title: Myofascial techniques: What are their effects on joint range of motion and pain? - A systematic review and meta-analysis of randomised controlled trials.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Research Department, European School of Osteopathy, Boxley House, Boxley, Maidstone, Kent, ME14 3DZ, UK. Electronic address: tamsynwebb@eso.ac.uk.
authors.forename: Tamsyn R
authors.initials: TR
authors.lastname: Webb
authors.affiliation: Research Department, European School of Osteopathy, Boxley House, Boxley, Maidstone, Kent, ME14 3DZ, UK. Electronic address: devanrajendran@eso.ac.uk.
authors.forename: Dévan
authors.initials: D
authors.lastname: Rajendran
mesh_terms: D018771:Arthralgia / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D026201:Musculoskeletal Manipulations / Q000379:methods*; D009209:Myofascial Pain Syndromes / Q000503:physiopathology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D016059:Range of Motion, Articular / Q000502:physiology*
keywords: Manual therapy; Meta-analysis; Myofascial technique; Pain; Range of motion; Systematic review