker neck muscle endurance, stiffer neck movement and more neck-related disability. Their head and neck posture, however, was similar to that of people without jaw problems.
Effectiveness of an 8-week neck exercise training on pain, jaw function, and oral health-related quality of life in women with chronic temporomandibular disorders: a randomized controlled trial
de Oliveira-Souza AIS et al. · Journal of oral & facial pain and headache
In this trial, 54 women with jaw problems were allocated by chance to an 8-week neck exercise programme, hands-on therapy or a placebo treatment. The neck exercise group had better pain and jaw function results than the placebo group at the end of treatment and at one- and three-month follow-up.
Dry needling and upper cervical spinal manipulation in patients with temporomandibular disorder: A multi-center randomized clinical trial
Dunning J et al. · Cranio : the journal of craniomandibular practice
This trial allocated 120 people with jaw problems by chance to either dry needling, which uses fine needles, combined with hands-on upper-neck manipulation, or a mouth splint, an anti-inflammatory medicine and hands-on jaw joint treatment. The needling-and-neck group had a greater reduction in jaw pain at three months. The reported mouth-opening result describes a reduction rather than an increase in pain-free opening, so it does not clearly support an improvement in this outcome. The trial cannot show how much of the pain benefit came from the neck treatment itself.
Effects of physical therapy for temporomandibular disorders on headache pain intensity: A systematic review
van der Meer HA et al. · Musculoskeletal science & practice
This review examined whether physiotherapy for jaw problems, including hands-on treatment of the jaw and neck, may reduce associated headache pain. It found a small reduction, but certainty was low to very low. Many studies were of poor quality and the treatments varied considerably, so the benefit remains uncertain.
Association Between Subjective Tinnitus and Cervical Spine or Temporomandibular Disorders: A Systematic Review
Bousema EJ et al. · Trends in hearing
This review looked at links between ringing in the ears (tinnitus), neck problems and jaw problems. People with tinnitus reported neck problems more often, and tinnitus and jaw problems were linked in both directions. The evidence was weak.
Conditions
Headache & migraine
Physiotherapy, manual therapy and exercise for tension-type, cervicogenic and migraine headache.
The bottom line
Hands-on treatment may help some people with tension-type headache or headache that starts in the neck (cervicogenic headache). For neck-related headache, combining treatments, including hands-on treatment and exercise, may improve short-term outcomes. Exercise may also help with migraine, while findings for hands-on treatment vary by the outcome measured. Several reviews report low or very low confidence in the evidence, so these findings remain uncertain.
At the clinic: Every new patient has a full assessment of the jaw, neck and nervous system together, and any tools such as dry needling are used only where the evidence supports them, inside an assessed plan. Krina refers on to neurology when a headache needs another specialist's input.
Manual physical therapy for neck disorders: an umbrella review
Reynolds B et al. · The Journal of manual & manipulative therapy
This review brought together 35 earlier reviews of hands-on treatment for neck problems. For headache that starts in the neck, the authors found good support for neck mobilisation, soft tissue work, and hands-on treatment combined with exercise.
The Comparative Efficacy of Treatments for Cervicogenic Headache: A Systematic Review and Network Meta-Analysis of Randomised Controlled Trials
Koonalinthip N et al. · European journal of pain (London, England)
This review included 41 trials involving 1,922 adults with headache that starts in the neck. Participants were allocated to treatment groups by chance. Combined treatments appeared more effective in the short term than single treatments or medicines. Hands-on treatment combined with dry needling, a needle-based treatment, showed favourable results for headache intensity and frequency. The certainty of the evidence was not reported.
Physical Therapist Interventions to Reduce Headache Intensity, Frequency, and Duration in Patients With Cervicogenic Headache: A Systematic Review and Network Meta-Analysis
Jung A et al. · Physical therapy
This review looked at physiotherapy treatments for adults with headache that starts in the neck. Some combined treatments, including hands-on treatment with exercise, may reduce headache intensity or frequency in the short term compared with control treatments. Confidence in the evidence was low, so firm treatment recommendations could not be made.
Myofascial Release for the Treatment of Tension-Type, Cervicogenic Headache or Migraine: A Systematic Review and Meta-Analysis
Lu Z et al. · Pain research & management
This review looked at myofascial release, a type of hands-on treatment. It may reduce pain and the impact of tension-type and neck-related headaches on daily activities. For migraine, pain results favoured treatment, but effects on daily activities were uncertain. Evidence quality was moderate for effects on daily activities in tension-type and neck-related headache, and low or very low for other findings.
Efficacy and optimal dosage of various exercises for migraine: a multilevel network and dose-response meta-analysis
Xie J et al. · PeerJ
This review compared different types of exercise for migraine. Combined aerobic and strength exercise, strength exercise, yoga and tai chi all looked promising, but the evidence was of low quality, so the findings are uncertain.
Manual Therapy and Quality of Life in People with Headache: Systematic Review and Meta-analysis of Randomized Controlled Trials
Falsiroli Maistrello L et al. · Current pain and headache reports
This review asked whether hands-on treatment improves quality of life in people with headache. Results favoured treatment for tension-type headache and migraine but were inconsistent for neck-related headache, and the evidence was very low-certainty.
Manual therapy in adults with tension-type headache: A systematic review
Cumplido-Trasmonte C et al. · Neurologia
This review included 10 trials in which adults with tension-type headache were allocated to treatment groups by chance. It reported improvements with hands-on treatment in pain, headache frequency and daily life. The review did not establish that one technique was more effective than another, although combining techniques appeared promising. The certainty of the evidence was not reported.
Effectiveness of dry needling for headache: A systematic review
Vázquez-Justes D et al. · Neurologia
This review included eight trials involving 577 people with several headache types. It examined dry needling, a needle-based treatment. The review reported improvements in function and symptoms, but effectiveness was similar to that of the other treatments studied. Study quality varied.
Conditions
Somatic tinnitus
Tinnitus influenced by the jaw or neck, and physiotherapy-based treatment.
The bottom line
Signals from the jaw or neck can influence some people's tinnitus. This is called somatic or somatosensory tinnitus. Research involving people allocated to treatment groups by chance suggests that jaw-focused physiotherapy may reduce tinnitus severity in people with jaw-related tinnitus. Adding hands-on jaw and neck treatment to exercises and advice may also help. These findings do not establish how well treatment works for tinnitus linked to neck problems alone. A review reports that improvement generally means reduced severity or loudness, with complete disappearance being rare.
At the clinic: If your tinnitus seems linked to your jaw or neck, your first visit includes a full assessment of the jaw, neck and nervous system together. You will be told plainly what treatment can and cannot do, and you will be referred on to ENT or neurology when something needs another specialist.
Effects of Cervico-Mandibular Manual Therapy in Patients with Temporomandibular Pain Disorders and Associated Somatic Tinnitus: A Randomized Clinical Trial
Delgado de la Serna P et al. · Pain medicine (Malden, Mass.)
People with jaw-related tinnitus were allocated to two treatment groups by chance. Both groups received exercises, self-massage and advice. The group that also received hands-on jaw and neck treatment had greater improvements in tinnitus severity and jaw pain. Assessments continued for six months after treatment, although separate results for each follow-up were not reported.
Reduction of Somatic Tinnitus Severity is Mediated by Improvement of Temporomandibular Disorders
van der Wal A et al. · Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
People with moderate to severe jaw-related tinnitus were randomly given either jaw-focused physiotherapy, with splints if needed, or basic advice only. Tinnitus severity improved more with treatment, and about a third of that improvement was linked to reduced jaw pain.
Somatosensory Tinnitus: Recent Developments in Diagnosis and Treatment
Michiels S · Journal of the Association for Research in Otolaryngology : JARO
This review describes how jaw- and neck-related tinnitus can be identified and treated. It reports that physiotherapy combining advice, exercises and hands-on techniques often lowers tinnitus severity. Complete disappearance of the tinnitus is rare.
Cervicogenic Somatic Tinnitus: A Narrative Review Exploring Non-otologic Causes
Wadhwa S et al. · Cureus
This review looks at tinnitus linked to neck problems such as whiplash, neck strain or wear and tear. It describes physiotherapy among several treatment options. It suggests that newer therapies show promise but are still being explored.
Maladaptive plasticity in tinnitus--triggers, mechanisms and treatment
Shore SE et al. · Nature reviews. Neurology
This review explains how tinnitus may arise from changes in the brain's hearing pathways. It notes that head or neck injuries can trigger tinnitus or change its loudness, because signals from the body can affect how sound is processed.
Advances in Understanding, Diagnosis, and Treatment of Tinnitus
Tang D et al. · Advances in experimental medicine and biology
This general review of tinnitus lists head or neck injury among its risk factors. It discusses several treatment approaches and reports that cognitive behavioural therapy, a talking therapy, improved tinnitus in a large trial in which people were allocated to groups by chance. It does not report findings about physiotherapy for somatic tinnitus.
Conditions
Clenching & grinding (bruxism)
What is known about managing awake and sleep bruxism.
The bottom line
Research on treatments for clenching and grinding gives mixed results. Splints worn over the teeth, devices that give feedback about clenching, some medicines and botulinum toxin injections may help with particular symptoms or measures of grinding. However, weaknesses in the research limit confidence in these findings, and side effects have been reported. There is not enough evidence to say whether splints help more than no treatment or other approaches. Daytime clenching and grinding appear common, particularly in adults with jaw disorders, but research on how common they are does not establish which treatment helps.
At the clinic: At the clinic, clenching and grinding are assessed as part of a full assessment of the jaw, neck and nervous system together, and you are told plainly what each option can and cannot do. Krina refers on to dentists or other specialists when something needs another specialist.
Managements of sleep bruxism in adult: A systematic review
Minakuchi H et al. · The Japanese dental science review
This review looked at ways of managing night-time clenching and grinding in adults. Splints worn over the teeth tended to reduce grinding events, but there was no clear difference compared with other types of splint. Devices that give feedback about clenching, some medicines and botulinum toxin injections showed improvements in particular measurements, although side effects were reported. Evidence for cognitive behavioural therapy, which focuses on thoughts and behaviours, was not convincing. More rigorous, longer-term studies are needed.
Bruxism treatment outcomes: A systematic review and meta-analysis
Assiri HA et al. · Medicine
This review of 22 studies examined treatments for clenching and grinding. Splints worn over the teeth were reported to help with symptoms, although their effects varied with design and material. Botulinum toxin injections and devices that give feedback about clenching were also studied. The authors suggested that combining approaches may help, but longer-term, more rigorous studies are needed to assess lasting effects.
Botulinum Toxin for Bruxism: An Overview
Coelho MS et al. · Toxins
This study pulled together 14 earlier reviews of botulinum toxin injections for grinding. Some reduction in pain and grinding was suggested, but all the reviews were of low quality, so firm conclusions cannot be drawn.
The efficacy of occlusal splints in the treatment of bruxism: A systematic review
Hardy RS et al. · Journal of dentistry
This review included trials that allocated people to treatment by chance and trials using allocation methods that were not fully random. It found insufficient evidence to say whether splints worn over the teeth help clenching and grinding more than no treatment or other approaches. The studies had limitations that reduced confidence in their results.
Oral splints for patients with temporomandibular disorders or bruxism: a systematic review and economic evaluation
Riley P et al. · Health technology assessment (Winchester, England)
This review of 52 trials examined splints worn over the teeth for jaw disorders or clenching and grinding, including their costs. The evidence was of very low quality. For people with jaw disorders, it did not show a clear reduction in pain compared with no splint or minimal treatment. This pain finding does not establish whether splints help grinding. Results for tooth wear were not reported, and value for money remained uncertain.
Comparative analysis of different types of occlusal splints for the management of sleep bruxism: a systematic review
Ainoosah S et al. · BMC oral health
This review compared different types of splint worn over the teeth for night-time clenching and grinding. It reported that adjustable splints, including devices that give feedback about grinding, were more effective at reducing grinding episodes and improving symptoms and wellbeing. The size of these differences and confidence in the evidence were not reported. The authors considered splints a possible treatment option and advised considering potential side effects for each person.
Associated factors and treatment options for sleep bruxism in children: an umbrella review
Scarpini S et al. · Brazilian oral research
This study gathered six reviews on night-time grinding in children. Sleep, breathing and emotional factors were often linked with grinding, but there was not enough evidence to recommend any particular treatment.
AWAKE BRUXISM PREVALENCE ACROSS POPULATIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Stanisic N et al. · The journal of evidence-based dental practice
This review estimated how common clenching and grinding while awake are in adults. Around a quarter of adults in the general population reported possible daytime clenching or grinding. Estimates based on clinical assessment were lower, at around one in six. The condition was more common in people with jaw disorders. This review assessed how common it was, rather than whether treatments helped.
Conditions
Persistent facial pain
Management of chronic and persistent idiopathic facial pain.
The bottom line
The research reviewed here discusses persistent facial pain with no clear cause, but offers limited evidence about how well treatments work. Reviews recommend careful diagnosis, avoiding dental treatment for this pain when teeth are healthy, and involving different healthcare professionals. Suggested treatments include certain antidepressant medicines and talking therapy to help manage pain. These are review recommendations rather than firm evidence of benefit, and further research is needed to guide treatment.
At the clinic: Every new patient has a full assessment of the jaw, neck and nervous system together, and Krina refers on to dentists, ENT or neurology when something needs another specialist. Patients are told plainly what each option can and cannot do.
Persistent idiopathic facial pain
Benoliel R et al. · Cephalalgia : an international journal of headache
This review looked at how persistent facial pain with no clear cause is diagnosed and managed. It recommends different specialists working together, checking for other causes of pain, and assessing early how pain affects daily life and mental health. It calls for research to clarify diagnosis and guide treatment.
Idiopathic Facial Pain Syndromes–An Overview and Clinical Implications
Ziegeler C et al. · Deutsches Arzteblatt international
This review explains a newer way of classifying facial pain. It says that if your teeth are healthy, dental procedures should be avoided for this kind of pain. Instead, it suggests treating it like nerve pain, often with certain medicines.
Chronic/Persistent Idiopathic Facial Pain
Zakrzewska JM · Neurosurgery clinics of North America
This review describes persistent facial pain with no clear cause and its associations with other long-term pain conditions, mental health difficulties and significant life events. It suggests that early treatment may help prevent pain becoming long-lasting. The authors recommend a team approach that considers physical, psychological and social factors, including antidepressant medicines and cognitive behavioural therapy, a talking therapy. Treatment effects are not quantified.
Atypical Facial Pain
Clarkson E et al. · Dental clinics of North America
This review describes persistent facial pain with no clear cause as difficult to diagnose because clear diagnostic criteria are lacking. Diagnosis involves ruling out other causes. The authors acknowledge limited research and favour a group of medicines called tricyclic antidepressants. Details of studies supporting their effectiveness are not reported.
Facial pain beyond trigeminal neuralgia
May A et al. · Current opinion in neurology
This review covers facial pain conditions other than trigeminal neuralgia, including persistent facial pain. It suggests these should be treated without surgery or invasive procedures. It also notes that current treatments are still not good enough and that people with these conditions are often undertreated.
Orofacial pain for clinicians: A review of constant and attack-like facial pain syndromes
May A et al. · Cephalalgia : an international journal of headache
This review describes different types of facial pain, including persistent pain, pain occurring in attacks and pain associated with jaw problems. It notes that people often see a dentist first and may undergo unnecessary dental treatment when no dental cause has been identified. Recognising the different pain conditions may help guide management.
Core care
Massage
Massage and myofascial release for jaw muscle pain.
The bottom line
Small trials suggest that massage and myofascial release, hands-on treatments involving muscles and surrounding tissue, may help with pain and jaw movement in some people with jaw problems. Several studies combined hands-on treatment with exercises or advice, so they cannot establish the effects of massage alone. Results are mixed: a physiotherapy programme including massage showed no clear extra benefit over advice for a locked jaw joint. Many studies assessed changes over days or weeks, although some followed people for longer. Research on physiotherapy for teeth clenching or grinding was judged very low quality.
At the clinic: At the clinic, hands-on soft-tissue work is part of selected manual therapy inside an assessed plan. The Signature Jaw Massage is a separate wellness experience, and we make no medical claims for it.
Evaluation of the efficacy of manual soft tissue therapy and therapeutic exercises in patients with pain and limited mobility TMJ: a randomized control trial (RCT)
Gębska M et al. · Head & face medicine
Women with painful, tight jaw muscles and limited opening were randomly split into exercise alone, massage plus exercise, or a muscle-relaxation technique plus exercise for 10 days. All groups improved. Massage was linked with earlier pain relief.
Effect of myofascial release therapy applied to selective muscles on mobility and function in patients with temporomandibular dysfunction and co-occurring chronic low back pain: A randomized controlled trial
Şenel Topaloğlu E et al. · Medicine
People with both jaw problems and low back pain were randomly given myofascial release, an exercise programme, or no treatment for 4 weeks. Both active treatments helped. Myofascial release showed greater improvement in most measures.
The Application of Manual Techniques in Masticatory Muscles Relaxation as Adjunctive Therapy in the Treatment of Temporomandibular Joint Disorders
Urbański P et al. · International journal of environmental research and public health
People with mainly muscle-related jaw problems who needed dental prosthetic treatment received either a muscle-relaxation technique or myofascial release, with 10 sessions in each group. People were assigned to the groups in turn rather than at random. Both groups had reduced electrical activity in the jaw muscles and less pain, but no clear difference between treatments was found. There was no untreated group for comparison.
Effects of Cervico-Mandibular Manual Therapy in Patients with Temporomandibular Pain Disorders and Associated Somatic Tinnitus: A Randomized Clinical Trial
Delgado de la Serna P et al. · Pain medicine (Malden, Mass.)
People with tinnitus attributed to jaw problems all received exercises, self-massage and education. They were assigned by chance to receive either this programme alone or additional hands-on treatment to the jaw, neck and jaw muscles. Overall, the additional-treatment group had better results for jaw pain and tinnitus. Assessments continued for six months after treatment. This study did not test massage on its own.
Randomized controlled trial on physical therapy for TMJ closed lock
Craane B et al. · Journal of dental research
People with a locked jaw joint received either physiotherapy, including massage, joint mobilisation and exercises, plus advice, or advice alone. Both groups improved over a year. The physiotherapy added no clear extra benefit.
Effect of Physical Therapy in Bruxism Treatment: A Systematic Review
Amorim CSM et al. · Journal of manipulative and physiological therapeutics
This review looked at physiotherapy approaches for teeth clenching and grinding. It included 24 studies, with one studying massage. Overall, the evidence suggesting benefits from physiotherapy approaches was judged very low quality, mainly because of weaknesses in how the studies were carried out. Findings specific to massage are not reported.
Reported concepts for the treatment modalities and pain management of temporomandibular disorders
Wieckiewicz M et al. · The journal of headache and pain
This review described treatments for jaw pain, including massage, exercises, advice and dental splints. The authors suggested considering these non-surgical approaches first because they regarded them as having a low risk of side effects. The size of any benefit from massage is not reported.
Technology
Dry needling
Fine-needle treatment of tender trigger points in the jaw, head and neck muscles.
The bottom line
Dry needling may help some people with muscle pain or headaches, but findings vary. For face and jaw pain, the evidence is low to very low certainty: reviews found no clear pain advantage over placebo treatments or hands-on therapy, or from adding needling to usual care. Some research suggests short-term benefits from combining needling with other treatments for headaches coming from the neck, but the contribution of needling itself is unclear. For neck and upper back muscle pain, a review found no clear difference from hands-on treatment. Long-term benefits and the most appropriate amount of treatment remain unclear.
At the clinic: Krina is trained in dry needling to levels 1 and 2. She uses it as one component of an assessed plan, never in isolation. Needling sits alongside exercise, postural work and manual therapy. She explains what she is targeting and why, and asks for your consent each time. If you would rather avoid needles, she will use hands-on alternatives.
Dry needling for orofacial pain: a systematic review and meta-analysis of randomized clinical trials
Kuzdzal A et al. · Pain reports
This review included 24 trials involving 1,318 people with face and jaw pain. Most trials had weaknesses, and confidence in the evidence was low to very low. Adding dry needling to usual care showed no clear pain benefit over usual care alone at follow-ups of up to 6 weeks. The authors found little reliable evidence of benefit overall.
Are acupuncture and dry needling effective in the management of masticatory muscle pain: A network meta-analysis of randomised clinical trials
Al-Moraissi EA et al. · Journal of oral rehabilitation
This review compared dry needling and acupuncture with placebo treatments for jaw muscle pain. It found no clear difference in pain between either treatment and placebo. Dry needling may improve how far people can open their mouths in the short term, but this finding was based on very low-quality evidence.
Effectiveness of deep dry needling versus manual therapy in the treatment of myofascial temporomandibular disorders: a systematic review and network meta-analysis
Menéndez-Torre Á et al. · Chiropractic & manual therapies
This review compared deep dry needling with hands-on (manual) therapy for jaw muscle pain. It found no clear difference in pain relief between the two. The authors urge caution because the studies were low quality and varied widely.
Physical Therapist Interventions to Reduce Headache Intensity, Frequency, and Duration in Patients With Cervicogenic Headache: A Systematic Review and Network Meta-Analysis
Jung A et al. · Physical therapy
This review looked at physiotherapy treatments for headaches coming from the neck. Combinations that included dry needling, with spinal manipulation or exercise, ranked highly for short-term relief. The evidence was low certainty, so no firm recommendation could be made.
The Comparative Efficacy of Treatments for Cervicogenic Headache: A Systematic Review and Network Meta-Analysis of Randomised Controlled Trials
Koonalinthip N et al. · European journal of pain (London, England)
This review included 41 trials involving 1,922 adults with headaches coming from the neck. It reported that combined non-drug treatments were more effective in the short term than single treatments or medicines. Hands-on therapy combined with dry needling showed favourable results for headache severity and frequency. These findings do not show how much of the benefit came from needling itself. Confidence in the evidence was not reported.
Effectiveness of dry needling for headache: A systematic review
Vázquez-Justes D et al. · Neurologia
This review gathered 8 trials of dry needling for different types of headache. Needling worked about as well as the other treatments it was compared with and was linked with improvements. Study quality ranged from low to high.
Comparison of dry needling and trigger point manual therapy in patients with neck and upper back myofascial pain syndrome: a systematic review and meta-analysis
Lew J et al. · The Journal of manual & manipulative therapy
This review compared dry needling with hands-on treatment for tender areas in muscles in people with neck and upper back muscle pain. It reported improvements in pain and everyday function with both treatments over the short to medium term, but found no clear difference between them.
Effectiveness of Different Deep Dry Needling Dosages in the Treatment of Patients With Cervical Myofascial Pain: A Pilot RCT
Fernández-Carnero J et al. · American journal of physical medicine & rehabilitation
This trial involved 84 people with neck pain. It compared four approaches to dry needling a muscle between the neck and shoulder, aiming to produce different numbers of brief muscle twitches. Pain improvement was reported at one week, but changes over time did not clearly differ between the approaches. More people had a meaningful improvement when six twitches were produced, or needling continued until no more twitches occurred, than when no twitches were produced. Everyone received needling, so the trial did not compare it with no treatment.
Recently added (via Consensus)
- Al-Moraissi et al. (2020), Journal of oral rehabilitation This analysis suggested needling therapies may reduce chewing-muscle pain, but stronger evidence is needed, and its findings do not establish dry needling’s effectiveness separately.
- Dib-Zakkour et al. (2022), Medicina A 36-person randomised trial reported reduced facial pain and muscle activity with dry needling, with follow-up limited to 15 days.
- Durmaz et al. (2026), Healthcare A 44-person randomised trial reported pain reduction immediately after one dry needling session, but no consistent change in measured jaw-muscle activity.
- Júnior et al. (2023), Journal of Clinical and Experimental Dentistry In a 30-person observational study, instrument-assisted muscle treatment was associated with greater pain reduction and bite-force improvement than dry needling, but this design cannot establish superiority.
Technology
Low-level laser therapy
Photobiomodulation applied over painful jaw muscles or the joint.
The bottom line
Research reviews suggest low-level laser therapy may reduce jaw pain in the short term. Some also report better mouth opening, but findings vary. Differences in treatment settings and concerns about study quality limit confidence in the results, and longer-term benefits remain uncertain. Further research is needed to establish consistent treatment methods. An international guideline makes a conditional recommendation against laser, alone or alongside other treatments, for jaw pain lasting three months or more. A broader review of light therapy suggests possible benefits for some other conditions, with varying confidence in the evidence.
At the clinic: Krina treats laser as a supporting tool, not a stand-alone answer. Where laser is used, it accompanies education, guided jaw exercise and manual therapy.
Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline
Busse JW et al. · BMJ (Clinical research ed.)
An international guideline looked at treatments for jaw pain lasting three months or more. It made a conditional recommendation against low-level laser, whether used alone or alongside other treatments. It favoured exercise, manual therapy and psychological approaches.
Efficacy of Low-Level Laser Therapy in the Treatment of Temporomandibular Myofascial Pain: A Systematic Review and Meta-Analysis
Munguia FM et al. · Journal of oral & facial pain and headache
This review pooled eight studies comparing laser with a dummy laser for jaw muscle pain. Laser appeared to reduce pain more than the dummy treatment. However, the studies were few, varied and at risk of bias, so the results are not definitive.
Differential effectiveness of photobiomodulation in muscular and articular temporomandibular disorders: a systematic review and critical appraisal
Candido-do-Prado LG et al. · Lasers in medical science
This review combined 18 randomised trials. In a randomised trial, people are allocated to treatments by chance. The review reported that laser was linked with less pain and better jaw movement, in both muscle and joint problems. The authors suggest effects may be more consistent for joint problems.
Effects of photobiomodulation on multiple health outcomes: an umbrella review of randomized clinical trials
Son Y et al. · Systematic reviews
This review of earlier reviews looked at light therapy across 15 health conditions. It found some possible benefits. However, the evidence for most outcomes was of low certainty, and the authors call for better trials and standard treatment methods.
Effectiveness of low-level laser therapy on temporomandibular disorders. A systematic review of randomized clinical trials
Díaz L et al. · Photodiagnosis and photodynamic therapy
This review included 44 trials in which people were allocated to treatments by chance. It reported less jaw pain and improved mouth opening with laser therapy. However, laser settings and treatment methods varied between studies, making it difficult to establish a consistent treatment approach.
Comparative efficacy of low-level laser therapy (LLLT) to TENS and therapeutic ultrasound in management of TMDs: a systematic review & meta-analysis
Ansari S et al. · Cranio : the journal of craniomandibular practice
This review compared laser with electrical nerve stimulation and therapeutic ultrasound for jaw problems. It included 12 trials in which people were allocated to treatments by chance, and combined results from nine. The authors reported greater pain relief and better mouth opening with laser. The size of these differences and confidence in the evidence are not reported.
Is low level laser effective for the treatment of orofacial pain?: A systematic review
Tengrungsun T et al. · Cranio : the journal of craniomandibular practice
This review of 33 studies examined laser therapy for face and jaw pain. Some studies favoured laser, while others found no clear difference from other treatments. The authors concluded that evidence of benefit over dummy laser or other treatments was limited.
Recently added (via Consensus)
- Xu et al. (2018), Pain Research & Management A review of 31 randomised trials found pain relief with low-level laser therapy compared with placebo for jaw disorders, but the studies differed considerably.
- Díaz et al. (2025), Photodiagnosis and photodynamic therapy A review of 44 randomised trials involving 1,816 participants reported reduced pain with low-level laser therapy for jaw disorders.
- Máximo et al. (2022), CoDAS A review found improvements in jaw movement with low-level laser therapy, but insufficient evidence to determine whether it improves chewing in adults with jaw disorders.
- Djordjević et al. (2026), Life A study of 63 people with jaw disorders reported pain reductions with both low-level laser therapy and treatment combining a dental splint with ibuprofen.
Technology
NESA neuromodulation
Non-invasive microcurrent neuromodulation delivered while you rest.
The bottom line
Research on NESA is at an early stage. A review discusses how it might affect pain, but does not establish that it helps patients. Small studies suggest possible sleep benefits, including a trial in women with hard-to-treat overactive bladder that found improvements compared with dummy treatment. Another bladder trial found no clear difference between NESA and another nerve stimulation treatment. A small study of superficial neuromodulation in women with long COVID found similar sleep improvements with active and dummy devices; whether that treatment was NESA is not reported. These findings need confirmation. These studies do not establish benefits for jaw disorders or headache.
At the clinic: Krina uses NESA as an optional adjunct, never as the plan itself. Sessions sit alongside jaw exercise, manual therapy, sleep and habit advice, and education about how persistent pain works.
Pain and the autonomic nervous system. The role of non-invasive neuromodulation with NESA microcurrents
Azevedo N et al. · Frontiers in pain research (Lausanne, Switzerland)
This review explains how the body's automatic nervous system may be involved in pain. It suggests NESA as a possible way to influence it. It sets out a theory rather than testing whether NESA helps.
Noninvasive NESA Microcurrent Neuromodulation for Refractory Overactive Bladder in Women: A Triple-Blind, Randomized, Sham-Controlled Pilot Trial
Conde-Santos G et al. · Medicina (Kaunas, Lithuania)
Women with hard-to-treat overactive bladder were allocated by chance to NESA or a dummy treatment for 10 sessions. Among the 43 women included in the analysis, those receiving NESA had better sleep scores and passed urine fewer times a day compared with the dummy-treatment group. Other bladder symptom questionnaires showed no clear difference between groups. No device-related side effects were reported. This small, early trial needs confirmation.
Superficial Neuromodulation in Dysautonomia in Women with Post-COVID-19 Condition: A Pilot Study
Melián-Ortíz A et al. · Brain sciences
Sixteen women with long COVID took part in a study comparing superficial electrical nerve stimulation with a dummy device over 15 sessions. Whether the treatment was NESA is not reported. Sleep improved by a similar amount in both groups, and tiredness decreased in both. Some measurements of heart rhythm variation and sensitivity to pressure improved more with active treatment. The researchers suggest that a placebo effect may have contributed to the improvements, but larger studies are needed.
Non-Invasive Autonomic Neuromodulation for Overactive Bladder: A Comparative Pilot Trial of NESA and Tibial Nerve Stimulation
Blasco-Bonora PM et al. · Journal of clinical medicine
Women with overactive bladder had either NESA or a nerve stimulation treatment at the ankle, plus exercises and advice. Bladder symptoms and sleep improved in both groups. Neither treatment did clearly better than the other.
Recovery of the physiological status in professional basketball players using NESA neuromodulation treatment during different types of microcycles in season: A preliminary randomized clinical trial
García F et al. · Frontiers in physiology
Twelve professional male basketball players were monitored over six weeks. Those receiving NESA spent less time awake at night and had lower heart rates during sleep than the comparison group. Blood markers and overall wellbeing were broadly similar between groups. A difference in stress was reported, but the description and numerical results disagree about which group had lower stress. This very small study suggests possible sleep benefits but does not establish wider recovery benefits.
Improving Sleep Quality and Well-Being in Institutionalized Older Adults: The Potential of NESA Non-Invasive Neuromodulation Treatment
Báez-Suárez A et al. · Geriatrics (Basel, Switzerland)
Twenty-four older adults living in a care home took part in a study comparing residents who received NESA with residents who did not receive NESA. The treatment group reported better sleep and fewer night-time awakenings. This observational study cannot establish that NESA caused these changes.
Recently added (via Consensus)
- Conde-Santos et al. (2026), Medicina A blinded, sham-controlled pilot trial reported improvements in urination frequency and sleep in women with persistent overactive bladder; these preliminary findings need confirmation.
- Blasco-Bonora et al. (2025), Journal of Clinical Medicine In a pilot trial of 24 women with overactive bladder, both treatment groups reported improvements; NESA and tibial nerve stimulation were each combined with exercises and education.
- Medina-ramírez et al. (2024), Stresses A preliminary placebo-controlled study of 12 basketball players reported sleep and cortisol changes with NESA, but provides limited evidence about recovery benefits.
- Azevedo et al. (2025), Frontiers in Pain Research This review discusses how NESA microcurrents might influence pain through the autonomic nervous system, but does not establish that NESA effectively treats pain.
Technology
Radiofrequency & diathermy (TMJ Velvet)
Capacitive-resistive radiofrequency (TECAR) warming of deep tissues.
The bottom line
Research on diathermy, a treatment that heats body tissues, for jaw problems is at an early stage. A TMJ Velvet case report described improvement in one child, while a small study of diathermy without a comparison group found improvement mainly in limitations on jaw function. The device used in that small study was not reported. Wider research on related treatments for muscle and joint pain suggests possible pain relief, but results vary considerably. Two trials found no clear advantage over dummy treatment for neck muscle pain or painful muscle knots. Another trial found greater improvement when TECAR was added to physiotherapy, but did not use a dummy treatment. These findings do not establish whether TMJ Velvet provides effective or lasting relief for jaw disorders.
At the clinic: Krina may use TMJ Velvet early in an appointment to warm the jaw area before manual therapy and guided exercise. It is a preparation and comfort tool, never the treatment on its own. She will not present it as repairing a disc or realigning your jaw. Its role is to sit alongside the active work you do together.
Severe Post-Traumatic Trismus Unresponsive to Drug Therapy in a 12-Year-Old Patient Treated with a Capacitive-Resistive Electrical Transfer Therapy: A Case Report
Campanella G et al. · Oral
This report describes one 12-year-old with severe jaw stiffness after an injury that had not improved with medicines. Mouth opening and pain improved after TMJ Velvet sessions. A single case cannot show the treatment works, and the authors call for larger studies.
Temporomandibular Disorder Treatment With Diathermy Stimulation Technique: A Pilot Study
Goker F et al. · International journal of dentistry
A small study gave 10 adults with jaw joint problems five weekly diathermy sessions, with no comparison group. Scores tended to improve, but the clearest statistical evidence of improvement was in reported limitations on jaw function. The size and practical importance of that improvement were not reported. Without a comparison group, the study cannot establish whether diathermy caused the changes.
Analgesic effects of a capacitive-resistive monopolar radiofrequency in patients with myofascial chronic neck pain: a pilot randomized controlled trial
Diego IMA et al. · Revista da Associacao Medica Brasileira (1992)
In this small trial, people with long-term neck muscle pain were randomised, meaning allocated by chance, to real or dummy radiofrequency. Pain eased in the real-treatment group, but it did not do clearly better than the dummy group.
Efficacy of capacitive-resistive therapy on the treatment of myofascial pain - A randomized control trial
Dinçer Ş et al. · Journal of bodywork and movement therapies
This trial allocated 36 people with painful muscle knots by chance to real or dummy diathermy. Pain, sensitivity to pressure and neck-related difficulties improved in both groups, with no clear difference between groups. The researchers suggested that exercise might explain improvement in the dummy-treatment group, but the exercise programme was not described.
Effectiveness of TECAR Therapy for Managing Pain in Sports-Related Musculoskeletal Pathologies: A Systematic Review with Meta-analysis
Kudich E et al. · SN Comprehensive Clinical Medicine
This review set out to pool studies on whether TECAR deep-heating therapy helps pain in sports-related muscle and joint problems. Its findings are not openly available to summarise here.
Effects of Transfer Energy Capacitive and Resistive On Musculoskeletal Pain: A Systematic Review and Meta-Analysis:
Vahdatpour B et al. · Galen medical journal
This review combined studies of TECAR for muscle and joint pain and found less pain than in comparison groups at four and eight weeks. Results varied considerably between studies, which limits confidence in how consistently the treatment may help. Findings specifically about jaw pain were not reported.
The Effects of TECAR Therapy in the Treatment of Patients With Myofascial Trigger Points in the Upper Trapezius Muscle: A Randomized Controlled Trial
Radinmehr H et al. · Musculoskeletal care
In a trial of 44 people with painful upper-shoulder muscle knots, participants were allocated by chance to standard physiotherapy alone or physiotherapy plus TECAR. The combined-treatment group had greater improvements in pain, neck movement and neck-related difficulties at the assessment after treatment. There was no dummy treatment for comparison. Treatment duration and longer-term effects were not reported.
Recently added (via Consensus)
- Vahdatpour et al. (2022), Galen medical journal This meta-analysis found less musculoskeletal pain with TECAR than control treatments at four and eight weeks, but results varied substantially between studies.
- Taheri et al. (2023), Journal of chiropractic medicine In a 50-person randomised trial for neck–shoulder muscle pain, both groups improved; the supplied results do not establish whether adding TECAR provided extra benefit.
- Giovanelli et al. (2026), Journal of Physical Therapy Science A retrospective study of 52 people with low back pain reported greater two-week pain reduction with one TECAR electrode than another, without establishing benefit over no TECAR.
- Fătu et al. (2025), Cureus An observational study reported pain reduction after combined TECAR and laser treatment for musculoskeletal conditions, but could not isolate TECAR’s contribution.
For dentists, GPs & clinicians
Download a reading list
A branded PDF of the research for one condition, prepared in your name — useful for your own CPD, for patients who ask, or before you refer.
- Clinician summary and full citation for every study, with DOI links
- The evidence level for each topic, from guideline-backed to early
- Studies that don’t favour a treatment, not just the ones that do
- How to refer a patient, with the clinic’s details
Research tells us what tends to help groups of people. Your assessment tells us what is likely to help you. Krina uses both, and will always tell you plainly what an option can and cannot do.